Tanzania - Demographic and Health Survey - 1997

Publication date: 1997

Demographic and Health Survey 1996 0 ;Z . Bureau of Statistics Planning Commission @DHS Demographic and Health Surveys ~ro In)/ernational Inc. World Summit for Children Indicators: Tanzania 1996 Value BASIC INDICATORS Childhood mortality Maternal mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Basic education Children in especially difficult situations Infant mortality rate Under-five mortality rate Maternal mortality rate Percent stunted Percent wasted Percent underweight Percent of households within 15 minutes of a safe water supply l Percent of households with flush toilets or VIP latrines Percent of women 15-49 with completed primary education Percent of men 15-49 with completed primary education Percent of girls 6-12 attending school Percent of boys 6-12 attending school Percent of women 15-49 who are literate Percent of children who are orphans (both parents dead) Percent of children who do not live with their natural mother Percent of children who live in single adult households 88 per 1,000 137 per 1,000 529 per 100,000 43.2 7,2 30.6 30.4 2.8 51.7 60.5 39.6 36.5 65.4 0.6 19.4 6.1 SUPPORTING INDICATORS Women's Health Birth spacing Safe motherhood Percent of births within 24 months of a previous birth Percent of births with medical prenatal care Percent of births with prenatal care in first trimester Percent of births with medical assistance at delivery Percent of births in a medical facility Percent of births at high risk 17.5 89.3 11.1 46.7 46.5 57.9 Family planning Contraceptive prevalence rate (any method, currently married women) 18.4 Percent of currently married women with an unmet demand for family planning Percent of currently married women with an unmet need for family planning to avoid a high-risk birth 23.9 I9.8 Nutrition Maternal nutrition Percent of mothers with low BMI 9.2 Low birth weight Percent of births at low birth weight (of those reporting numeric weight) 11.2 Breastfeeding Percent of children under 4 months who are exclusively breastfcd 385 Child Health Vaccinations Percent of children whose mothers received tetanus toxoid vaccination during pregnancy 91.4 Percent of children 12-23 months with measles vaccination 80.9 Percent of children 12-23 months fully vaccinated 70.5 Diarrhea control Percent of children with diarrhea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) 50.4 Acute respiratory inl~ction Percent of children with acute respiratory inl?ction in preceding 2 weeks who were seen by medical personnel 69.6 k Piped, well, and bottled water. Tanzania Demographic and Health Survey 1996 Bureau of Statistics PLanning Commission Dar es Saalam, Tanzania Macro International Inc. Calverton, Maryland USA August 1997 This report summarises the f'mdings of the 1996 Tanzania Demographic and Health Survey (TDHS) conducted by the Bureau of Statistics, in collaboration with the Ministry of Health. Macro International Inc. provided technical assistance. Fundings for the TDHS were provided by the U.S. Agency for International Development (USAID) through the worldwide Demographic and Health Surveys programme. The TDHS is part of the worldwide Demographic and Health Surveys (DHS) programme, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the TDHS may be obtained from the Bureau of Statistics, P.O. Box 796, Dar es Salaam, Tanzania (Telephone 051-111993). Additional information about the DHS programme may be obtained by writing to: DHS, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (Telephone 301-572-0200; Fax 301-572-0999). Recommended citation: Bureau of Statistics [Tanzania] and Macro International Inc. 1997. Tanzania Demographic and Health Survey 1996. Calverton, Maryland: Bureau of Statistics and Macro International. CONTENTS Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1,1 1 .2 1.3 1.4 1.5 Geography, History, and the Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Demographic Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . 3 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Objectives and Organization of the 1996 Tanzania Demographic and Health Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 Population by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Population by Age from Selected Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Fosterhood and Orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Educational Level of Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . 11 School Enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Characteristics of Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Educational Level of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Exposure to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Employment and Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 CHAPTER 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Current Fertifity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Retrospective Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 CHAPTER 4 FERTILITY REGULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.1 4.2 4.3 Knowledge of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Trends in Contraceptive Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 iii 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 CHAPTER 6 6.1 6.2 6.3 6.4 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 CHAPTER 8 8.I 8.2 8.3 8.4 8.5 8.6 8.7 Current Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Number of Children at First Use of Family Planning . . . . . . . . . . . . . . . . . . . 50 Effect of Breastfeeding on Conception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . 54 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . 55 Exposure to Family Planning Messages in the Electronic Media . . . . . . . . . . 56 Acceptability of Media Messages on Family Planning . . . . . . . . . . . . . . . . . 56 Exposure to Family Planning Messages Through the Print Media . . . . . . . . . 58 Contact of Nonusers with Family Planning Providers . . . . . . . . . . . . . . . . . . . 58 Attitudes Toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Knowledge of Family Planning Logo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Exposure to Family Planning Drama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Knowledge of "Salama" Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 PROXIMATE DETERMINANTS OF FERT IL ITY . . . . . . . . . . . . 71 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Sexual Relationships Among Unmarried Women . . . . . . . . . . . . . . . . . . . . . . 72 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . 82 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Reproductive Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Wanted and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . 97 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . 97 Socioeconomic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . 98 Demographic Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . I00 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . lO5 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Medical Care at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Childhood Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 18 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 iv CHAPTER 9 MATERNAL AND CHILD NUTRIT ION . . . . . . . . . . . . . . . . . . . . . 123 9.1 9.2 9.3 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Maternal Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 CHAPTER 10 MATERNAL MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 10.1 10.2 10.3 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 CHAPTER 11 SEXUAL ACT IV ITY AND KNOWLEDGE OF A IDS . . . . . . . . . 139 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Awareness of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . 140 Prevalence of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . 144 AIDS Knowledge and Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Perception of the Risk of Getting H1V/AIDS . . . . . . . . . . . . . . . . . . . . . . . . 154 AIDS Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Sources of Condom Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 CHAPTER 12 FEMALE C IRCUMCIS ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 12.1 12.2 12.3 12.4 Prevalence of Female Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Type of Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Age at Circumcision and Person who Performed Circumcision . . . . . . . . . . 167 Female Circumcision Among Daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 APPENDIX B EST IMATES OF SAMPL ING ERRORS . . . . . . . . . . . . . . . . . . . 181 APPENDIX C DATA QUAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 APPENDIX D ADDIT IONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 APPENDIX E PERSONS INVOLVED IN THE 1996 TANZANIA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . 235 APPENDIX F QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Table 1.1 Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5.1 Table 2.5.2 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11.1 Table 2.11.2 Table 2.12 Table 2.13 Table 2.14 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 4.1 Table 4.2 Table 4.3 Table 4.4.1 Table 4.4.2 Table 4.5.1 Table 4.5.2 Table 4.6.1 Table 4.6.2 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 TABLES Demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . 7 Household population by age, residence, and sex . . . . . . . . . . . . . . . . . . . . . . . . 9 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . 13 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . 14 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Differential of characteristics between spouses . . . . . . . . . . . . . . . . . . . . . . . . . 21 Level of education: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Level of education: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Employment: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Occupat ion : men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Trends in current fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Trends in fertility by marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . . 36 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Knowledge of contraceptive methods among couples . . . . . . . . . . . . . . . . . . . . 40 Knowledge of contraceptive methods by background characteristics . . . . . . . . . 42 Ever use of cont racept ion : women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Ever use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Current use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Current use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Current use of contraception by background characteristics: women . . . . . . . . . 48 Current use of contraception by background characteristics: men . . . . . . . . . . . 49 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . 51 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . 52 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . 53 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . 56 Heard about family planning on radio and television . . . . . . . . . . . . . . . . . . . . . 57 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . 59 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . . . 61 Wives' perceptions of their husbands' attitudes toward family planning . . . . . . 63 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 vii Table 4.19 Table 4.20.1 Table 4.20.2 Table 4.21 Table 4.22 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9.1 Table 5.9.2 Table 5.10 Table 5.11 Table 5.12 Table 6. l Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 8.14 Table 9.1 Table 9.2 Table 9.3 Spouses' actual and perceived attitudes toward family planning . . . . . . . . . . . . 64 Green Star logo - family planning symbol: women . . . . . . . . . . . . . . . . . . . . . . 65 Green Star logo - family planning symbol: men . . . . . . . . . . . . . . . . . . . . . . . . . 65 Exposure to family planning drama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Knowledge of "Salama" condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Sexual relationships of non-married women . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Number of co-wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g l Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . . . 82 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . 83 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . 86 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . . 88 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . . 89 Need for family planning services among all women . . . . . . . . . . . . . . . . . . . . . 90 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . 93 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . 99 Infant and child mortality by biodemographic characteristics . . . . . . . . . . . . . 101 High-risk fertility bebaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . 107 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . 113 Vaccinations by source of information . . . . .~. . . . . . . . . . . . . . . . . . . . . . . . . . 115 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Vaccinations in first year of life by current age . . . . . . . . . . . . . . . . . . . . . . . . 117 Prevalence and treatment of acute respiratory infection and prevalence of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Median duration and frequency of breastfeeding by background variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 viii Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 9.8 Table 10.l Table 10.2 Table 11.1.1 Table 11.1.2 Table 11.2 Table 11.3 Table I 1.4 Table 11.5.1 Table 11.5.2 Table 11.6.1 Table 11.6.2 Table 11.7.1 Table 11.7.2 Table 11.8 Table 11.9 Table I 1.10 Table 11.11 Table 11.12.1 Table 11.12.2 Table 11.13.1 Table 11.13.2 Table 11.14 Table 11.15.1 Table 11.15.2 Table 12.1 Table 12.2 Table 12.3 Table 12.4 Table 12.5 Table 12.6 Table A. 1 Table A.2.1 Table A.2.2 Table B.2.1 Table B.2.2 Table B.3.1 Table B.3.2 Table B.4.1 Table B.4.2 Table B.5.1 Table B.5.2 Table B.6.1 Table B.6.2 Table B.7.1 Table B.7.2 Types of food received by children in preceding 24 hours . . . . . . . . . . . . . . . . 127 Nutritional status of children by demographic characteristics . . . . . . . . . . . . . 129 Nutritional status of children by background characteristics . . . . . . . . . . . . . . 131 Trends in nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Maternal nutritional status by background characteristics . . . . . . . . . . . . . . . . 133 Adult moral ity rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Number of sexual partners: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Number of sexual partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Knowledge of STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Self-reporting of sexually transmitted diseases in the past year . . . . . . . . . . . . 145 Act ion taken by respondents who reported a sexually transmitted diseases in the past year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Knowledge of AIDS and sources of AIDS information: women . . . . . . . . . . . 147 Knowledge of AIDS and sources of AIDS information: men . . . . . . . . . . . . . 148 Knowledge of ways to avoid AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Knowledge of ways to avoid AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Knowledge and perception about AIDS: women . . . . . . . . . . . . . . . . . . . . . . . 152 Knowledge and perception about AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . 153 Perception of risk of getting AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Perception of risk of getting HIV/AIDS among couples . . . . . . . . . . . . . . . . . 156 Reasons for perception of small/no risk of getting AIDS . . . . . . . . . . . . . . . . . 156 Reasons for perception of moderate/great risk of getting AIDS . . . . . . . . . . . . 157 AIDS prevention behaviour: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 AIDS prevention behaviour: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Testing for AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Testing for AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Knowledge of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Prewdence of female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Types of female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Age at circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Person who performed the circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Age at circumcision: eldest daughter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Person who performed the circumcision: eldest daughter . . . . . . . . . . . . . . . . 171 Sample allocation by enumeration areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Sampling errors - National sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Sampling errors - National sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Sampling errors - Urban sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Sampling errors - Urban sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Sampling errors - Rural sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Sampling errors - Rural sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Sampling errors - Coastal zone sample: women . . . . . . . . . . . . . . . . . . . . . . . . 192 Sampling errors - Coastal zone sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Sampling errors - Northern Highlands zone sample: women . . . . . . . . . . . . . . 194 Sampling errors - Northern Highlands zone sample: men . . . . . . . . . . . . . . . . 195 Sampling errors - Lake zone sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Sampling errors - Lake zone sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 ix Table B.8.1 Table B.8.2 Table B.9.1 Table B.9.2 Table B.10.1 Table B. 10.2 Table B. 11.1 Table B.11.2 Table B.12.1 Table B.12.2 Table BA3.1 Table B. 13.2 Table B.14.1 Table B. 14.2 Table B.15.1 Table B. 15.2 Table B.16.1 Table B.16.2 Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Table C.9 Table D. 1 Table D.2.1 Table D.2. I Sampling errors - Central zone sample: women . . . . . . . . . . . . . . . . . . . . . . . . 198 Sampling errors - Central zone sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Sampling errors - Southern Highlands zone sample: women . . . . . . . . . . . . . . 200 Sampling errors - Southern Highlands zone sample: men . . . . . . . . . . . . . . . . 201 Sampling errors - Southern zone sample: women . . . . . . . . . . . . . . . . . . . . . . 202 Sampling errors - Southern zone sample: men . . . . . . . . . . . . . . . . . . . . . . . . . 203 Sampling errors - Mainland sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Sampling errors - Mainland sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Sampling errors - Zanzibar sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Sampling errors - Zanzibar sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Sampling errors - Mainland urban sample: women . . . . . . . . . . . . . . . . . . . . . 208 Sampling errors - Mainland urban sample: men . . . . . . . . . . . . . . . . . . . . . . . . 209 Sampling errors - Mainland Sampling errors - Mainland Sampling errors - Mainland Sampling errors - Mainland Sampling errors - Mainland rural sample: women . . . . . . . . . . . . . . . . . . . . . . 210 rural sample: men . . . . . . . . . . . . . . . . . . . . . . . . 211 Dares Salaam city sample: women . . . . . . . . . . . 212 Dares Salaam city sample: men . . . . . . . . . . . . . 213 other urban sample: women . . . . . . . . . . . . . . . . . 214 Sampling errors - Mainland other urban sample: men . . . . . . . . . . . . . . . . . . . 215 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . 223 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Births by calendar year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Completeness of information on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Data on siblings: Indicators on data quality . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Sibship size and sex ratio of siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Knowledge of contraceptive methods by background characteristics: married respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Current use of contraception by background characteristics: currently married women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Current use of contraception by background characteristics: currently married men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 5.1 Figure 6.1 Figure 6.2 Figure 6.3 Figure 6.4 Figure 6.5 Figure 7.1 Figure 7.2 Figure 7.3 Figure 8.1 Figure 8.2 FIGURES Distribution of the household population by age . . . . . . . . . . . . . . . . . . . . . . . . 10 Level of education for men and women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 School enrolment by age and place of residence . . . . . . . . . . . . . . . . . . . . . . . . 16 Age-specific fertility rates by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . 30 Total fertility rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 30 Age-specific fertility rates 1991-92 TDHS and 1996 TDHS . . . . . . . . . . . . . . . 32 Adolescent childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Trends in contraceptive knowledge among women 15-49 . . . . . . . . . . . . . . . . . 45 Modem contraceptive method use among all women 15-49 by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Trends in contraceptive use 1991-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Distribution of current users of modem contraceptive methods by source of contraceptive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Percent of married women in polygynous unions by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Fertility preferences of women 15-49 and men 15-59 . . . . . . . . . . . . . . . . . . . . 86 Fertility preferences of all women by number of living children . . . . . . . . . . . . 87 Trends in fertility preferences among currently married women . . . . . . . . . . . . 87 Trends in need for family planning among currently married women . . . . . . . . 91 Ideal family size among women and men by age . . . . . . . . . . . . . . . . . . . . . . . . 94 Trends in infant and under-five mortality rates 1979-1994 . . . . . . . . . . . . . . . . 98 Infant mortality by selected background characteristics . . . . . . . . . . . . . . . . . . . 99 Under-five mortality by selected background characteristics . . . . . . . . . . . . . . 1 O0 Percent distribution of births by antenatal cam and delivery characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Vaccination coverage among children age 12-23 months 1991-92 and 1996 TDHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 xi Figure 9.1 Figure 11.1 Figure 11.2 Figure C.1 Figure C.2 Nutritional status of children under five years, mean Z-scores by age in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Knowledge of AIDS and source of AIDS information . . . . . . . . . . . . . . . . . . . 149 Changes in behaviour after heating about HIV/AIDS, by sex . . . . . . . . . . . . . 157 Distribution of de facto household population by single year of age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Calendar birth ratios for living, dead, and all children . . . . . . . . . . . . . . . . . . . 220 xii FOREWORD Similar to the 1991-92 Tanzania Demographic and Health Survey and the 1994 Tanzania Knowledge, Attitudes and Practices Survey (a subsample of the 1991-92 survey), the 1996 TDHS was a truly representative survey that utilised the sample frame and the same sample clusters that were covered in the first survey. This report summarises basic information on fertility, mortality (infant, child, and maternal), contraceptive knowledge and use, and child bearing. It also looks at key maternal and child health indicators including the extent to which mothers utilise the available medical care during pregnancy and at the time of delivery, and for the young children, the immunisation coverage and the prevalence and treatment of malaria. Compared to the 1991-92 survey, the present survey was significantly expanded to cover areas on the sexual behaviour and awareness regarding AIDS. For the first time, data on maternal mortality and prevalence of female circumcision were collected and national estimates are presented in this report. Before the 1991-92 survey, Tanzania had been relying on censuses as the principal source of demographic data. Vital registration which is a very important source of fertility and mortality information has been run on a small scale and could not be used to generate national estimates. Data on maternal and child health were obtained from health facility records alone and hence any information that could have been included from outside this source was not obtainable. These surveys represent a big step forward, which has enabled this country to collect high-quality data on demographic situations, family planning, and health. The availability of data on a periodic basis provides policymakers, planners and analysts with the relevant information to monitor trends. The challenge that remains is to use the information collected in the two rounds of the TDHS as a basis for monitoring and improving the health status and reproductive child health service delivery programmes in Tanzania. N.K. Mbalilaki GOVERNMENT STATISTICIAN xiii ACKNOWLEDGMENTS The 1996 TDHS is another successful undertaking by the Bureau of Statistics. The successful completion of this volume is an indication of the dedication and commitment of various individuals and institutions to which the Bureau of Statistics will remain indebted. I would like to extend my thanks to the Family Planning Unit in the Ministry of Health for their total commitment in proving logistical support particularly female interviewers and transport. My sincere appreciation is extended to various Government departments that participated in the design of the questionnaires. Tanzania Food and Nutrition Centre (TFNC), UMATI, and Maternal and Child Health Unit in the Iringa Regional Hospital are also acknowledged for providing training services to the interviewers. To the nurses who worked tirelessly throughout the survey period, my sincere thanks for their very valuable participation in the survey. They left their homes and family to endure the difficult logistical and technical difficulties in the field. Likewise, I thank staff in the Census Office under the supervision of Mr. S.A.M. Ngallaba who supervised the entire work of the survey. I wish to express my deep appreciation to USAID for their continuing financial support to the data collection efforts, and sincere gratitude to Dr. F.M. Mburu for his encouraging support in the project during the entire period of the survey. The technical and material supports provided by Macro International Inc. is highly acknowledged. My special appreciation goes to Dr. Tulshi Saha, Demographic Expert and the country monitor for Tanzania, for his effort and contribution throughout the survey. I also thank Ms. Anne Cross, the regional coordinator, Dr. Alfredo Aliaga, who served as the sampling expert, and Ms. Jeanne Cushing, the data processing specialist. I would like to thank the Project Statisticians: Ms. A. Chuwa, Ms. A Komba, Mr. S.M. Abud, Mr. I. Ruyobya, and Mr. I. Masanja for their contributions to this report. This report would not have been completed without the services of Ms. A. Komba, Mr. P. Riwa, Mr. S. Ngallaba, Dr. F. Mburu, and Dr. Tulshi Saha who prepared the document in its final form. The contribution of Government Officials at the national, regional, district, ward, and village levels for their vital role in ensuring the smooth and successful completion of the survey fieldwork is also appreciated, Last but not least, I wish to extend my sincere thanks to the women and men who agreed to give their time to attend to the interviews that were sometimes time consuming. There are many who also put long hours to ensure the successful completion of this work; I thank them all for their valuable contributions. N.K. Mbalilaki GOVERNMENT STATISTICIAN XV SUMMARY OF FINDINGS The 1996 Tanzania Demographic and Health Survey (TDHS) is a nationally representative survey of 8,120 women age 15-49 and 2,256 men age 15-59. The main purpose of the 1996 TDHS is to provide detailed information on fertility, family planning, infant and child mortality, maternal and child health and nutrition, knowledge and attitudes of AIDS, and female circumcision. The 1996 TDHS is the third national sample survey of its kind to be undertaken. The first survey was done in 1991-92, which was followed by the Tanzania Knowledge, Attitudes and Practices Survey (TKAPS) in 1994. Fertil ity Fertility Trends TDHS data show that fertility in Tanzania may be starting to decline. The total fertility rate (TFR) has declined from the level of 6.3 births per woman that prevailed in 1989-92 to 5.8 births for the period 1993- 1996. The crude birth rate (CBR) for the period 1993-1996 is 41 live births per 1,000 population, lower than those from the 1991-92 TDHS (43 live births per 1,000 population) and the 1988 Census (46 births). Fertility Differentials Some women are apparently leading the fertility decline. Fertility levels are much higher in rural areas (TFR 6.3 children) than in urban areas (4.1) on the mainland. Total fei'tility rates are lowest in the Coastal and Southern zones (4.9 children per woman) and higher in the Lake and Central zones (7.0 and 6.1 children per woman, respectively). Women who have received some secondary education have the lowest level of fertility, with a total fertility rate of 4.8 compared with a rate of 7.1 children per women from those with either no education or incomplete primary education, a difference of more than two children. Age at First Birth Childbearing begins early in Tanzania, with just under half of the women becoming mothers by the time they reach age 18 and more than two-thirds having had a child by the time they reach age 20. Twenty-six percent of women age 15-19 are already mothers or pregnant with their first child, with teenage childbearing more common among mainland women (26 percent) than Zanzibar women (17 percent). The Southern zone has the highest prevalence of teenage childbearing (35 percent) while the Coastal zone has the lowest level (23 percent). Birth Intervals The majority of Tanzanian children (83 percent) are born after a "safe" birth interval (24 or more months apart), with 43 percent born at least 35 months after a prior birth. Nevertheless, 17 percent of non-first births occur less than 24 months after the preceding birth, with 7 percent occurring less than 18 months since the previous birth. The overall median birth interval is 34 months. Fertility Preferences Survey data indicate that there is a strong desire for children and a preference for large families. Among those with six or more children, almost one in five women wants to have more children compared to 43 percent of men. Overall, women report a mean ideal number of children of 5.5, compared with 5.9 children for men; ideal family size is higher among currently married women and men (5.9 and 6.7, xvii respectively). Only 5 percent of women and men regard a two-child family as ideal. Despite high fertility preferences, the data show that there has been a decline in ideal family size among women in Tanzania, from an average of 6.1 children in 1991-92 to 5.5 in 1996. Unplanned Fertility Despite the increasing level of contraceptive use, the 1996 TDHS data show that unplanned pregnancies are still common. About one-fourth of the births in the three years prior to the survey were reported to be unplanned; 15 percent were mistimed (wanted later) and 9 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in Tanzania would be 5.l births per woman instead of the actual level of 5.8. Family Planning Knowledge of Contraceptive Use More than 80 percent of women and men know of at least one modem method for family planning. Knowledge of at least one method mentioned by both spouses is high (86 percent). Among women, the pill is the best known method (78 percent), while among men, the condom is the best known method (86 percent). Seventy-one percent of women and 67 percent of men know at least three modem methods. The proportion of all women who have heard of at least one modem method increased from 72 percent in 1991-92 to 77 percent in 1994 and to 83 percent in 1996, Use of Contraception Sixteen percent of all women in Tanzania are currently using a contraceptive method and 12 percent are using modem methods. The most widely used methods are the pill (5 percent) and injectables (4 percent). Current use among men is higher than among women. Twenty-two percent of men in Tanzania are currently using contraception, 14 percent using modem and 8 percent using traditional methods. Contraceptive use in 1996 has increased since the 1991-92 TDHS, from 10 to 16 percent of all women using any method and from 6 to 12 percent using modem methods. Injectables had the highest increase from less than 1 percent to 4 percent in the same lime period. Among men, use of modem methods increased from 8 percent to 14 percent for the same period. However, the 1996 TDHS data show a slight decline in the contraceptive use rate since the 1994 TKAPS (from 18 to 16 percent of all women), which is due to a decline in the use of traditional methods; use of modem methods has slightly increased since 1994. Differentials in Family Planning Use There are differences in current use between the mainland and Zanzibar and more notably by regions, educational levels, and number of living children. Use of modem family planning methods is lower in Zanzibar (8 percent) than on the mainland (12 percent). In the mainland, urban women are much more likely to be using modem contraceptive methods (24 percent) than rural women (8 percent). Levels of current use of modem family planning methods are highest in the Kilimanjaro, Coast, and Dares Salaam regions (23-24 percent) and lowest in the Shinyanga, Kagera, and Mara regions (4-5 percent). Twenty-six to 30 percent of men in the Mbeya, Singida, Dares Salaam, and Coast regions are using modem family planning methods, compared with only 1 to 5 percent in the Mwanza and Shinyanga regions. Women with some secondary and higher education are five times more likely to use modem methods than women with no education (23 vs. 5 percent). Greater contraceptive use was also found to be associated with increasing level of education for men. Contraceptive use in Tanzania rises with the number of living children. xviii Sources of Contraceptives About three-fourths of women currently using modem contraceptives obtained the method from the pubfic sector, including government and district hospitals (24 percent), government health centres (22 percent), and government dispensaries or parastatal facilities (28 percent). Private medical sources account for 18 percent of current users. Community-based (CBD) workers supply nearly 2 percent of modem methods. Family Planning Messages Sixty-one percent of men and 45 percent women report that they have heard or seen a family planning message on the radio or television in the previous six months. Younger respondents are more exposed to family planning messages through radio and television than older respondents. Access to the media is much higher in Zanzibar than on the mainland. The proportion of respondents who have been exposed to family planning messages on the radio or television varies across regions and is by far the highest among respondents in Dar es Salaam. Unmet Need for Family Planning Overall, 24 percent of currently married women have unmet need for family planning services--15 percent for spacing and 9 percent for limiting births. The unmet need for family planning among currently married women in Tanzania has declined from 30 percent in 1991-92 to 24 percent in 1996 and the total demand satisfied has increased from 26 percent to 44 percent during the same period. Maternal And Child Health Childhood Mortality At current mortality levels, one in every seven children born in Tanzania will die before the fifth birthday, with two-thirds of the deaths occurring during the first year of life. Results from the 1996 TDHS suggest a marked decline in child mortality over the years. All of the mortality rates, with the exception of postneonatal mortality, have declined steadily over the 15 years before the survey, with an 18 percent decline in under-five mortality, a 24 percent decline in child mortality, and a 14 percent decline in infant mortality. However, the biggest improvement was made in neonatal mortality with a decline of 32 percent. There is evidence of a decline when mortality rates in the 1996 TDHS are compared with the 1991-92 TDHS. For example, the infant mortality rate has declined from 92 to 88 deaths per 1,000 births and under-five mortality has declined from 141 to 137. Mortality is consistently lower in urban than rural areas, In the 10 years preceding the survey, infant mortality is about 14 percent lower and under-five mortality is 19 percent lower in urban than in rural areas on the mainland. There are considerable variations in mortality by zones. Infant mortality rates are the lowest (41 per 1,000 live births) in the Northern Highlands. With the exception of this zone, infant mortality is about I00 per 1,000 live births in all other zones. Children born to mothers with no education suffer the highest mortality. The under-five mortality of children born to mothers with incomplete primary education is 7 percent lower than that for children whose mothers have no education. xix Childhood Vaccination Coverage The 1996 TDHS results show that 71 percent of children age 12-23 months have received all of the recommended vaccinations, while only 3 percent have not received any vaccination. The remaining 26 percent of children were partially vaccinated. Vaccination coverage is higher in Zanzibar than in the mainland. Less than half of the children age 12-23 months were fully vaccinated in the Shinyanga region in comparison with 94 percent coverage in the Kilimanjaro region. Immunisation coverage improves substantially as mothers' level of education increases, from 58 percent for children whose mothers have no formal education to 77 percent for children whose mothers have completed primary education or higher. Childhood Health Diarrhoeal and respiratory illnesses are common causes of child death. In the two weeks before the survey, 14 percent of children suffered from diarrhoea and 13 percent were ill with acute respiratory infections (ARI). About 60 percent of children with diarrhoea and 70 percent of children with ARI were taken to a health facility. Of all children with diarrhoea, 48 percent were treated with a solution prepared from packets of oral rehydration salts (ORS), 3 percent received recommended home fluids (RHF), and 50 percent received either ORS or RHF. In addition, 57 percent of mothers reported that they increased the amount of fluids given to their children who had diarrhoea. Breastfeeding Practises The 1996 TDHS results suggest that breastfeeding is almost universally practised in Tanzania, with a median duration of 22 months. Data show that about 60 percent of the children were breastfed within an hour of birth and 88 percent in the first 24 hours after delivery. Though exclusive breastfeeding is recommended until 4-6 months of age, 77 percent of children age 4-5 months receive complementary foods. Childhood Nutritional Status Overall, 43 percent of Tanzanian children under five are classified as stunted (low height-for-age) and 18 percent are severely stunted. Seven percent of children under five are wasted (low weight-for-height); 1 percent are severely wasted. Comparison with the 1991-92 TDHS shows little change in chronic undemutrition or stunting or acute undernutrition or wasting. Maternal Health Care The results of the survey indicate very high utilisation of antenatal care in Tanzania for most pregnancies (97 percen0. In most cases antenatal care was provided by a trained nurse or midwife (43 percent), or a health aide (40 percent). Doctors provided about 7 percent of antenatal care, while traditional birth attendants (TBAs) provided 8 percent of antenatal care. In Tanzania, almost all women (91 percent) received tetanus toxffld vaccination during pregnancy, with women receiving two or more doses of vaccine for almost three-fourths of births and only one dose of tetanus toxoid vaccine for 17 percent of births. Overall, 47 percent of births were delivered in a health facility, while about half of the births occurred at home. More than 40 percent of births were assisted by medically trained personnel. XX AIDS Most women and men in Tanzania are aware of AIDS. Radio and friends or relatives are the main sources for knowledge of AIDS among both women and men. Thirty-nine percent of women and 55 percent of men cite use of condoms as a way to avoid AIDS. One-fourth say that having only one partner can help to prevent the spread of the disease, and 20 percent of women and 17 percent of men report that limiting the number of sexual partners can prevent AIDS. Twenty-nine percent of women and 41 percent of men say that they have no chance of being infected. Eighty-two percent of women and 91 percent of men reported changing their sexual behaviour to prevent getting AIDS. Female Circumcision The 1996 TDHS data show that 18 percent of women in Tanzania are circumcised. Younger women (age 15-19 years), women living in Zanzibar, and in urban areas on the mainland are less likely to be circumcised than other women. A higher proportion of women in the Arusha (81 percent), Dodoma (68 percent), and Mara (44 percent) regions are circumcised. About 7 percent of the eldest daughters of respondents were reported to have been circumcised. xxi TANZANIA IIGANDA RW BL ZAIF IBAR ~,) S N, JU~ r.~) 'IA INDIAN OCEAN MOZAMBIQUE • = Enumeration Area xxii CHAPTER 1 INTRODUCTION 1.1 Geography, History, and the Economy Geography The United Republic of Tanzania is the largest country in East Africa, covering 940,000 square kilometres, 60,000 of which is inland water. Tanzania lies south of the Equator and borders eight countries: Kenya and Uganda to the north; Rwanda, Burundi, Zaire, and Zambia to the west; and Malawi and Mozambique to the south. Tanzania has an abundance of inland water with several lakes and rivers. Lake Tanganyika runs along the western border and is Africa's deepest and longest freshwater lake, and the world's second deepest lake. Lake Victoria is the world's second largest lake and drains into the Nile River. The Rufiji river is Tanzania's largest river and drains into the Indian Ocean south of Dares Salaam. Although there are many rivers, only the Rufiji and Kagera are navigable by vessels larger than canoes. One of Tanzania's most distinctive geological features is the Great Rift Valley which was caused by faulting throughout eastern Africa and is associated with volcanic activity in the north-eastern regions of the country. Two branches of the Rift Valley run through Tanzania. The western branch holds Lakes Tanganyika, Rukwa, and Nyasa, while the eastern branch ends in northern Tanzania and includes Lakes Natron, Manyara, and Eyasi. Except for a narrow belt of 900 square kilometres along the coast, most of Tanzania lies above 200 metres, and much of the country is higher than 1,000 metres above sea level. In the north, Mount Kilimanjaro rises to more than 5,000 metres with the highest peak, Kibo, reaching 5,895 metres above sea level. This is the highest point in Africa. In all, this shows that Tanzania has a diversity of landscape. The main climatic feature for most of the country is the long dry spell from May to October, followed by a period of rainfall from November to April. The main rainy season along the coast and the areas around Mount Kilimanjaro is from March to May, with short rains between October and December. In the western part of the country, around Lake Victoria, rainfall is well distributed throughout the year, with the peak period between March and May. Administratively, the mainland of Tanzania is divided into 20 regions and Zanzibar into 5 regions. Each region is subdivided into districts. To estimate geographic differentials for certain demographic characteristics, this report collapsed the administrative regions of mainland Tanzania into six ecological/geographical zones. This strategy allowed the necessary geographical comparisons to be made because it provided relatively large numbers of cases in each zone and thereby reduced sampling error. However, it should be noted that these "zones" do not conform to the administrative zones of the United Republic of Tanzania. The classification of regions into the zones is shown below: Coastal Zone : Northern Highland Zone: Lake Zone: Central Zone: Southern Highland Zone: Southern Zone: Tanga, Morogoro, Coast, Dar es Salaam, and Zanzibar. Arusha and Kilimanjaro. Tabora, Kigoma, Shinyanga, Kagera, Mwanza, and Mara. Dodoma and Singida. Iringa, Mbeya, and Rukwa. Lindi, Mtwara, and Ruvuma. History Tanzania the former Tanganyika, became independent of British colonial rule in December 1961. One year later, on December 9, 1962, it became a republic, severing all links with the British crown except for its membership in the Commonwealth. Zanzibar became independent on January 12, 1964, after the overthrow of the rule of the Sultanate. On April 26, 1964, Tanganyika and Zanzibar united to form the United Republic of Tanzania. Economy Tanzania has a mixed economy in which agriculture plays a key role. Agriculture which comprises crop, animal husbandry, forestry, fishery and hunting subsectors, contributes the largest share of any sector to the Gross Domestic Product (GDP). The GDP increased by 3.9 percent in 1995 according to 1985 prices, compared with 3 percent recorded in 1994. However, this growth did not reach the targeted growth of 5 percent that was predicted in the 1995-98 Economic Recovery Programmes. The economic growth rate attained in 1995 is higher than the predicted population growth rate of 3 percent. 1.2 Demographic Statistics The 1967 population Census of Tanzania reported a total population of 12.3 million. According to the 1988 census, the population had increased to 23.1 million as shown in Table 1.1. Tanzania is still sparsely populated, though the population density is high in some parts of the country and has been increasing over time. In 1967, the average population density was 14 persons per square kilometre; by 1988 it bad increased to 26 persons per square kilometre. Although the population is still predominantly rural, the proportion of urban residents has been increasing steadily, increasing from 6 percent in 1967 to 18 percent in 1988. While crude death rates in Tanzania may be decreasing, the total fertility rate--among the highest in Africa--is beginning to decline. Although many small-scale surveys have been conducted in the country, censuses and the 1991-92 Tanzania Demographic and Health Survey (TDHS) have been the main sources of national-level demographic statistics in Tanzania. Civil registration has never been used as a source of demographic statistics because its coverage is incomplete. Table 1.1 gives the demographic indices as compiled from the censuses since 1967. Table 1.1 Demograt, hic characteristics Selected demographic indicators, Tanzania: 1967-1988 Census year Index 1967 1978 1988 Population (millions) 12.3 17.5 23.1 Intercensal growth rate 2.6 3.2 2.8 Sex ratio 95.2 96.2 94.2 Crude birth rate 47 49 46 Total fertility rate 6.6 6.9 6.5 Crude death rate 24 19 15 Infant mortality rate 155 137 115 Percent urban 6.4 13.8 18.3 Density (pop/km 2) 14 20 26 Source: Bureau of Statistics, 1967; 1978; 1988. 1.3 Population and Family Planning Policies and Programmes Population Policy The population of Tanzania has trebled from 7.7 million in 1948 to 23.1 million in 1988. It is estimated that the population increase is at present roughly more than 600,000 persons per year. It is, therefore, projected that by the year 2000, the population will be about 33 million on an assumption of a slight decline in fertility offset by the continued decline in mortality. However, the national economy did not grow significantly in the past decade due to various constraints, and therefore the resources available per head increased by 1 percent per annum between 1985 and 1991. During 1988-91, the economy grew at an average of 5.2 percent per year and the per capita income increased by 2 percent. However, in 1992-95, the economy grew at an average of 3.7 percent and the per capita income grew at an average of 0.8 percent per year. On the other hand, the population continued to grow at a high rate, the consequences of which are felt acutely and visibly in the public budgets for health, education, and related fields of human resource development. It is evident, therefore, that improvement in the quality and expansion of these services is unlikely to happen without controlling rapid population growth and strengthening the national economy. It is against this background that Tanzania adopted the 1992 National Population Policy. The principal objective of the policy is to reinforce national development through developing available resources to improve the quality of life of its people. Special emphasis is placed on regulating the population growth rate, enhancing population quality, and improving the health and welfare of women and children. The primary concerns of the National Population Policy are to safeguard, as much as possible, the satisfaction of the basic needs of vulnerable groups in the population, and to develop human resources for current and future national socioeconomic progress. Since Tanzania was concerned with population and development issues before the adoption of an explicit population policy, the country has the tradition of taking population issues into account in its development plans. With specific reference to family planning, the goals of the policy are to strengthen family planning services to promote the health and welfare of the family, the community and the nation, and eventually reduce the rate of population growth. Other specific objectives related to population regulation include making family planning services available to all who want them, encouraging every family to space births at least two years apart, and supporting family life education programmes for youth and family planning for men and women. Family Planning The Family Planning Association of Tanzania (UMATI) introduced family planning services to Tanzania in 1959. During the early years the services were mostly provided in few urban areas with little support from the govemment. With the expansion of UMATI in the early 70s, services were extended to cover more areas in the country. The government became actively involved in providing family planning services following the launching of the integrated Maternal and Child Health (MCH) programme in 1974. Currently, family planning services are provided by both governmental and nongovernmental organisations under the coordination of the Family Planning Unit (FPU) in the Ministry of Health. Clinical services are complemented by community-based services. A social marketing programme is being considered. 1.4 Health Priorities and Programmes The Tanzania government emphasises equity in the distribution of health services and views access to services as a basic human fight. To respond to the worldwide efforts to attain the social goal of "Health to All" by the year 2000, Tanzania's health strategy focuses on the delivery of primary health care services. In 3 1991 a new Primary Health Care (PHC) strategy was developed by the Ministry of Health. The primary objective of the PHC focuses on strengthening district management capacity, multisectoral collaboration, and community involvement. The government provides more than 60 percent of health services; the remainder is provided by nongovernmental organisations. The top of the extensive network of health facilities consists at the national level of four referral hospitals, one of which is the university teaching hospital. Most regions have a regional hospital and there are 183 hospitals in the country. At the divisional level, there are 291 health centres and at the ward level there are 3,286 dispensaries. At the village level, village health posts have been established, staffed with at least two village health workers. There are more than 5,550 village health workers in Tanzania. 1.5 Objectives and Organisation of the 1996 Tanzania Demographic and Health Survey The 1996 TDHS is the third national sample survey of its kind to be undertaken. The first survey was done in 1991-92 followed by the Tanzania Knowledge, Attitudes and Practices Survey (TKAPS) in 1994. In addition to most of the same questions included in these two surveys, the 1996 TDHS added more detailed questions on AIDS, maternal mortality, and female circumcision. The general objectives of the 1996 TDHS are to: Provide national-level data that will allow the calculation of demographic rates, particularly fertility and childhood mortality rates Analyze the direct and indirect factors which determine the level and trends of fertility Measure the level of contraceptive knowledge and practice (of both women and men) by method, by urban-rural residence, and by region Collect reliable data on maternal and child health indicators; immunisation, prevalence, and treatment of diarrhoea and other diseases among children under age five; antenatal visits; assistance at delivery; and breastfeeding Assess the nutritional status of children under age five and their mothers by means of anthropometric measurements (weight and height), and child feeding practices Assess among women and men the prevailing level of specific knowledge and attitudes regarding AIDS and evaluate patterns of recent behaviour regarding condom use • Measure maternal mortality and collect data on female circumcision. Survey Organisation The 1996 TDHS, like the previous similar surveys, involved various institutions and individuals. The Bureau of Statistics in the Planning Commission had the overall responsibility of running the survey while the Ministry of Health provided technical and logistical support. Financial support was provided by the USAID and administered by Macro International Inc., which also rendered technical advice. The funds were used to meet expenses related to allowances for field personnel, data processing, anthropometric equipment, printing of questionnaires, fuel and maintenance of field vehicles, and dissemination of the survey results. The Government of Tanzania provided local professional staff, accommodation, transport, and other field logistics. 4 Sample Design The TDHS sample was a three-stage design consisting of the same 357 enumeration areas (EAs) that were used in the 1991-92 TDHS (262 EAs in rural and 95 EAs in urban areas). The selection of EAs was made in two stages: first, wards/branches and then EAs within wards/branches were selected. Lists of all households were prepared for the selected EAs and, at the third sampling stage, households were selected from these lists. The TDHS was designed to provide estimates (based on the results of the Woman's Questionnaire) for the whole country, for urban and rural areas in the country, and groups of regions (zones). In addition, the sample will provide certain estimates for each of the 20 regions in the mainland and 2 subgroups in Zanzibar: Pemba Island and Ungaja. In most regions, one in every four households was selected for the men's survey, and in six regions (Dares Salaam, Dodoma, Iringa, Kilimanjaro, Morogoro, and Shinyanga), men in every second household were selected for the interview. The sample of men was designed to provide estimates for the country as a whole and for urban and rural areas. Unlike most other DHS surveys, households in Tanzania were selected from the household listing for each ward (or branch) on the basis of contiguity, beginning with a randomly selected start number. This selection process was used to minimise the difficulty encountered in moving from one selected household to another given the scattered nature of households. Questionnaires Three types of questionnaires were used during the survey. The Household Questionnaire was used to list the names of the household members and certain individual characteristics of all usual members of the household and visitors who had spent the previous night in the household. Certain basic information was collected on characteristics of each person listed, including relationship, age, sex, education, and place of residence. Furthermore, the Household Questionnaire collected information on characteristics relating to the household. These included the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various durable goods. However, the main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. The Female Questionnaire was used to collect information from eligible women age 15-49. The topics covered in this questionnaire included the following: Background characteristics of the woman including age, education, residential history Reproductive history Knowledge and use of family planning methods Fertility preferences and attitudes about family planning Antenatal and delivery care Breastfeeding and weaning practices Vaccinations and health status of children under age five Marriage and sexual activity Husband's occupation and education Woman's employment, occupation, and earnings Awareness and behaviour regarding AIDS and other sexually transmitted diseases Maternal mortality Female circumcision Height and weight of children under five years and their mothers. The Male Questionnaire was used to collect information from a subsample of men age 15-59, namely, those living in every fourth household except in Dares Salaam, Dodoma, Kilimanjaro, Morogoro, Shinyanga, and Iringa regions where every second household was selected for the male interview. The Male Questionnaire collected much of the same information found in the Women's Questionnaire, but was shorter because it did not contain questions on reproductive history and maternal and child health. All questionnaires were translated and printed in Kiswahili. The final versions of the English questionnaires are provided in Appendix F. Before the design of the questionnaires could be finalised, a pretest was done in May-June, 1996 to assess the viability of the questions, the flow and logical sequence of the skip pattern, and the field organisation. It covered an area outside Dares Salaam and took about a week to complete. Modifications to the questionnaires were then made based on lessons drawn from the exercise. Training and Fieldwork As in the 1991-92 TDHS, the need to find competent interviewers was the guiding factor in recruiting interviewers. The Ministry of Health was again requested to secure the services of trained nurses to be interviewers in the 1996 TDHS. For Zanzibar, a similar request was made to the Zanzibar Ministry of Health to provide nurses for the interview work. The 1996 TDHS field staff consisted of eight teams, each composed of six female interviewers, one male interviewer, a field editor, a supervisor, and a driver. Sixty female nurses and 12 male nurses were recruited and 8 statisticians were selected as supervisors. After three weeks of intensive training, 50 female and 8 male interviewers were selected for the fieldwork. During training, a series of assessment tests were given to the class. These tests were graded and the results were used to select interviewers. Those who showed extra understanding of the questionnaires and were also able to detect errors in completed questionnaires were later chosen to be field editors. The list of persons who were involved in the survey is presented in Appendix E. The training of field staff for the main survey was conducted over a three-week period in early July 1996, at the Vocational Training Institute (VETA) in Iringa. Permanent staff from the Bureau of Statistics and staff from Macro International conducted the training with the support of guest lecturers from the UMATI, MCH personnel from the lringa regional hospital, and staff from the Tanzania Food and Nutrition Centre. Trial interviews were conducted in nearby villages and some parts of the city of Ifinga. Computer operators participated in the training to acquaint themselves with the questionnaires. The training course consisted of instructions in interviewing techniques, field procedures, a detailed review of items on the questionnaires, training and practice in weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in areas in and around Iringa. Supervisors and editors were trained exclusively for three days to discuss their duties and responsibilities. Emphasis was given to the importance of ensuring data quality. The supervisor was required to act as the leader of the field team and be responsible for the well-being and safety of team members, completion of the assigned workload, and maintenance of data quality. The duties and responsibilities of the editor were to monitor interviewer performance and take anthropometric measurements of children and women. Close supervision of the interviewers and editing of completed questionnaires were emphasised to ensure that data collection was accurate and complete. The fieldwork for the main survey began in late July 1996 and lasted until November 1996. Women and men for the individual interviews were identified during the household interview. It was stressed that the household interview had to be done by an interviewer other than the one who would conduct the individual interview. This was intended to reduce the error due to the age shifting particularly among women or men at the youngest or oldest age groups. Team supervisors located the households and assigned them to the interviewers. Completed household and individual questionnaires were handed over to the field editors who checked them to ensure that all relevant questions were properly recorded, that the skip pattern instructions were followed, and that responses were internally consistent. Each team was instructed to complete the editing work and resolve all errors found in the questionnaires before the team left the cluster. Supervisors were required to ensure that all the selected households and eligible women and men in a cluster were interviewed, and that assignment sheets for the interviewers and supervisors were filled out completely and correctly. The questionnaires and the control sheets were dispatched to the head office in Dares Salaam for data processing. Data Processing The data processing staff for the survey initially consisted of four clerks and one supervisor who were staff of the Bureau of Statistics. However, to speed up the data processing work, an additional four data processing staff were recruited. All questionnaires for the TDHS were returned to the Bureau of Statistics for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing of computer-identified errors. All data were processed on microcomputers with a software programme developed for DHS surveys, called the Integrated System for Survey Analysis (ISSA). Data entry was 100 percent verified. Office editing and data processing activities were initiated immediately after the beginning of fieldwork and completed in mid-December, 1996. Response Rates A summary of response rates from the household and individual interviews is shown in Table 1.2. In all, 8,900 households were selected, out of which 8,141 were occupied. Of the households found, 7,969 were interviewed, representing a response rate of 98 percent. The shortfall between the selected and the interviewed households was largely because many dwellings were either vacant or no competent respondents were present at the time of the visit. In the interviewed households, 8,501 eligible women (i.e. women age 15- 49) were identified for the individual interview, and 8,120 women were actually interviewed, yielding a response rate of 96 percent. In the subsample of households selected for the male interview, 2,658 eligible men (i.e., men age 15-59) were identified, 2,256 were interviewed, representing a response rate of 85 percent. The principal reason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. The lower response rates among men than women were due to the more frequent and longer absences of men. The response rates are lower in urban areas. One-member households are Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, Tanzania 1996 Residence Result Urban Rural Total Household interviews Households sampled 2,228 6,672 8,900 Households occupied 1,989 6,152 8,141 Households interviewed 1,912 6,057 7,969 Household response rate Individual interviews Number of eligible women Number of eligible women interviewed Eligible women response rate Number of eligible men Number of eligible men interviewed Eligible men response rate 96.1 98.5 97,9 2,186 6,315 8,501 2,088 6,032 8,120 95.5 95.5 95.5 773 1,885 2,658 616 1,640 2,256 79.7 87.0 84.9 more common in urban areas and are more difficult to interview because they keep their houses locked up most of the time. In urban settings, neighbours often do not know the whereabouts of such people. CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter presents information on selected socioeconomic characteristics of the household population and the individual survey respondents, such as age, sex, marital status, urban-rural residence, and regional distribution. The chapter also considers the conditions surrounding the households in which the survey population live, including sources of drinking water, availability of electricity, sanitation facilities, building materials, and persons per sleeping room. The 1996 TDHS collected information on individual socioeconomic characteristics of all usual residents and visitors who had spent the previous night preceding the survey interview. This was done by using a questionnaire which was completed for each household. A household was defined as a person or group of persons who live together and share a common source of food. 2.1 Population by Age and Sex Table 2.1 shows the distribution of the household population by five-year age groups, according to sex and urban-rural residence. As was observed in the censuses and the 1991-92 TDHS, the distribution conforms to the pattern typical of high-fertility populations, that is, a much higher proportion of the population is in the younger age groups than in the older age groups as clearly seen in the population pyramid (Figure 2.1 ). The slight irregular bulge of women at age 50-54 indicates that some women from ages 45-49 were shifted to the 50-54 age group, perhaps to reduce the workload of the interviewer. There is also an unusually large Table 2.] Household r~ooulation by a~e. residence, and sex Percent distribution of the de facto household population by five-year age group, according to urban-rural residence and sex, Tanzania 1996 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 16.4 13.8 15.1 18.1 17.1 17.6 17.8 16.4 17.1 5-9 13.5 13.0 13.2 17.5 16,0 16.7 16.7 15.4 16.0 10-14 12.6 13.1 12.8 15.3 13.5 14.4 14.8 13.4 14.1 15-19 10.8 11.3 11.1 9.8 8.8 9.3 10.0 9.3 9,6 20-~ 9.4 12.2 10,8 5.9 8.2 7.1 6.6 9.0 7.8 25-29 8.4 9.8 9,1 5,6 7,1 6,4 6,2 7.6 6.9 30-34 6.6 6.3 6.4 5.2 5.6 5.4 5.5 5.8 5.6 35-39 5,8 5.9 5.8 4.0 4.5 4.3 4.4 4.8 4.6 40-~ 4.4 3.5 3,9 3.3 3.5 3.4 3.5 3.5 3.5 45-49 3.2 2.3 2.7 3.2 3.3 3.2 3.2 3,1 3.1 50-54 2.0 2.4 2.2 2.2 3.4 2.9 2.2 3.2 2.7 55-59 1.8 1.8 1.8 2.1 2.9 2.5 2.0 2.7 2.4 60-64 2,1 1.7 1.9 2;4 2.0 2.2 2.3 2.0 2.1 65-69 1.3 1.3 1.3 2,2 1.6 1.9 2.0 1.5 1.8 70-74 0.9 0.7 0.8 1.3 1.2 1.2 1.2 1.1 1.1 75-79 0.3 0.4 0.4 0.8 0.6 0.7 0.7 0.6 0.6 80+ 0.3 0.5 0.4 0.9 0.7 0.8 0.8 0.7 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,690 3,876 7,567 14.775 15,931 30,714 18,464 19,807 38,281 Note: Total includes 9 persons whose sex was not stated. number of girls age 14 relative to the number age 15 (see Appendix Table C.1), which presumably is due to the same phenomenon. This pattern of age shifting has also been observed in other DHS surveys. 2.2 Population by Age from Selected Sources Table 2.2 shows that the population age structure is similar to that found in the 1967, 1978, and 1988 censuses as well as that observed in the 1991-92 TDHS. The proportion of the population under age 15 is about 47 percent and the population in age group 15-64 accounts for 49 percent, Age Figure 2.1 Distribution of the Household Population by Age 10 5 0 5 10 Percent TDHa 1996 with the remaining 4 percent above age 65. The population has a low median age of 16.4 years. A dependency ratio is also presented in Table 2.2. The age dependency ratio is the ratio of the total number of persons below age 15 years and age 65 and above divided bythe number of persons age 15 to 64. This is simply an indicator of the dependency responsibility of adults in their productive years. In 1996, the dependency ratio is 106 which means that there are 106 persons less than 15 years old or more than 64 years of age in Tanzania for every 100 persons age 15-64. 2.3 Household Composition Information about the composition of households by sex of the head of the household and size of the household is presented in Table 2.3. This table also shows the percentage of households with foster children. The data show that 78 percent of the households in Tanzania are headed by men, which is higher than that found in the 1988 Census (70 pereen0, but lower than the 1991-92 TDHS figure (81 percent). Table 2.2 Ponulation bv age from selected ~Qurces Percent distribution of the population by age group, according to selected sources, Tanzania 1967-1996 1967 1978 I988 1991-92 1994 1996 Age group Census Census Census TDHS TKAPS TDHS <15 43.9 46.1 45.8 46.8 49.3 47.2 15-64 50.5 49.9 49.9 49.3 46.4 48.5 65+ 5.6 4.0 4.3 3.9 4.3 4.3 Total 100.0 100.0 I00.0 100.0 100.0 100.0 Median age U U U 16A 15.4 16.4 Dependency ratio 98 I00 100 103 115 106 Households with one or two members constitute 21 percent of all Sources: Bureau of Statistics, 1967-1996 households. This category of u = Unknown households is more common in urban areas (30 percent) than in rural areas (19 percent). Rural households are larger than urban households--the mean household size is 5.1 in rural areas and 4.3 in urban areas. The average household size is 4.9 persons which is higher than the 1988 Census figure of 4.2 (Bureau of Statistics, 1994). 10 About one in five households has foster children, that is, children under age 15 living in a household with neither their biological mother nor father present. Although figures show a slight decline in foster children (from 23.1 percent in 1991-92 to 21 percent in 1996), the proportion is still high. The high proportion of households with foster children certainly intensifies the economic burden on these households. With the current high prevalence of AIDS, the percentage of households with foster children in Tanzania is likely to rise. 2.4 Fosterhood and Orphanhood Information regarding fosterhood and orphanhood of children under 15 years of age is presented in Table 2.4. Sixty-three percent of children under 15 years of age are living with both parents, 18 percent are living with their mothers (but not with their fathers), 4 percent are living with their fathers (but not with their mothers) and 14 percent are living with neither their natural father nor natural mother. Of children under 15 years of age, 6 percent have lost their fathers and 3 percent have lost their mothers. Less than 1 percent of children have lost both their natural parents. Table 2.3 Household comnosition Percent distribution of households by sex of head of household, household size. and presence of foster children, according to urban-rural residence, Tanzania 1996 Residence Characteristic Urban Rural Total Household headship Male 76.7 78.7 78.2 Female 23.3 21.3 21.8 Number of usual members 1 14.6 7.4 9.0 2 15.4 11.5 12.4 3 16.7 13.0 13.8 4 12.4 14.5 14.0 5 12.8 14.2 13.9 6 9.1 13.4 12.4 7 6.4 10.2 9.3 8 4.8 6.1 5.8 9+ 7,8 9.7 9.3 Total 100.0 100.0 100.0 Mean size 4.3 5.1 4.9 Percentage of households with foster children 20.1 21.2 21.0 Note: Table is based on de jure members; i.e., usual residents. Note: By convention,foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. 2.5 Educational Level of Household Population In the three decades since independence, the education sector has expanded to reach most parts of the country and phenomenal growth has been recorded in both enrolment and the number of new institutions. For example, in 1970, a nationwide literacy programme was launched and in 1975 a national policy of Universal Primary Education was adopted. This programme gave every child the right to free primary education. In the mainland, primary education which includes seven years of schooling was made compulsory for all children 7 to 14 years of age in 1978. There are six years of secondary education. Entry into the fifth year of secondary education (Form V) is based on open competitive examination results. In Zanzibar, although education incorporates two stages, it differs slightly from the mainland system. Primary education begins at age 6-8 years and takes 8 years to complete. It is followed by two three-year cycles of secondary education. In the 1996 TDHS, information on educational attainment was collected for every member of the household. Tables 2.5.1 and 2.5.2 show the percent distribution of the de facto female and male household population age six and over, respectively, by the highest level of education attended, and the median number of years of schooling completed, according to selected background characteristics. 11 Table 2.4 Fosterhood and omhanhood Percent distribution of de jure chi ldren under age 15 by survival status of parents and child's l iv ing arrangements, according to child's age, sex, residence, and region, Tanzania 1996 Living Living with mother with father Not living with but not father but not mother either parent Missing Living inform- with Father Mother ation on Number Background both Father Father Mother Mother Both only only Both father/ of characteristic parents alive dead Mive dead alive alive alive dead mother Total children Age <2 74.1 i9.1 1.6 0.5 0.1 3.0 0.2 0.1 0.0 1.2 100.0 3,932 3-5 66.7 13.9 3.0 2.1 0.6 11.1 0.7 0.8 0.3 0.9 100.0 3,868 6-9 61.3 11.8 4.1 3.6 1.1 12.5 1.2 1.9 0.7 1.6 100.0 4,892 10-14 54.2 10.8 6.2 4,5 2.3 13.4 2.0 2.9 l . l 2.6 100.0 5,384 Sex Male 63.2 13.6 3.8 3.l 1.3 10.1 1.I 1.6 0.6 L6 100.0 9.110 Female 63.1 13.5 4.1 2.6 1.0 10.6 1.1 1.5 0.6 1.8 I00.0 8,962 Residence Mainland 63.2 13.5 4.0 2.9 1.2 10.3 1.1 1.6 0.6 1.6 100.0 17,503 Total urban 58.6 16.0 2.9 3.2 1.5 12.1 0.8 1.9 0.9 2.1 100.0 2,935 Dares Salaam city 61.0 13.3 2.4 3.2 1.3 11.1 1.3 2.1 1.3 3.2 100.0 787 Other urban 57.7 17.0 3.1 3.2 1.6 12.5 0.7 1.8 0.8 1.7 100.0 2,148 Total rural 64.1 13.0 4.2 2.8 1.1 9.9 1.2 1.5 0.6 1.6 100.0 14,568 Zanzibar 60.8 15.7 2.6 2.9 0.2 13.5 0.6 1.4 0,4 1.9 100.0 573 Pemba 64.0 15.7 3.4 2.6 0.3 10.3 1.3 t),8 0.1 1.5 100.0 269 Unguja 58.1 15.6 1.9 3.0 0.1 16,3 0.0 1,9 0.7 2.2 100.0 305 Region 1 Dodoma 63.0 14,6 5.0 2.3 1.9 9.0 1.4 2.0 0.0 0.9 I00.0 803 Arusha 74.8 9.8 4.5 1.2 0.8 6.2 0.9 0.9 0.4 0.5 100.0 1,466 Kilimanj aro 54.5 20.6 2.6 1.5 0.5 14.5 1.1 1.8 0.4 2,7 100.0 843 Tanga 62.9 15.6 3.4 3.9 1.0 8.4 1.5 0,9 0.5 2.0 100.0 948 Morogoro 59.1 19.1 4.6 3.0 2.0 8,6 1.5 1.6 0.2 0.4 100.0 870 Coast 53.5 21.8 1.7 4.2 0.7 11.0 1.3 1.5 1.2 3.3 100.0 344 Dares Salaam 61.8 11.8 2.7 3.1 1.3 11.1 1,3 2.0 1.4 3.3 I00.0 952 Lindi 47.0 21.0 3,1 5.3 2.4 14.9 1.0 2.8 0.4 2.1 100.0 404 Mtwara 48.4 19.0 3.3 5.5 1.5 15.4 0.5 3.0 0.4 2.9 100.0 628 Ruvuma 62.5 18.2 2.2 3.8 1.2 6.0 1.1 1.0 0.3 3.7 100.0 689 iringa 62.3 18.2 7.1 0.6 0.8 6,3 0.8 1.4 0.6 1.8 100.0 1,009 Mbeya 60.7 11.5 6.4 3.6 1.8 11.6 2.8 0.7 0.2 0.8 100.0 929 Singida 66.7 11.3 2.6 3.0 0.5 12.0 1.3 0.8 0.3 1.5 100.0 763 Tabota 55.2 14.9 1.6 3,6 1.4 19,1 0.0 0.5 0.9 2.9 100.0 502 Rukwa 68.9 14.1 2.1 3.0 1.4 7.9 0.9 1.5 0.0 0.4 100.0 571 Kigoma 77.5 8.1 2.9 3.3 0.9 3£ 1.0 0,8 0.2 1.9 100.0 850 Shinyanga 66,4 11.1 3.7 3.5 0.9 10.3 1.2 1.3 0.5 1.2 100.0 1,587 Kagera 62.8 8.0 6.7 3.5 1,9 9.9 0.7 2.5 2.4 1.7 100.0 1,240 Mwanza 67.4 10.2 1.7 1.4 0.4 14.7 1.4 1.6 0.8 0.4 100.0 1,425 Mara 54.5 10.9 9.3 2.9 2,2 12,8 0.3 4.0 0.4 2.7 100.0 681 Total 63.1 13.6 4.0 2.9 1.2 10.4 1.1 1.6 0.6 1.7 100.0 18,076 Note: By convention,foster children are those who are not living with either biological parent. This includes orphans, i.e., children with ~oth parents dead. This table and subsequent tables show 20 regions from Mainland and do not include any region from Zanzibar. Dares Salaam region neludes Dares Salaam city and l~ral areas in Dares Salaam region. 12 Table 2.5.1 Educational level of the female household t~oDulatirm Percent distribution of the de facto female household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Tanzania 1996 Level of education Some Don't Median Background No Primary Completed secondary know/ years of Total characteristic education incomplete primary and higher missing Total schooling number Age 6-9 75.4 23.2 0.0 0,0 1.4 100.0 0.0 2,409 10-14 21.4 76.0 1.9 0.2 0.6 I00.0 1.6 2,650 15-19 16.0 32.6 45.5 5.6 0.4 100.0 6.0 1,840 20-24 16.6 13.6 61.2 8.2 0.4 100.0 6.3 1,781 25-29 19.2 11,9 62.6 5.7 0.6 100.0 6.3 1,508 30-34 28,1 16,0 50.2 5.4 0.3 100.0 6.1 1,140 35-39 44-.1 19.1 33.1 3.2 0.6 100.0 2.1 943 40-44 54.I 25.2 16.9 2.9 0.9 i00.0 0.0 688 45-49 62.7 26.1 8.5 1.8 0.9 100.0 0.0 614 50-54 71.7 22.3 2.9 0.3 2.8 100.0 0.0 641 55-59 79.2 15.3 2.2 0.5 2.7 100.0 0.0 528 60-64 83.5 12.6 0,5 0.2 3.2 100.0 0.0 388 65+ 88.1 6.9 1.2 0.0 3.8 100.0 0.0 761 Residence Mainland 41.7 29.0 25.8 2.6 1.1 100.0 1.2 15,417 Total urban 24.7 29.0 37.0 8.3 1.0 100.0 4.4 3,069 Dares Salaam city 22.0 25.4 38.2 12.6 1.8 100.0 6.0 878 Other urban 25.8 30.5 36.5 6.6 0.6 100.0 3.9 12,191 Total rural 45.9 29.0 23.0 1.1 1.1 i00.0 0.2 2,348 Zanzibar 43.4 30.4 9.5 15.5 1.2 100.0 1.0 484 Pemba 49.6 32.6 6.5 10.4 0.9 100.0 0.0 200 Unguja 39.1 28.8 11.7 19.0 1.3 100.0 2.2 283 Region Dodoma 46.6 24.9 25.7 2.3 0.5 100.0 0.0 741 Arusha 50.9 20.1 24.8 2.0 2.1 100.0 0.0 1,113 Kilimanjaro 21.5 40.l 3•.9 5.7 0.8 100.0 3.7 819 Tanga 39.6 30.9 28.8 0.4 0.3 100.0 1.9 903 Morogoro 45.0 30.6 23.3 0.8 0.4 100.0 0.5 857 Coast 47.6 25.9 24.0 1.1 1.4 100.0 0.1 357 Dares Salaam 23.5 25,8 37.8 11.2 1.7 100.0 5.6 1,019 Liodi 40.8 29.7 25.0 2.2 2.3 100.0 1.1 387 Mtwara 48.5 27.0 22.9 0.4 1.3 100.0 0.0 709 Ruvuma 28.7 36.6 31.8 1.9 1.1 100.0 3.2 623 Iringa 42.9 31.7 21.8 3.1 0.5 100.0 0.8 905 Mbe~a 35.8 31.6 29.4 2.1 1,1 100.0 2.1 858 Singlda 44.1 29.7 23.4 1,8 1,1 100.0 0.6 604 Tabora 44.4 25.4 26.1 2.1 1.9 100.0 0.4 476 Rukwa 50.5 28.4 19.1 1.7 0.3 100.0 0.0 460 Kigoma 44.3 28.0 25.7 0.4 1.6 100.0 0.1 697 Shmyanga 49.1 25.6 20.7 3.3 1.3 100.0 0.0 1,285 Kagara 42.4 30.7 25.0 1.0 0.9 100.0 0.7 965 Mwanza 49.7 28.4 19.6 2.0 0.3 100.0 0.0 1,123 Mara 36.7 33.5 28.1 0.9 0.9 100.0 1.7 517 Total 41.7 29.0 25.3 3.0 1.1 100.0 1.2 15,901 Note: Total includes 11 women with age missing. 13 Table 2.5.2 Educational level of the male household nooulation Percent distribution of the de facto male household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Tanzania 1996 Level of education Some Don't Median Background No Primary Completed secondary know/ years of Total characteristic education incomplete primary and higher missing Total schooling number Age 6-9 79.1 19.0 0.0 0.0 1.9 100.0 0.0 2,462 10-14 23.4 74.7 1.2 0.1 0.6 100,0 1.1 2,729 15-19 9.9 47.9 36.9 5.0 0.3 100,0 5.3 1,853 20-24 9.3 15.4 61.3 13.3 0.7 100,0 6.4 1,223 25-29 10.8 11.2 66.1 11.3 0.5 100,0 6.4 1,143 30-34 11.2 12.0 66.0 10.4 0.4 100.0 6.4 1,018 35-39 16.6 17.3 54.7 10.5 0.9 100,0 6.3 810 40-44 21.7 31.4 34.4 I 1.7 0.7 100.0 4.2 641 45-49 26.9 34.2 28.3 9.6 1.0 100.0 3.7 589 50-54 29,8 45.8 17.2 6.6 0.6 100.0 3.3 407 55-59 39.8 41.9 11.2 5.5 1.6 100.0 2.6 378 60-64 52.I 36.5 7.4 1.5 2.5 100.0 0.0 427 65+ 64.7 27.5 3.9 1.5 2.4 100.0 0.0 863 Residence Mainland 31.6 35.2 27.3 4.9 1.0 100.0 2.9 14,109 Total urban 18.7 31.2 35.3 13.8 1.0 100.0 5.7 2,831 Dares Salaam city 14.6 26.3 38.6 18.3 2.2 100.0 6.2 904 Other urban 20.6 33.5 33.7 11.7 0.5 100.0 4.6 1,927 Total rural 34.8 36.2 25.3 2.7 1.0 100.0 2.1 11,278 Zanzibar 33.0 34.4 12.1 18.7 1.8 100.0 25 450 Pemba 41.9 36.2 7.9 13.3 0.7 100,0 0.7 187 Unguja 26.6 33.2 15.1 22.6 2.6 100.0 3.6 263 Region Dodoma 39.5 32.4 23.2 4.2 0.7 100.0 1.7 648 Arusha 40.3 27.1 26.5 4.5 1.7 100.0 1.4 1,038 Kilimanjaro 13.8 43.5 33.9 8.1 0.7 100.0 4.7 741 Tanga 27.6 41.0 28.9 1.5 1.0 100.0 3.1 796 Morogoro 34.2 35.8 26.3 3.1 0.6 100.0 2.9 704 Coast 33.4 33.8 26.6 4.7 1.5 100.0 2.5 313 Dares Salaam 15.8 27.0 37.5 17.2 2.4 100.0 6.1 1,058 Lindi 36.3 36.1 23.1 3.1 1.5 100.0 2.4 367 Mtwara 35.7 39.0 23.2 1.3 0.8 100.0 1.9 590 Ruvuma 24.1 37.8 33.4 3.6 I.I 100.0 3.4 549 lringa 36.1 36.3 24.1 3.1 0.3 100.0 2.2 710 Mbeya 29.6 33.0 30.0 7.1 0.4 100.0 3.4 817 Singida 37,1 35,2 23.8 2.5 1.4 100.0 1.5 552 Tabora 32.4 30.7 32.2 3.9 0.7 100.0 2.9 460 Rukwa 34.9 33.8 29.0 2.2 0.0 100.0 2.8 440 Kigoma 35.6 34.6 26.8 2.4 0.6 100.0 2.2 616 Shinyanga 38.4 33.9 21,4 5.3 1.1 100.0 1,2 1,22I Kagera 28.8 38.3 26.2 5.5 1.2 100.0 2.5 931 Mwanza 35.5 38.1 23.7 2.1 0.5 100.0 2.1 1,076 Mara 26.7 42.0 26.9 2.9 1.5 100.0 2.6 481 Total 31.6 35.1 26.9 5.3 1.0 100.0 2.8 14,559 Note: Total includes 17 men with age missing 14 There is a strong differential in educational attainment between the sexes, especially as age increases. About 42 percent of women and 32 percent of men in Tanzania have never been to school (Figure 2.2). The proportions with no education increase with age. For example, the proportion of women who have never attended any formal schooling increases with age from 16 percent (age group 15-19) to 88 percent (age group 65 and over); for men, the proportion increases from 10 percent (age group 15-19) to 65 percent (age group 65 and over). Fifty-four percent of women and 62 percent of men have attained some primary education and only 3 percent of women and 5 percent of men have attained some secondary education. There are Percent Figure 2.2 Level of Education for Men and Women No Education Primary Primaw SeCondary/ Incomplete Complete Higher IIIWomen =Men I TDHS1996 more men with completed primary education than women at almost all age groups except the younger age groups (below 20 years). The median number of years of schooling is 1.2 for women and 2.8 for men. Overall, educational attainment is higher in urban areas than in rural areas on the mainland. The proportion of women with no education in urban areas is lower (25 percent) than in rural areas (46 percent); among men, the proportion with no education in urban areas is 19 percent compared to 35 percent in rural areas. The percentage with primary and secondary education is higher for urban than for rural women and men. In Zanzibar, the proportions of both males and females with no education are higher than those observed in the mainland. However, Zanzibar records the highest proportion of the population with secondary or higher education. This is due to the fact that compulsory primary education incorporates three years of secondary education. The highest proportions of women with no education (above 40 percent) and men (above 35 percent) are concentrated in the Dodoma, Arusha, Lindi, Mtwara, lringa, Singida, Kigoma, Shinyanga and Mwanza regions. Dares Salaam and Kilimanjaro regions have the lowest proportions of male and female respondents with no education (below 20 and 25 percent, respectively). 2.6 Schoo l Enro lment Table 2.6 and Figure 2.3 present the percentage of the de facto household population 6-24 years of age enrolled in schools by age, sex, and urban-rural residence. The school enrolment ratio is the number enrolled in a specific age group per hundred persons in that particular age group. As shown in this table, enrolment of children age 11-15 is higher than for children age 6-10 (71 vs. 27 percent) suggesting that many children start primary education after age 6 or 7. In age group 6-15 there is a remarkable urban-rural difference in enrolment with 45 percent of rural children and 57 percent of urban children enrolled. This is in contrast with enrolment ratios observed in the 1991-92 TDHS in which an urban-rural difference of 6 percent was recorded. Enrolment drops after age 15 with about 31 percent of male children and 18 percent of females age 16-20 years old, and 5 percent of males and 1 percent of females in their early 20s still in school. 15 Table 2.6 School enrolment Percentage of the de facto household population age 6-24 years enrolled in school, by age, sex, and residence, Tanzania 1996 Male Female Total Age Urban Rural Total Urban Rural Total Urban Rural Total 6-10 36.3 23.0 25.1 45.9 26.0 29.5 41.2 24.5 27.3 11-15 76.3 70.3 71.3 73.9 70.6 71.2 75.1 70.4 71.3 Total 6-15 54.8 44.0 45.8 58.5 45.4 47.7 56.6 44.7 46.8 16-20 31.1 31.1 31.1 17.6 17.8 17.8 23.7 24.3 24.1 21-24 9.4 3.0 4.8 2.7 0.9 1.4 5.5 1.7 2.7 Figure 2.3 School Enrolment by Age and Place of Residence Percent 6-10 11-15 16-20 21-24 ]lUrban-Male lUrCh-Female 1Rural-Male ~RuraI-Female I TDHS1996 2.7 Housing Characterist ics To assess the economic and environmental conditions in which respondents live, women were asked questions about certain characteristics of their households, including electricity, sources of drinking water, time to water sources, type of toilet facility, floor materials, and number of rooms used for sleeping. Information on these characteristics is useful from a public health point of view, as well as indirectly in reflecting the household's socioeconomic status. This information on housing characteristics is given in Table 2.7. Only 9 percent of households in Tanzania have electricity. Access to electricity is concentrated in urban areas where 36 percent of the households have electricity, compared to a mere 2 percent of rural households. I6 Table 2.7 Hnusin~ characteristics Percent distribution of households by according to residence, Tanzania 1996 housing characteristics, Residence Characteristic Urban Rural Total Electridty No 63.9 97.5 90.0 Yes 35.5 1.8 9.4 Missing/Don't know 0.7 0.6 0.6 Total 100.0 100.0 100.0 Source of drinking water Piped into residence 31.5 2.0 8.6 Public tap 46,3 23,1 28,3 Well in residence 0.8 1.3 1.2 Public well 13.6 31.6 27.6 Spring 1.8 15.1 12.1 River/stream 3.2 20,5 16.6 Pond/lake 1.1 4.5 3.7 Dam 0.0 1.0 0.8 Rainwater 0.0 0.1 0.1 Other 1.0 0.0 0.2 Missing/Don't know 0.6 0.7 0.7 Total 100.0 100.0 100.0 Time to water source (in minutes) <15 minutes 63.6 31.5 38.7 Median time to source 6.0 20.8 16.0 Sanitation facility Own flush toilet 3.6 0.5 1.2 Shared flush toilet 1.4 0.3 0.5 Traditional pit toilet 89.3 81.9 83.5 Vent. imp. pit latrine 3.3 0.4 1.1 No facility/bush 1.7 16.0 12.8 Missing/Don't know 0.7 0.9 0.8 Total 100.0 100.0 100.0 l~oor material Earth/sand 35.4 90.6 78.2 Cement 63.4 8.5 20.8 Carpet/other 0.3 0.2 0.2 Missing/Don't know 0.9 0.7 0.8 Total 100.0 100.0 100.0 Table 2.7---Continued Percent distribution of households by housing characteristics, according to residence, Tanzania 1996 Residence Characteristic Urban Rural Total Persons per room 1-2 65.0 56.6 58.5 3-4 27.0 28.9 28.5 5-6 5.2 9.0 8.1 7+ 1.1 4.1 3.4 Missing/Don't know 1.7 1.3 1.4 Total i00.0 100.0 100.0 Mean number of persons per room 2.4 2.8 2.7 Level of houshold food consumption Always surplus 54.3 40.3 43.4 Sometimes defter 39.2 52.0 49.2 Frequently deficit 3.3 4.9 4.5 Always deficit 2.3 2.0 2.1 Missing/Don't know 0.9 0,8 0.8 Total 100.0 100,0 100.0 Number of households 1,783 6,186 7,969 The source of drinking water is important because waterborne diseases, including diarrhoea and dysentery, are numerous in the country. Sources of water expected to be relatively free of these diseases are piped water, springs, and rainwater. Other sources like wells, rivers and streams, ponds and lakes, and gravity water are more likely to carry the bacteria that bring about these diseases. Table 2.7 shows that 37 percent of all households in Tanzania have access to piped water--78 percent of urban households and about 25 percent of rural households. About half of the rural households get their drinking water from wells and springs, while one-fourth use less safe sources such as rivers, ponds, and lakes. In urban areas, 16 percent of households get their drinking water from wells and springs, but only 4 percent use less safe sources such as rivers, ponds, and lakes, In urban areas, 64 percent of the households have access to water within 15 minutes, compared to 32 percent of rural households. Modern sanitation facilities are not yet available to large proportions of the households. The use of traditional pit toilets is still common in both urban and rural areas, accounting for about 89 percent of urban households and 82 percent of rural households. Households with no toilet facilities are more exposed to the risk of diseases such as dysentery, diarrhoea, and typhoid fever. Overall, about 13 percent of the househo lds in 17 Tanzania have no toilet facilities. This problem is more common in rural areas, where 16 percent of the households have no toilet facilities, compared to 2 percent of households in urban areas. The type of material used for the floor in these households is an indicator of the quality of housing as well as an indicator of health risk. Some flooring materials like earth and sand may pose a health problem because they may be breeding grounds for parasites such as ticks and jiggers and also may be a source of dust. They are also difficult to keep clean since they are not washable. Seventy-eight percent of Tanzanian households have floors made of earth or sand and only 21 percent are made of cement. One-third of households in urban areas and 91 percent of rural households have floors made of earth or sand. On the other hand, 63 percent of households in urban areas have cement floors, compared to only 9 percent of households in rural areas. In general, rural households have poorer quality floors than urban households. Information on the number of rooms a household uses for sleeping was collected to determine the extent of crowding. On average, there are 2.7 persons per sleeping room, and this varies very slightly between urban and rural households. In the 1996 TDHS, respondents were asked whether they thought their household was a surplus or deficit household in terms of food consumption. Forty-three percent of Tanzanian households indicated that they always have a surplus of food, while 56 percent of the households mentioned that they have food deficits. Food deficits are more common among rural than urban households (59 compared to 45 percent). 2.8 Household Durable Goods Respondents were asked about ownership of particular durable goods. Ownership of a radio and a television set is a measure of access to mass media; refrigerator ownership indicates the capacity for hygienic food storage; and ownership of a bicycle, motorcycle, or private car shows the means of transport available to the household. Information on ownership of these items is presented in Table 2.8. The results indicate that 41 percent of households own a radio, compared to only 2 percent with a television. Both radio and television ownership is higher in urban than rural households. Bicycles are the most common means of transport owned by households; 25 percent of urban households and 34 percent of rural households own a bicycle. Only 1 percent of the households owns a car and most of them are located in urban areas. Half the rural households surveyed and 29 percent of urban households do not own may of the above durable goods. Table 2.8 Household durable ~oods Percentage of households possessing various durable consumer goods, by residence, Tanzania 1996 Residence Characteristic Urban Rural Total Radio 65.4 33.8 40.9 Television 6.0 0.4 1.6 Refrigerator 7.5 0.4 2.0 Bicycle 25.0 33.8 31.9 Motorcycle 1.7 0.6 0.8 Private car 4.3 0.6 1.4 Ownership of radios, televisions, and None of the above 29.4 50.3 45.6 bicycles has increased since 1991-92. For Number of households 1,783 6,186 7,969 example, the proportion of households with radios has increased from 33 to 41 percent and the proportion with bicycles has increased from 22 to 32 percent. The proportion of households with a television in urban areas has increased from a mere I percent in the 1991-92 TDHS to about 6 percent in 1996. The increase reflects the introduction of three television stations in the country during the period between the two surveys. 18 2.9 Background Characteristics of Respondents Table 2.9 presents the percentage distribution of women and men by age, marital status, residence, level of education, and religion. Women and men were asked two questions to determine their ages, "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained in probing techniques for situations in which respondents were not able to state their ages or date of birth, and as a last resort, interviewers were trained to record their best estimate of the respondent's age. Results show that about 42 percent of women and 38 percent of men am in the age group 15-24, and 32 percent of women and 26 percent of men are in the 25-34 age group. The vast majority of women and men live on the Mainland (97 percent), while only 3 percent live in Zanzibar. On the mainland, 22 percent of women and men live in urban areas, and three- fourths of women and men live in rural areas. Data on marital status at the time of the survey show that 23 percent of women and 38 percent of men have never married, 67 percent of women and 57 percent of men were currently in unions, while 10 percent of women and 5 percent of men were divorced, separated, or widowed. The proportion of women who have never attended school is more than twice that of men (29 vs. 14 percent). About 46 percent of women and 47 percent of men have completed primary education only, while 5 percent of women and 10 percent of men have gone beyond primary education. Thirty-one percent of respondents are Moslems, an equal proportion are Catholics, one-fourth are Protestants, and 12 percent of women and 14 percent of men either adhere to traditional religions or have no religion. 2.10 Characteristics of Couples Because the men who were interviewed individually in the TDHS were selected from the same house- holds in which women were interviewed, it is possible to match married men with their wives to form a sample of couples. The result does not exactly represent all married couples in Tanzania, since not all couples live together. Nevertheless, the sample of 1,125 couples can be viewed as a reasonable reflection of men and women who are living together. Table 2.10 presents the distribution of couples by age difference between spouses and level of education. According to the 1996 TDHS, among 30 percent of Tanzanian couples, the husband is 0-4 years older than his wife, while among 38 percent of couples, the husband is 5-9 years older than his wife. Among only 3 percent of couples, the wife is older than her husband. On average, men are almost eight years older than their wives. Among 61 percent of couples, both spouses have at least some education. Among 22 percent of cou- ples, the husband has some education and the wife has none, while the wife has some education and the husband none among only 6 percent of couples. Cases in which neither spouse has been to school make up 11 percent of all couples. 2.11 Educational Level of Survey Respondents Tables 2.11.1 and 2.11.2 show the percent distribution of female and male respondents by highest level of education attended, respectively, according to age, residence, and region. As mentioned before, men are generally better educated than women. While 29 percent of women age 15-49 have had no formal education, only 14 percent of men age 15-59 have had no schooling. The proportion of respondents who 19 Table 2.9 Back,2"round characteristics of resnondents Percent distribution of women and men by selected background characteristics, Tanzania 1996 Women Men Number of women Number of men Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted Alg5e- 19 21.3 1,732 1,729 21.6 488 493 20-24 20.6 1,676 1,694 i6.4 371 375 25-29 17.7 1,440 1,415 13.4 301 293 30-34 13.8 1,118 1,135 12.1 272 267 35-39 10.9 888 896 1 l.I 251 248 40-44 8.4 680 670 9. I 206 2 l 6 45-49 7.2 585 58I 6.6 149 145 50-54 NA NA NA 5.2 118 119 55-59 NA NA NA 4.4 100 100 Residence Mainland 97.1 7,881 7,479 96.9 2,187 2,148 Total urbma 22.3 1,811 1,853 22.6 509 579 Dar es Salaam city 6.9 563 666 7.6 171 272 Other urban 15.4 1,248 1,187 15.0 338 307 Total rural 74.7 6,070 5,626 74.4 1,678 1,569 Zanzibar 2.9 239 641 3.1 69 108 Pemba 1.1 92 295 1.2 28 54 Unguja 1.8 148 346 1.8 41 54 Region Dodoma 4.4 355 315 4.2 96 140 Arusha 7.2 589 469 6.9 156 94 Kilimanj are 4.8 390 393 5.3 119 195 Tanga 5.7 464 398 4.8 108 75 Morogoro 5.0 408 377 4.2 95 143 Coast 2.0 159 277 2.0 45 62 Dares Salaam 8.0 646 764 8.5 191 304 Lindi 2.3 187 318 2.4 54 71 Mtwara 4.4 355 441 4.2 96 101 Ruvuma 3.8 305 466 3.6 82 102 lringa 5.7 466 389 4.5 100 137 Mbeya 5.8 473 314 6.l 137 72 Singzda 3.5 283 394 3.6 80 84 Tab~ra 2.8 225 198 3.6 82 54 Rukwa 3.0 242 353 3.1 71 78 Kigoma 4.3 351 367 4.2 95 70 Shmyanga 8.4 686 375 8.9 202 164 Kagera 5.8 467 284 6.1 139 69 Mwanza 7.1 573 3 I0 7.8 176 78 Mara 3.2 257 277 2.9 64 55 Marital status Never married 23.2 1,887 1,899 37.5 847 861 Married 59.9 4,864 4,787 53.0 1,196 1,161 Living together 6.7 548 617 4.1 91 107 Widowed- 3.1 250 250 0.9 20 21 Divorced 4.9 399 400 1.8 40 43 Not living together 2.1 172 166 2.5 57 60 Missing 0.0 1 1 0.2 4 3 Education No education 28.5 2 316 2,24l 13.5 304 292 Primary incomplete 20. I 1,630 1,636 29.4 664 654 Primary complete 46.0 3 732 3,685 47.2 1,066 1,059 Secoanary+ 5.4 44 558 9.8 222 251 Currently attending school Yes 6.6 534 553 10.4 235 238 No 93.0 7,552 7,532 88.9 2,006 2,004 Religion Moslem 31.2 2 531 3,200 30.8 694 839 Catholic 31.4 21546 2,418 31.0 698 693 Protestant 25.4 2 065 1,792 23.9 538 491 Traditional/none 11.7 95 682 13.3 300 211 Other 0. I 7 7 0.4 10 10 Missing 0.2 20 21 0.6 15 12 Total 100.0 8,120 8,120 100.0 2,256 2,256 NA = Not applicable 20 completed secondary education is higher among men than women. Education is inversely related to age; older women and men are generally less educated than younger women and men. The percentage of women with no education rises with age, from 16 percent in the 15-19 age group to 64 percent in the age group 45-49. This means that younger women have had better educational opportunities than older women. This is again reflected in the higher percentage of women in the age group 15-19 who completed primary education (46 percent), compared to women age 45-49 (8 percent). Urban women and men in mainland Tanzania are much more likely than rural women and men to go to school. One-third of rural women age 15-49 have no education, compared to only 14 percent of urban women in the mainland. Conversely, 58 percent of urban women on the mainland have completed primary education and 13 percent have been to secondary school, while 44 percent of rural women completed primary education and only 2 percent have been to secondary school. Seven percent of urban men have no education compared with 16 percent of rural men. As a result of the difference in the secondary education system between the mainland and Zanzibar, a higher proportion of women with some secondary education is observed in Zanzibar (33 percent) compared to the mainland (5 percent). The proportion of men with some secondary education is also higher in Zanzibar (32 percent) than in the mainland (9 percent). Table 2.10 Differential of characteristics between snou~c~ Percent distribution of couples by differences between spouses in age and |cvel of education, Tanzania 1996 Number Difference Percent/ of between spouses Years couples Wife older 3.2 36 Husband older by: 0-4 years 29.8 335 5-9 years 38.4 432 10-14 years 17,5 196 15 years + 11.1 125 Mean age difference (years) 1st wife 7.5 1,087 2nd wife (11.5) 38 All wives 7.6 1,125 Education (percent) Both husband and wife not educated 10.7 120 Wife educated, husband not 5.8 65 Husband educated, wife not 22.4 252 Both husband and wife educated 61.1 688 Total 100.0 1,125 Note: Figures in parentheses are based on 25-49 unweighted cases. A comparison of regions shows that the Arusha, Shinyanga, Mwanza, and Rukwa regions have the highest proportions of women with no education, while the Kilimanjaro region has the lowest proportion of women with no education. The highest percentages of men who have no education are recorded in the Dodoma, Coast, and Shinyanga regions, while again Kilimanjaro recorded about 2 percent of men with no education. The proportion of women with secondary education is high in Dares Salaam (16 percent) and Kilimanjaro (11 percent), but lowest in the Tanga, Mtwara, and Kigoma regions (less than 1 percent). 2.12 Exposure to Mass Media Women and men were asked how often they read newspapers and listen to the radio and watch television. This information is important to programme planners seeking to reach people with family planning and health messages through the media. Table 2.12 shows the percentage of female and male respondents exposed to different types of mass media by age, residence, region, and level of education. Results show that 13 percent of women and 26 percent of men read newspapers or magazines weekly, while 44 percent of women and 68 percent of men listen to the radio at least once a week, and only 9 percent of women and 18 percent of men watch television at least once a week. Five percent of women and 12 percent of men have access to all three mass media. However, 55 percent of women and 29 percent of men do not use any of these mass media. Access to media is somewhat higher among younger respondents and among those 21 l iv ing in urban as opposed to rural areas. As expected, educated persons are more l ikely to read newspapers or magaz ines , watch televis ion, and listen to the radio than less educated persons. Table 2.11.1 Level of education: women Percent distribution of women by d~e highest level of education attended, according to selected background characteristics, Tanzania 1996 Level of education: women Number Background No edu- Primary Primary of characteristic cation incomplete complete Secondary+ Total women Age 15-19 16.4 32.3 45.9 5.5 100.0 1,732 20-24 17.5 13.4 60.5 8.6 I00.0 1,676 25-29 18.8 11.8 63.3 6.0 100.0 1,440 30-34 28.3 15.7 50.5 5.5 100.0 1,118 35-39 45.7 18.9 32.4 2.9 100.0 888 40-44 54.7 25.8 16.8 2.6 100.0 680 45-49 63.7 26.8 7.6 1.8 100.0 585 Residence Mainland 28.5 20.1 46.9 4.6 100.0 7,88l Total urban 13.5 15.6 57.8 13.1 100.0 1,811 Dares Salaam city 14.4 13.4 54.5 17.7 100.0 563 Other urban 13.1 16.7 59.3 11.0 I00.0 1,248 Total rural 32.9 21.4 43.6 2.1 100.0 6,070 Zanzibar 30.9 20.7 15.2 33.2 100.0 239 Pemba 44.4 20.0 10.8 24.7 100.0 92 Unguja 22.5 21.1 17.9 38.4 i00.0 148 Region Dodoma 30.5 16.5 48.6 4.4 100.0 355 Arusha 38.2 13.2 44.1 4.5 100.0 589 Kilimanj aro 7.4 19.6 61.8 11.2 I00.0 390 Tanga 18.3 29.4 51.5 0.8 100.0 464 Morogoro 30.8 23.1 45.1 1.1 100.0 408 Coast 31.8 15.5 51.6 1.1 100.0 159 Dares Salaam 15.7 13.5 54.7 16.1 100.0 646 Lindi 24.8 22.6 48.1 4.4 I00.0 187 Mtwara 34.5 22.2 42.9 0.5 100.0 355 Ruvuma 13.7 22.7 60.3 3.2 100.0 305 lringa 34.4 20.6 39.3 5.7 100.0 466 Mbeya 23.2 22.3 50.6 3.8 100.0 473 Singida 29.7 20.8 45.9 3.6 100.0 283 Tabora 29.3 13.6 52.5 4.5 100.0 225 Rukwa 35.4 26.3 36.0 2.3 100.0 242 Kigoma 31.9 18.5 48.8 0.8 100.0 351 Shinyanga 43.2 17.1 33.9 5.9 100.0 686 Kagera 26.8 22.9 48.9 1.4 I00.0 467 Mwanza 37.4 22.3 37.1 3.2 100.0 573 Mara 20.9 24.9 52.3 1.8 100.0 257 Total 28.5 20.1 46.0 5.4 100.0 8,120 22 Table 2.11.2 Level of education: men Percent distribution of men by the highest level of education attended, according to selected background characteristics, Tanzania 1996 Level of education: men Number Background No edu- Primary Primary of characteristic cation incomplete complete Secondary+ Total men Age 15-19 9.2 47.4 37.3 6.1 100.0 488 20-24 7.6 15.3 64.1 13.0 100.0 371 25-29 8.2 12.3 68,3 11.1 100.0 301 30-34 8.1 15.4 66.5 9.9 100.0 272 35-39 16.9 17.3 56.4 9.4 100.0 251 40-44 19.4 36.6 29.0 15.1 100.0 206 45-49 22.6 41.7 25.5 10.3 100.0 149 50-54 28.2 55.0 9.9 6.8 100.0 118 55-59 35.2 51.1 8.3 5.4 100.0 100 Residence Mainland 13.5 29.4 48.0 9.1 100.0 2,i87 Total urban 6.8 22.3 50.1 20.8 100.0 509 Dares Salaam city 8.1 15.4 51.8 24.6 100,0 171 Othar urban 6.2 25.8 49.2 18.8 100.0 338 Total rural 15.5 31.5 47.4 5.6 100.0 1,678 Zanzibar 13.4 31.5 22.9 32.1 100.0 69 Pemba 27.8 37.0 13.0 22.2 100.0 28 Unguja 3.7 27.8 29.6 38.9 100.0 41 Region Dodoma 22.1 29.3 41.4 7.1 109.0 96 Arusba 17.0 19.1 54.3 9.6 100.0 156 Kilimanj aro 1.5 24.1 60.5 13.8 100.0 119 Tanga 4.0 36.0 60.0 0.0 100.0 108 Morogoro 13.3 37.8 43.4 5.6 100.0 95 Coast 22.6 19.4 46,8 11,3 100.0 45 Dares Salaam 8.2 15,8 51.3 24.7 10O.0 191 Lindi 16.9 31.0 46.5 5.6 100.0 54 Mtwara 10.9 51.5 36.6 1.0 100.0 96 Ruvuma 5.9 30.4 59.8 3.9 100.0 82 lringa 13.1 32.1 44.5 10.2 100.0 100 Mbeya 8.3 25.0 55.6 11.1 100.0 137 Singida 13.1 27.4 54.8 4.8 100.0 80 Tabora 11.1 24.1 51.9 13.0 100.0 82 Rukwa 19.2 37,2 38.5 5.1 100.0 71 Kigoma 18.6 28,6 47.1 5.7 100.0 95 Shiuyanga 22.6 32.3 36.0 9.1 100.0 202 Kagera 14.5 27.5 47.8 10.1 100.0 139 Mwanza 17.9 35.9 42.3 3.8 100.0 176 Mara 9.1 36.4 41.8 12.7 100.0 64 Total 13.5 29.4 47.2 9.8 100.0 2,256 23 i.,o 4~ Table 2.12 Access to mass media Percentage of women and men who usually read a newspaper once a week, watch television once a week, or listen to the radio weekly, by selected background characteristics, Tanzania 1996 Women Men No Read - - - Watch~ Listen fd All Number No Read Watch -Listen to ~ Number Background mass newspaper television radio three of mass newspaper television radio three o f characteristic media weekly weekly weekly media women media weekly weekly weekly media men A•e- 19 54.1 15.2 10.2 43.0 5.8 1,732 30.9 23.7 19.9 66.2 12.6 488 20-24 47.7 16.7 11.7 49.9 6.2 1,676 23.2 33.1 25.5 74.3 18.0 371 25-29 52.2 15.1 10.1 45.9 6.0 1,440 23.7 30.1 23.4 72.7 16.3 301 30-34 55.6 11.8 7.9 42.1 3.8 1,118 26.2 29.8 17.6 71.8 12.2 272 35-39 56.5 9.3 6.4 42.3 3.9 888 30.3 22.5 15.3 68.3 11.6 251 40-44 60.1 7.9 4.7 39.0 1.3 680 28.8 29.8 16.0 66.8 10.9 206 45-49 68.7 5.3 3.8 30.3 1.5 585 31.7 20.7 11.4 67.2 7.8 149 50-54 NA NA NA NA NA NA 41.9 13.1 3.5 57.6 2.4 118 55-59 NA NA NA NA NA NA 50.0 14.0 2.6 45.9 1.9 100 Residence Mainland 55.5 13.0 8.1 42.5 4.6 7,881 30.1 253 16.5 67.3 11.4 2,187 Total urban 22.5 39.2 25.6 73.6 16.6 1,811 7.8 63.6 42.7 89.3 36.6 509 Dares Salaam c i~ 7.7 60.7 47.4 88.7 35.0 563 1.5 82.4 69.5 94.1 59.9 171 Other urban 29.3 29.5 15.8 66.7 8.3 1,248 11.0 54.2 29.1 86.9 24.8 338 Total rural 65.3 5.2 2.8 33.3 1.0 6,070 36.9 13.7 8.6 60.6 3.8 1,678 Zanz2thar 21.1 |4.8 34.4 75.1 9.4 239 4.1 49.4 63.7 92.9 40.5 69 Pemba 29.2 6.4 18.6 68.5 1.7 92 7.4 24.1 18.5 90.7 7.4 28 Unguja 16.2 19.9 44.2 79.2 14.2 148 1.9 66.7 94.4 94.4 63.0 41 Region Dodoma 55.6 12.7 10.2 40.6 4.8 355 35.0 16.4 18.6 59.3 7.1 96 Arusha 58.0 15.6 7.9 39.9 4.5 589 41.5 28.7 19.1 57.4 16.0 156 KiIimanjaro 33.6 13.2 9.2 64.4 4.6 390 24.6 21.0 15.9 72.3 8.7 119 Tanga 61.6 5.0 8.8 36.2 2.0 464 41.3 14.7 13.3 5%3 10.7 108 Morogoro 62.9 10.9 5.8 36.6 3.4 408 45.5 18.2 14.0 50.3 5.6 95 Coast 33.9 18.1 6.5 65.0 2.5 159 12.9 22.6 29.0 82.3 9.7 45 Dares Salaam 8.0 58.6 44.1 88.4 32.5 646 2.0 79.6 65.8 93.l 55.9 191 Lindi 49.7 8.2 4.4 48.1 1.6 187 14.1 19.7 2.8 85.9 1.4 54 Mtwara 70.1 2.3 3.4 27.7 0.7 355 14.9 13.9 1.0 84.2 0.0 96 Ruvuma 57.3 4.5 2.8 41.4 IA 305 27.5 24.5 2.0 72.5 1.0 82 Iringa 70.7 4.9 2.6 28.8 0.8 466 48.2 12.4 2.9 48.9 1.5 100 Mbeya 54.1 12.4 1.6 42.4 1.0 473 31.9 25.0 6.9 66.7 5.6 137 Singlda 65.2 9.9 3.8 31.5 1.3 283 35.7 16.7 11.9 60.7 3.6 80 Tabora 57.1 9.1 7.6 40.9 3.5 225 25.9 33.3 11.1 72.2 7.4 82 Rukwa 73.4 5.1 3.4 24.9 1.4 242 50.0 12.8 11.5 48.7 10.3 71 Kigoma 58.9 4.6 2.5 40.3 0.5 351 24.3 14.3 5.7 72.9 1.4 95 Shmyanga 69.1 9.1 4.0 29.6 2.9 686 47.0 21.3 9.l 52.4 8.5 202 Kagera 51.4 7.7 5.6 45.1 1.1 467 23.2 20.3 17.4 73.9 10.l 139 Mwartza 67.7 8.1 1.6 31.9 1.0 573 26.9 17.9 14.1 70.5 9.0 176 Mara 59.6 8.7 0.4 39.7 0.4 257 23.6 25.5 18.2 69.l 7.3 64 Education No education 76.3 0.2 2.3 23.2 0.1 2,316 60.8 2.4 5.9 37.5 0.8 304 Primary incomplete 61.1 6.1 4.8 36.9 12 1,630 35.5 17.5 11.4 61.5 6.1 664 Primary complete 436 18.9 10.4 53.7 5.8 3,732 21.6 29.9 19.6 76.1 14.0 1,066 SecondalT+ 7.1 57.0 45.1 87.9 33.0 441 5.0 65.6 46.2 91.4 38.6 222 Total women/men 54.5 13.1 8.8 43.5 4.8 8,120 29.3 261 180 68.1 12.3 2.256 NA -- Not appllcabte 2.13 Employment and Occupation In the 1996 TDHS, information was collected from women regarding their current employment situation. Table 2.13 shows that 46 percent of women were unemployed; the proportion not working was higher among younger women and those residing in Zanzibar and the Mtwara region. Women who reported to be working at the time of the survey were asked if they were working for pay, selling things, or working on a family farm or in a family business. Forty-eight percent reported being self- employed, with 39 percent working on a family farm, 17 percent engaged in the food processing business, and a small proportion selling wild products or engaged in crafts or skilled work. Fifteen percent of women combine agriculture with other economic activities of their own. Another 15 percent of women were working for others and 7 percent were working in agriculture jobs. In the 1996 TDHS, men were asked to state their occupation or the kind of work they were mainly doing. Table 2.14 gives the percent distribution of men age 15-59 by current occupation according to background characteristics. Twelve percent of men were not working. Most men (64 percent) are occupied in agriculture and other related activities. About 3 percent are in a professional job, while an equal proportion are employed in sales or services, and 16 percent are in skilled or unskilled manual work. As expected, employment in nonagricultural occupations is relatively more common among men in urban areas and among those with formal education. More than 60 percent of men on the mainland are employed in an agricultural occupation. 25 Table 2.13 Emnlovment: women Percentage of women in various employment categories, according to selected background characteristics, Tanzania 1996 Working for self Working for others Agri Food culture Not Any Agri- Wild process- Shop/ and any Any Agri- working work culture product ing Craft taxi other work culture Agri- culture Number self and of other Missing women Age 15-19 62.3 30.0 23.5 1.4 9.3 2.0 0.4 7.1 19.7 9.9 3.5 0.0 1,732 20-24 47.5 47.1 36.7 1.6 15.9 3.1 1.5 12.5 14.3 5.8 2.7 0.1 1,676 25-29 42.7 52.8 42.8 1.8 17.5 4.6 1.8 16.1 12.2 47 2,5 0.0 1,4411 30-34 40.3 53.6 41.6 2.3 20.3 4.0 2.4 16.7 14.0 5.4 1.6 0.3 1,11~ 35-39 35.9 58.2 46.3 3.2 25,0 4.1 0.9 20.8 14.8 5.6 2.0 0.0 888 40-44 35.0 60.3 50.6 2.5 24.7 4.1 0.6 20.9 11.5 6.6 1.7 0 1 680 45-49 40.2 56.4 48.2 2,4 20.1 3.5 (I,5 17.3 9.4 5.5 2.5 0.0 585 Residence Mainland 45.7 48.6 39.1 1.9 17.7 3.3 1.2 14.7 14.6 6.6 2.6 0.1 7,881 Total urban 47.7 37.7 16.6 1.8 16.1 3.9 2.6 6.7 31.6 7.0 1.2 0.1 [,811 Dares Salaam city 56.9 29.0 4.1 0.9 17.4 2.3 2.6 1.5 30.0 2.3 0.3 0.0 563 Other urban 43.5 41.6 22.3 2.1 15.5 4.6 2.6 9.0 32.2 9.1 1.6 0.1 1,248 Total rural 45.2 51.8 45.8 1.9 18.2 3.2 0.8 17.2 9.6 6.4 3.0 0.1 6,070 Zanzibar 53,7 41.2 24.6 5.6 6.8 7.8 1.2 6.9 11.0 2.8 0.3 0.0 239 Pemba 55.9 42.4 33.9 3.1 8.5 6.4 0.3 8.8 4. i 0.7 0,7 0.0 92 Unguja 52.3 40,5 18.8 7.2 5.8 8.7 1.7 5,8 15.3 4.0 0.0 0.0 148 Region Dodoma 42.2 51.1 41.6 3.8 26.0 4.1 1.6 2L9 14.3 7.0 0.6 0.0 355 Arusha 54.2 37.1 26.4 2.6 3.8 1.9 1.9 3.2 18.3 4.5 1.1 0.2 589 Kilimanj aro 46.3 41,0 33.6 0.8 3.8 2.3 1.3 1.8 28.5 14.8 2.3 (1.5 390 Tanga 56.3 39.4 25.9 0.5 7.8 5,3 0.3 20 10.8 3.3 1.3 0.0 464 Morogoro 41.9 50.1 42,2 2,7 21.5 1.1 0.8 17.2 15.9 9.5 0.5 0.3 408 C~3ast 58.5 40.1 21.7 1.4 15.5 4.3 (I.4 4,3 5.8 1.4 I.t 00 159 Dares Salaam 57.2 30.0 3.8 1.4 17,3 2.4 2.5 1.3 27.2 2.2 0.3 0.(1 646 Lindi 53.8 42.5 30.8 5.7 19.2 4,1 0.3 14.8 14.5 9.4 5.3 (I,0 187 Mtwara 72.8 24.5 18.4 2.9 9.3 1.8 0.2 6.8 152 1(1.2 8.2 0.0 355 Ruvuma 49.6 45.7 36.9 1.7 29.2 1.9 1.3 24.0 18.9 12.0 7.7 00 305 lringa 31.9 59.6 56.0 1.5 42.9 5.9 1.8 44.5 23.1 I1.1 5.4 0.0 466 Mbeya 22.6 72.6 57.0 2.2 32.8 2.9 0.6 26.4 l l .5 8.9 1.9 0.0 473 Singida 19.5 74.4 64.5 3.0 40.9 9.4 1,8 37.8 15.2 9,6 2.5 03 283 Tabora 54.5 41.4 33.3 1.0 21.7 4.0 2.0 19.2 13.1 9.1 5.1 0,0 225 Rukwa 34.3 64.3 59.8 1.1 32.3 1.1 0.8 31.2 12.2 10.8 8.5 0,0 242 Kigoma 55.3 43.9 37.6 1.6 11.4 2.5 1.1 11.4 6.8 5.2 4.1 0.0 351 Shinyanga 29.6 66.7 63.7 0.8 6.4 2.9 1.6 8.5 8.3 3.5 0.8 00 686 Kagera 46.1 52.1 44.7 3,5 14.4 3.2 1.1 13.4 8.5 3,2 3.2 0.4 467 Mwanza 48.1 47.7 43.5 0.0 12.3 2.9 1.0 12.9 9.0 2.9 0.3 0.0 573 Mara 56.7 41 9 39.4 2.9 11,9 6,5 0.7 17.7 3.2 2.5 0.4 0.0 257 Education N~ educaflon 44.3 54.2 48,2 2.4 16.6 2.1 (k4 14.8 5.2 3.9 2.1 0.l 2,316 Primary incomplete 52.4 43.8 35.7 2.0 17.5 2.8 0.7 14.7 10.6 7.2 2.8 0.1 1,630 Primary complete 44.3 48.9 37.1 1.9 19.2 4.2 1.4 15.4 17.6 6,9 2.8 (11 3,732 Secondary+ 45.2 29.6 12.8 1.3 6.6 6.9 6.2 5.4 52.2 12.9 0.9 0.4 441 Total 46.0 48.3 38.7 2.0 174 3.5 1.2 14.5 14.5 6.5 2.5 0 l 8,120 26 Table 2.14 Occupation: men Percent distribution of men by current occupation and type of nonagricultural employment, according to selected background characteristics, Tanzania 1996 Occupation Not Fro- Number Background currently Agd- fessional/ Sales/ Skilled Unskilled of characteristic employed culture technical service manual manual Other Missing Total men Age 15-19 45.2 39.5 0,7 0.9 4.1 4.9 3.6 1,2 100.0 488 20-24 8.6 60.1 0.3 2.1 12.5 14.9 1.2 0.2 100.0 371 25-29 1.6 71.6 2.4 2.7 10.9 9.9 0.7 0.2 100.0 301 30-34 0.2 72.4 4.4 2.6 6.8 13.1 0.5 0.0 100.0 272 35-39 0.0 70.7 7.7 6.6 8.4 5.7 0.6 0.3 100.0 251 40-44 0.7 67,2 7.7 4.5 7.0 9.5 2.7 0.7 100.0 206 45-49 0.0 74.8 4.1 4.4 9.1 7.1 0.5 0.0 100.0 149 50-54 0.5 87.2 5.6 1.4 3,7 1.5 0.0 0,0 100.0 118 55-59 0.0 88.8 1.2 1.9 4.2 1.9 0.0 1.9 100.0 100 Residence Mainland 11.3 64.8 3.2 2.9 7.7 8.3 1.4 0.5 100.0 2,187 Total urban 14.1 24.4 5.9 6.8 21.5 24.5 2.3 0.5 100.0 509 Dares Salaam city 13.6 4.0 6.6 12.5 25.0 33.5 3.3 1.5 100.0 171 Other urban 14.3 34.7 5.6 3.9 19.8 19.9 1.9 0.0 100.0 338 Total rural 10.4 77.0 2.4 1.7 3.5 3.4 1.1 0.5 100.0 1,678 Zanzibar 19.6 44.5 4.1 0.0 11.5 15.9 3.3 1.1 100.0 69 EduCation No education 1.4 89.8 0.2 1.7 1.8 3.3 1.2 0.6 100.0 304 Primary incomplete 25.3 60.6 0.6 1.3 3.6 5.7 2.4 0.6 100.0 664 Primary complete 3.7 67.5 2.4 3.6 10.9 10.7 0.7 0.4 100.0 1,066 Secondary+ 21.7 23,3 19.6 5.0 13.4 13.7 2.8 0.6 100.0 222 Total 11.5 64.2 3.2 2.8 7.8 8.5 1.5 0.5 100.0 2,256 27 CHAPTER 3 FERTILITY A major objective of the 1996 TDHS was to estimate fertility levels, trends, and differentials. Like the 1991-92 TDHS, detailed information from all women on current, cumulative, and past levels of fertility was collected for the 1996 TDHS. Each woman age 15-49 was asked to provide information on the total number of sons and daughters to whom she had given birth who were living with her, the number living elsewhere, and the number who had died. She was then asked for each birth, the month and year of birth, name, sex, and survival status of the child and for those who died, age at death. This information was used to obtain various measures of fertility. It should be noted that the birth history method collects responses from surviving women and assumes that women's fertility does not differ significantly with survival status. 3.1 Current Fertility Current fertility is important because of its direct relevance to population policies and programmes. The indices used to study current fertility include age-specific fertility rates (ASFR), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR). ASFRs are calculated by dividing the number of live births during a specified period to women in a particular age group at the time of the birth by the number of woman-years lived in that age group during the specified period. The TFR is five times the sum of the ASFRs and is considered as a useful means of summarizing the overall level of fertility. The TFR can be interpreted as the number of children a woman would have at the end of her reproductive life if she experienced the current age-specific fertility. Other summary measures of fertility include the GFR which is the number of live births per 1,000 women of reproductive age and CBR which is the annual number of live births per 1,000 population. Measures of current fertility are estimated for the three-year period preceding the survey, which corresponds roughly to 1993-1996. The choice of the estimation period is a compromise between providing the most recent information, avoiding problems of omission or displacement of births due to a recall lapse, and obtaining enough cases to reduce the sampling errors. Table 3.1 presents several fertility measures including ASFRs, TFRs, CBR, GFR, for all of Tanzania, and for urban and rural areas. ASFRs by residence are shown also in Figure 3.1. The TFR indicates that if fertility were to remain constant at current levels, the average Tanzanian woman would bear 5.8 children in her lifetime, a decline from 6.3 in the 1991-92 TDHS. As seen in Table 3.1, Tanzanian women bear children early in the reproductive period. A Tanzanian woman would give birth to two children by age 25 and to more than three children by age 30. Table 3.1 Current fertility Age-specific and cumulative t~rtility rates and crude birth rate lbr the three years preceding the survey, by urban-rural residence, Tanzania 1996 Residence Age group Urban Rural Total Age 15-19 115 143 135 20-24 183 288 260 25-29 209 270 255 30-34 138 239 217 35-39 82 192 167 40-44 41 97 87 45-49 (54) 40 42 TFR 15-49 4,11 6,34 5,82 TFR 15.44 3.84 6,14 5.61 General fertility rate 145 216 199 Crude birth rate 36.3 41.9 40.8 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Rates in parentheses are based on 125 to 249 women years of exposure, TFR: Total fertility rate expressed per woman. GFR: General fertility rate (births divided by number of women 15-49), expressed per 1,000 women. CBR: Crude birth rate expressed per 1,000 population. 29 The childbearing peak occurs in the ages 20-29 when women have almost half~cir lifetime ~ However, fertility declines sharply after the mid-30s, with the ASFRs being only 42 births per 1,000 women at age group 45-49 (see Figure 3.1). Fertility levels are much higher in rural areas (TFR of 6.3 children) than in urban areas (4.1). This pattern of fertility differentials by urban-rural residence is evident at every age but is more prominent at ages 30- 34, 35-39, and 40-44. The results show a GFR for the three-year period of 199 births per 1,000 women and a CBR of 41 live births per 1,000 population. The CBR is lower than those from the 1991-92 TDHS (43 live births per 1,000 population) and the 1988 Census (46 births per 1,000 population). However, it should be noted that the census estimates were obtain- ed using indirect methods, thus part of the difference may be due to a difference in methodology. 3.2 Ferti l ity Differentials Table 3.2 presents total fertility rates, percentage of women currently pregnant and the mean number of children ever born to women ages 40-49 years (completed fertility) for major Figure 3.1 Age-Specific Fertility Rates by Urban-Rural Residence B~hs per 1.00G Wome~ 25O 2O0 150 IO0 15-19 i i i i 20-24 25-29 30.34 35~39 Age Group l~Urban q'Rural +Total I i 4044 4549 ~HS 1996 Figure 3.2 Total Fertility Rates by Background Characteristics RESIDENCE . . . . . . . . . Mainland Urban 4.1 Mairdspd RureJ 6.3 Zanzibar 5.9 ZONE Co~staJ 4,9 7.0 Northern Highl~ 5.7 C,e~traJ 6,1 Southern H}ghlands 5.4 Southerrl 4.9 EDUCATION NO Educat~n 6A 0.0 1,0 2,0 3.0 4.0 5.0 S,0 7.0 Total Fertility Rate TDHS 1~ sub-groups of the population. The measure of completed fertility is vulnerable to understatement of parity by older women, most of whose births took place longer ago and who consequently may omit children who died young. Various differentials in current fertility are notable from Table 3.2 and Figure 3.2.TFRs are lowest in the Coastal and Southem zones (4.9 children per woman). Southem Highlands and Norflaem Highlands zones have TFP, s of 5.4 and 5.7 children per woman, respectively. The Lake and Central zones have the highest level of fertility (7.0 and 6.1 children per woman, respectively). 30 Women with secondary education have a total fertility rate of 3.2 children per woman, which is much less than that of other women. Women who have completed primary education have a total fertility of 5.4; women with incomplete primary education and women with no formal education have a total fertility rate of 5.9 and 6.4, respectively. The gap in fertility between women with no education and those with some secondary education has widened significantly in the five years between 1991-92 and 1996. In 1991-92, women who had never gone to school had an average of 2.3 children more than women who had attended secondary education. In 1996, the difference was 3.2 children. Table 3.2 also allows a general assessment of trends in fertility over time among population subgroups. The comparison of completed fertility (mean number of children ever born) with the TFR provides an indicator of the direction and magnitude of fertility change in the country during the past 20-25 years. The results suggest that there has been a major decline in fertility (more prominent in urban areas) in the country during the period as shown by a TFR of 5.8 births, compared with a mean number of children ever born to women in their 40s (age 40-49) of 7.0 children. This decline is con- finned by looking at trends in TFRs obtained from previous surveys (see next section). Table 3.2 Fertility by hacka'round characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant and mean number of children ever born to women age 40-49, by selected background characteristics, Tanzania 1996 Background characteristic Mean number of Total Percentage children fertility currently ever born rate pregnagt to women 15 -49 15 -49" age 40-49 Residence Mainland 5.81 9.74 6.95 Total urban 4.09 7.13 6.07 Dares Salaam city 3.43 5.71 5.48 Other urban 4.36 7,77 6.28 Total Rural 6,33 10,52 7.13 Zanzibar (5.93) 10.17 7.65 Zones Coastal 4.93 8.92 6.53 Northern Highlands 5,71 10.05 6.65 Lake 6.97 11.54 7.63 Central 6,10 9.45 6.90 Southern Highlands 5.42 9.17 6.80 Southern 4.94 6.95 6.55 Education No education 6.36 9.82 7.13 Primary incomplete 5.90 7.14 7.11 Primary complete 5.43 l 1.10 6.31 Secondary+ 3.24 7.66 4.79 Total 5.82 9.75 6.97 Note: Total fertility rates in parentheses are based on 500-999 women age 15-49. iRate for women age 15-49 years At the time of the survey, 10 percent of interviewed women reported that they were pregnant. This may be an underestimate of the true percent pregnant because many women at early stages of pregnancy will not yet know for sure that they are pregnant. 3.3 Ferti l i ty Trends Table 3.3 examines trends in fertility in Tanzania by comparing the results of the 1996 TDHS with the earlier 1991- 92 TDHS. This comparison is appropriate because the methods of data collection and rate calculation were identical in the two surveys. The TFR calculated from the 1991-92 TDHS was 6.3 children per woman, compared with 5.8 derived from the 1996 TDHS, showing a decline in fertility of 7 percent during the period between 1989-92 and 1993-96. Examination of changes in age-specific fertility rates in Figure 3.3 shows a roughly equal declines at all ages. Table 3.3 Trends in current fertility rates Age specific fertility ratesand total fertility rates, Tanzania, 1989-1996 1991-92 1996 TDHS TDHS Age group 1989-92 1993-96 15-19 144 135 20-24 282 260 25-29 270 255 30-34 231 217 35-39 177 167 40-44 108 87 45-49 37 42 Total fertility rate 6.25 5,82 31 Figure 3.3 Age-Specific Fertility Rates 1991-92 TDHS and 1996 TDHS 300 250 200 150 100 50 Births per 1,000 Women 0 i --. i i 7- i -- 15-19 20-24 25-29 3~34 35~39 40-~4 Age Group L'~1991o92 TDHS ~-1996 TDHS 1 4549 TDHSIS96 A second way to analyze fertility trends is by using the 1996 TDHS data alone for successive five-year periods preceding the survey as given in Table 3.4. Because women age 50 and above were not interviewed in the survey, the rates are successively truncated as the number of years before the survey increases. According to the table, there has been a gradual decline in fertility during the past 20 years, e.g., the cumulative fertility of women ages 15-34 decreased from 5.4 to 4.3 during this period. Table 3.5 gives fertility rates for ever-married women by duration since first marriage. Like the rates by age, these are also truncated as the duration and period before the survey increase. The data show that fertility rates among women married less than 10 years have not changed significantly over time, perhaps because newly married couples tend to start their families fight after marriage. Table 3.4 Trends in a~e-soecific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by woman's age at the time, Tanzania 1996 Number of years preceding the survey Woman's age 0-4 5-9 10-14 15-19 15-19 130 151 153 174 20-24 261 284 290 295 25-29 258 278 302 299 30-34 218 248 269 [305] 35-39 174 202 [228] 40-44 90 [14gl 45-49 [42] TFR 15-34 4.3 4.8 5.0 5.4 Note: Age-specific fertility rates per 1,000 women. Estimates enclosed in brackets are truncated. Table 3,5 Trends in fertility by marital status Fertility rates for ever-roamed women by duration (years) since first marriage for five-year periods preceding the survey, Tanzania 1996 Number of years preceding the survey Marriage duration 04 5-9 10-14 15-19 0-4 319 347 342 356 5-9 275 298 327 309 10-14 242 276 290 304 15-19 199 226 251 [261] 20-24 139 190 [212] 25-29 65 [116] Note: Fertility rates per 1,000 women. Estimates enclosed in brackets are truncated. 32 3.4 Retrospective Fertility Measures of lifetime fertility reflect the accumulation of births over the past 30 years or so, and therefore have limited relevance to current fertility levels, especially if the country has experienced a decline in fertility. Information on lifetime fertility is useful for examining average family size across age groups as well as estimating levels of primary infertility. Lifetime fertility is also useful in understanding changes that have taken place in the age pattern of current fertility. The percent distribution of women by age and number of children ever born is given in Table 3.6 for all women as well as for currently married women. The mean number of children ever born for all women is 3.1, which means that, on average, Tanzanian women age 15-49 had 3.1 births, while currently married women in Tanzania have on average 3.9 births. In contrast, women at the end of their reproductive life have given birth to an average of 7.3 children, of whom 5.8 survived. Therefore, women at the end of their reproductive period have lost one-fifth of their children to mortality. A comparison of the mean number of children ever born reported in the 1996 TDHS and the 1991-92 TDHS shows a decline in completed fertility over time at all ages except among women age 45-49 where it shows a slight increase. Table 3.6 Children ever born and livin~ Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Tanzania 1996 Mean Mean number Number of children ever born number of Number Age of living of group 0 l 2 3 4 5 6 7 g 9 10+ Total CEB children women ALL WOMEN 15-19 79.1 18.6 1.9 0.3 0,0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.23 0.21 1,732 20-24 25.6 35.4 23.9 11.2 3.0 0.7 0.1 0.0 0.0 0.0 0,0 100.0 1.33 1.15 1,676 25-29 8.2 13.2 20.9 24.5 19.3 9.8 3.3 0.7 0.1 0.0 0.0 100.0 2.80 2.43 1,440 30-34 3.9 7.0 9.9 15.2 18.9 18.4 12.9 9.0 3.3 1.3 0.4 100.0 4.21 3.59 1,118 35-39 3.7 4.4 5.3 7.5 12.4 13.7 17.7 14.5 10.2 6.3 4.3 100.0 5.46 4.59 888 40-44 1.8 3.5 4.6 3.1 7.2 10.6 14.1 14.5 14.1 10.4 I6.1 100.0 6.70 5.52 680 45-49 1.9 2.8 4.8 4.4 4.7 5.9 8.3 13.6 16.2 12.2 25.2 100.0 7.29 5.76 585 Total 24.8 15.6 11.7 10.2 8.9 7.2 6.l 5.1 3.9 2.6 3.7 100.0 3.09 2.58 8,120 CURRENTLY MARRIED WOMEN 15-19 42.5 49.2 6.9 1.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.67 0.60 401 20-24 13.9 35.9 29.9 14.9 4.3 1~0 0.2 0.0 0.0 0.0 0.0 100.0 1.63 1.41 1,131 25-29 4.9 10.5 20.7 26.4 21.7 10.9 3.9 0.8 0.1 0.0 0.0 100.0 3.03 2.62 1,184 30-34 2.4 5.6 9.0 14.5 19.5 19.5 13.7 10.1 3.8 1.5 0.4 100.0 4.44 3.80 947 35-39 3.1 4,1 5,2 6.8 11.8 13.3 17.8 15.2 11.1 6.5 5.2 100.0 5.62 4.75 740 40-44 1.2 3.1 4.2 3.2 6.8 10.6 12.8 15.3 14.7 10,6 17.5 100.0 6.87 5.65 561 45-49 1.2 2.0 3.5 4.1 3.8 5.4 8.0 14.5 16.9 11.7 28.8 100.0 7.63 6.07 447 Total 8.2 15.5 14.3 13.1 11.7 9.4 7.7 6.8 5.1 3.2 5.0 100.0 3.94 3.31 5,411 33 The distribution of children ever bom by age shows that early childbearing is quite common in Tanzania; 21 percent of all women age 15-19 have already had at least one birth. The percent childless among women at the end of the reproductive period is an indirect measure of primary infertility--the proportion of women who are unable to bear children at all. Table 3.6 shows that primary sterility is low, about 2 percent. The incidence of primary sterility seems to have declined from about 4 percent in the 1991-92 TDHS to 2 percent in the 1996 TDHS. 3.5 Birth Intervals Information on the length of the birth interval provides insight into birth spacing patterns. Previous research has shown that short birth intervals are closely associated with poor health of children, especially during infancy. This is particularly true for babies born at an interval of less than 24 months. Thus, the study of birth intervals is important in understanding the health status of mothers, infants, and young children. Table 3.7 shows the distribution of births in the five years before the survey by the interval since previous birth, according to various demographic and background characteristics (first births have been excluded). As with the 1991-92 TDHS, the 1996 TDHS indicates that most Tanzanian children (83 percent) are born after a "safe" birth interval (24 or more months apart), with about 43 percent born at least 36 months after a prior birth. Nevertheless, 17 percent of non-first births occur less than 24 months after the preceding birth, with 7 percent occurring less than 18 months since the previous birth. The overall median birth interval is 34 months. Expectedly, younger women tend to have shorter birth intervals than older women. On the other hand, there is no significant difference in median birth interval by birth order or sex of the previous child. The survival status of the previous birth is strongly associated with the length of the preceding birth interval. The median birth interval is six months shorter for children whose previous sibling died compared with children whose previous sibling survived. Twenty-two percent of children whose preceding sibling died are born after an interval of less than 18 months, compared with only 4 percent among children whose preceding sibling survived. The median birth interval in urban areas is four months longer than that for rural areas on the mainland. Thirteen percent of the births in urban areas occur at intervals which are "too short" (less than 24 months), compared with 18 percent of births in the rural areas. The percentage of births with an interval of four years or more is higher for urban than rural births (30 percent vs. 17 percent). Births in the Southern zone exhibit a higher median birth interval (38 months) than the other zones. 3.6 Age at First Birth The age at which childbearing starts has important consequences for the overall level of fertility and also the health and welfare of the mother and the child. Today, teenage pregnancy and motherhood are a major health and social concern. In some societies, postponement of first births due to an increase in age at marriage has contributed to overall fertility decline. However, in many societies, premarital childbearing is common. Table 3.8 shows the percent distribution of women by age at first birth, according to current age at the time of the survey. The distribution is similar to that in the 1991-92 TDHS, and shows that the prevalence of early childbearing has declined slightly over time. While about 12 percent of older women (45-49) had their first birth before reaching age 15, only 3 percent of the younger women (20-24) did so. Among older women (45-49), 61 percent had their first birth before reaching age 20, compared to 52 percent of the young women (20-24). The median age at first birth has increased nearly one year across cohorts age 45-49 to 20-24. 34 Table 3.7 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Tanzania 1996 Median Number of months since previous birth number of Number Background months since of characteristic 7-17 18-23 24-35 36-47 48+ Total previous birth births Age of mother 15-19 16.3 23.5 34.3 24.7 1.3 100.0 26.2 44 20-29 7.5 12,8 45,6 21.3 12.8 100.0 31.2 2,583 30-39 5.6 9,2 36.0 26.0 23.2 100.0 35.8 2,174 40+ 5.8 7,6 31.9 22.2 32.6 100.0 38.1 633 Birth order 2-3 6.6 11,7 39.7 23.2 18.8 100.0 33.4 2,264 4-6 6.3 9,8 41.4 23.9 18.7 100.0 33.8 2,014 7 + 7.4 11.0 38.3 22.4 20.9 100.0 33.9 1,157 Sex of prior birth Male 6.5 10.8 40.6 22.9 19.2 100.0 33.6 2,786 Female 6.7 10.9 39.5 23.6 19.2 100.0 33.7 2,649 Survival of prior birth Dead 22.0 14.1 31.2 15.8 17.0 100,0 28.1 755 Living 4.1 10.3 41.5 24.5 19.6 100.0 34.2 4,680 Residence Mainland 6,6 10.8 40.0 23.3 19.3 100.0 33.7 5,250 Total urban 4.1 8.7 34.0 23.3 29.9 100.0 37.1 808 Dares Salaam city 1.2 8.2 33.7 22.4 34.5 100.0 39.1 215 Other urban 5.2 8.9 34.1 23.6 28,2 100.0 36.6 592 Total rural 7.1 11.2 41.1 23.3 17.4 100.0 33.1 4,442 Zanzibar 7.1 11.6 42.1 23.5 15.7 100.0 33.3 185 Zones Coastal 4.6 8.9 38.4 25.1 23.0 100.0 35.4 1.049 Northern Highlands 7.3 12.5 34,3 25.1 20.8 100.0 34.3 654 Lake 9.1 13.7 43.7 19.0 14.5 100,0 30.8 2,051 Central 7.4 8,7 42.5 22.1 19.3 100.0 33.7 453 Southern Highlands 3.9 8.7 41.1 26.4 19.8 100.0 34.9 765 Southern 3.1 5.6 31.8 31,3 28.1 100.0 38.4 462 Education No education 6.6 11.0 37.5 24,6 20.3 100.0 34.5 1.787 Primary incomplete 7.0 11.0 38.8 21.9 21,3 100.0 33.9 919 Primary complete 6.6 10.8 42.6 22.6 17.4 100.0 33.0 2.581 Secondary+ 6.1 8.8 34.6 26.7 23.8 100.0 36.2 147 Total 6.6 10.8 40.1 23.3 19.2 100.0 33.7 5,435 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 35 Table 3.8 A~e at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Tanzania 1996 Women Median with Age at first birth age at Number no first of Current age births <15 15-17 18-19 20-21 22-24 25+ Total birth women 15-19 79.1 1.1 12.4 7.4 NA NA NA 101).0 a 1,732 20-24 25.6 3.2 22.1 27.0 17.3 4.7 NA 100.0 19.8 1,676 25-29 8.2 4.2 24.1 30.1 19.0 10.9 3.5 100.0 19.4 1,440 30-34 3.9 6.8 27.3 25.0 17.0 13.9 6.3 100.0 19.2 1,118 35-39 3.7 8.2 31.7 22.6 16.0 10.7 7.1 100.0 18.9 888 40-44 1.8 I0.4 33.4 24.8 13.5 9.1 7.0 100.0 18.5 680 45-49 1.9 11.6 27.4 22.3 12.5 13.2 11.1 t00.0 19.0 585 NA = Not applicable. a , . . Omitted because less than 50 percent of the womett m the age group 15-19 have bad a btrth by age 15. To study dif ferentials in age at first birth, Tab le 3.9 gives the median age at first birth for di f ferent subgroups o f the populat ion. There is l ittle var iat ion in age at f irst birth by urban and rural residence. The median age at first birth shows an inverse relat ionship with educat ional attainment, be ing as low as 18 years for women with no education or incomplete pr imary and increasing to 20 years for women with completed pr imary and 23 years for women with secondary or h igher education. Tgl~l~ ~,9 Median alze at first birth bv backeround characteristics Median age at first birth among women 20-49 years, by current age and selected background characteristics, Tanzania 1996 Current age Background Ages Ages characteristic 20-24 25-29 39-34 35-39 40-44 45-49 20-49 25-49 Urban/Rural Urban a 19.9 19.4 18.7 18.3 19.1 19.6 19.3 Rural 19.7 19.3 19.2 19,0 18.6 18.9 19.2 19.1 Education No education 18.6 18.8 17.8 18.5 18.3 18.7 18.5 18.4 Primary incomplete 18.6 19.2 17.9 18,1 17.9 19.0 18,4 18.4 Primary complete 19.9 19.5 19.9 19.7 19.8 20.5 19.8 19.7 Secondary+ b 23.7 22.8 22.1 22.1 22.3 b 23.0 Total 19.8 19.4 19.2 18.9 18.5 19.0 19.3 19.1 a . Omitted because less than 50 percent of the women m age group 20-24 had a birth by age 20. b Omitted because less than 50 percent of the women in the age group 20-24 and 20-49 had a birth by age 20. 36 3.7 Teenage Pregnancy and Motherhood The issue of fertility among women aged 15-19 is vital because teenage mothers and their children am at high risk for social and health problems. Children born to young mothers are more prone to illness and higher mortality during childhood than children born to older mothers. Table 3.10 and Figure 3.4 present the proportion of women age 15-19 years who have begun childbearing, separating those who are already mothers from those who are pregnant with their first child. Overall, 26 percent of teenagers covered by this survey have already begun childbearing with 21 percent having had a child already and 5 percent carrying their first child. This represents a decline in teen childbearing--the 1991-92 TDHS showed that 23 percent of women 15-19 were already mothers and 6 percent were pregnant with their first child (Ngallaba et al., 1993:30). As expected, the percentage who have started the reproductive process increases with age, from 1 percent among the 15 year olds to 61 percent by age 19. Table 3.10 further shows that overall teenage childbearing is higher among rural women (27 percent) than their urban counter-parts (24 percent) on the Mainland. This is true for both the proportion who are already mothers and the proportion who are pregnant with their first child. The Southern zone has the highest prevalence of teenage childbearing (35 percent) while the Coastal zone has the lowest level (23 percent). 70 60 50 40 30 20 10 0 Peme~ 15 Figure 3.4 Adolescent Childbearing 16 17 18 Age IEMothers mPregnant (1st chlld)l 19 TDHS 1996 37 Table 3.10 Teenaee Dre~nancv and moth¢l'h99~l Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Tanzania 1996 Percentage of women who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 0.9 0.4 1.3 288 16 9.0 2.3 11.2 408 17 9.7 7.4 17.1 343 18 30.0 9.2 39.2 358 19 54.3 6.3 60.6 335 Residence Mainland 21.1 5.2 26.3 1,683 Total urban t9.6 4.6 24.2 393 Dares Salaam city 19.3 4.7 24.0 127 Other urban 19.7 4.6 24.2 266 Total total 21.6 5.3 27.0 1,290 Zanzibar 11.5 5.9 17.4 49 Zones Coastal 17.9 5. I 23.0 444 Northern Highlands 18.2 6.0 24.2 206 Lake 23.0 4.2 27.2 538 Central 22.5 4.8 27.3 125 Southern Highlands 18.7 5.2 23.9 247 Southern 26.9 8.0 34.8 173 Education No education 33.1 6.5 39.6 284 Primary incomplete 14.1 2.0 16.1 559 Primary complete 23.1 7.2 30.2 795 Secondary+ 5.9 3.5 9.4 95 Total 20.9 5.2 26.1 1,732 38 CHAPTER 4 FERTILITY REGULATION Knowledge of family planning methods and sources to obtain them are necessary in deciding whether to adopt a contraceptive method and the choice of method to use. A positive attitude toward family planning affects use. This chapter presents data on contraceptive knowledge, attitudes, behaviour, and sources. While the focus is placed on women of reproductive age, some results from the men's survey will also be presented, since men play an important role in the realisation of reproductive goals. 4.1 Knowledge of Family Planning Methods Information about knowledge of family planning methods was obtained in two ways in the 1996 TDHS. Respondents were first asked to name ways or methods by which a couple could delay or avoid pregnancy. When a respondent failed to mention a particular method spontaneously, the interviewer described the method and asked if the respondent knew it. Information was collected for eight modem methods: the pill, IUD, injectables, Norplant, vaginal methods (foam, jelly, or diaphragm), condom, and female and male sterilisation, and three traditional methods: the calendar (rhythm) method, mucus method, and withdrawal. In addition, provision was made in the questionnaire to record any other methods named spontaneously by respondents. Both prompted and unprompted knowledge are combined in the report. Table 4.1 shows the percentage of all women and men, currently married women and men, and sexually active unmarried women and men, and women with no sexual experience who know specific contraceptive methods. Almost all of the women who have heard of any method have heard of a modem method, while about half of the women have heard of a traditional or folk method. Results show that 84 percent of women age 15-49 have heard of at least one method of family planning, The level is higher among currently married women (88 percent). The most commonly recognised methods in Tanzania are the pills (78 percent), condoms (72 percent), injectables (71 percent), female sterilisation (61 percent), and IUD (49 percent). Only 31 percent of all women know of diaphragm/foam/jelly, and about one-fourth know of male sterilisation and implants (Norplant). Of the traditional methods, similar proportions of women have knowledge of withdrawal and calendar or mucus methods (recognised by 31 to 32 percent of women, respectively). Knowledge of family planning methods is higher among men than women. Almost 90 percent of all men interviewed know of at least one method. The difference in knowledge between men and women is especially notable for male sterilisation and condom: 35 percent of men compared with 25 percent of women know of male sterilisation and 86 percent of men compared with 72 percent of women know about condoms. While women are generally more likely than men to know the methods used by women, it is surprising to note that the proportion of men who know of the calendar or mucus method is higher than among women (45 vs. 31 percent). Overall, knowledge of contraceptive methods is higher among married respondents. Seventy-one percent of women and 67 percent of men know of at least these modem methods (Table 4.1). On average, women and men know of five methods, four of which are modem methods. Table 4.2 shows the correspondence between the contraceptive knowledge of husbands and wives for the 1,125 couples interviewed in the TDHS sample. Knowledge of at least one method by both spouses is high (86 percent). For couples where only one partner knows of a method, husbands are more likely to know the method than their wives; exceptions are the pill, 1UD, injectables, implants and folk methods, which wives are more likely to know about than their husbands. 39 Table 4.1 Knowledge of contraceptive methods Percentage of all women, of currently married women, and of sexually active unmarried women and of women with no sexual experience, and the percentage of all men 15-59, of currently married men, and of sexually active unmarried men who know specific contraceptive methods, Tanzania 1996 Women who know method Men who know method Sexually Sexually Currently active No Currently active Contraceptive All married unmarried sexual All married unmarried method women women women experience men men men I Any method 84.2 88.5 85.5 55.1 89.2 93.4 90.8 Any modern method 83.6 87.7 85.2 55.1 88.8 92.8 90.8 Pill 78.4 84,0 79.5 41.4 71.l 82.2 66.6 IUD 48.8 52.8 55.7 17.8 34.9 43.8 32.1 lnjectables 70.8 76.8 72.1 31.0 55.6 67. i 52.2 Diaphragm/foam/jelly 30.7 34.2 32.0 8.5 35.3 42.5 33.8 Condom 72.2 75.2 78.9 45.6 85.8 89.8 89.8 Female sterilisation 60.7 66.2 63.8 25.8 63.3 74.7 58.9 Male sterilisation 24.8 27.6 24,8 8.0 35.1 42.9 32.7 Implant 23.5 25.4 29.5 7.7 17.0 21.4 17.6 Any traditional/folk method 47.0 51.8 50.3 14.4 56.1 69. I 55.0 Calendar/mucus 30.7 32.1 35.9 12.1 45.2 56.4 42.4 Withdrawal 31.6 36.3 29,2 6.2 42.5 52.6 43.9 Abstinence 0,3 0.3 0.0 0.1 0.4 0.5 0.2 Other 12.6 14.8 12.1 1.4 6.2 9.3 2.8 Number of respondents 8,120 5,411 671 1,048 2.256 1,288 355 Mean number of methods known 5.0 5.4 5.3 2.1 5.1 6.1 4.9 Percent knowing three or more modem methods 70.9 76.6 73,5 31.9 66.8 78.2 64.3 Mean number of modem methods known 4.1 4.4 4.4 1.9 4.0 4.6 3.8 Table 4.2 Knowledge of contraceptive methods amone Couples Percent distribution of couples by contraceptive knowledge, according to specific methods, Tanzania, 1996 Only Only Both husband wife Neither Contraceptive know knows knows knows method method method method method Total Any method 86.3 7.3 3.9 2.5 100.0 Any modern method 85.6 7.7 3.8 3.0 100.0 Pill 74.6 8.2 10.2 7.0 100.0 IUD 29.7 14.8 22.4 33.1 100.0 lnjectables 59.0 8.8 19.5 12.7 100.0 Diaphragm/foam/jelly 18.0 24.8 15.5 41.8 100.0 Condom 71.8 18.5 4.0 5.7 1130.0 Female sterilisation 56.4 18.6 12.5 12.5 100.0 Male sterilisation 16.9 27.3 15.5 44.3 100.0 Implant 10.1 11.4 14.7 63.8 100.0 Any traditional/folk method 4d-.2 25.9 10.2 19.7 100.0 Calendar/mucus 23.4 34.0 9.1 33.5 100.0 Withdrawal 25.8 26.7 13.1 34.4 100.0 Abstinence 0.0 0.5 0.4 99.1 100.0 Other 3.6 5.9 10.6 79.9 100.0 Note: Table is based on 1,125 couples. 40 Table 4.3 presents the percentage of all respondents who know any method or any modem method according to background characteristics. Knowledge of contraceptive methods is highest among women 20-34, urban women, women in the Dares Salaam, Coast, Lindi, Tabora, and Mbeya regions, and among women with completed primary or secondary education. Similar patterns are also observed for men. 4.2 Trends in Contraceptive Knowledge There has been some increase over time in the proportion of women and men who have heard of methods of family planning (Figure 4.1). The proportion of all women who have heard of at least one method has increased from 74 percent in 1991-92, to 80 percent in 1994 and to 84 percent in 1996. The proportion who have heard of a modem method increased from 72 percent in 1991-92 to 77 percent in 1994 and to 83 percent in 1996. Knowledge of specific methods has increased even more dramatically. For example, in 1991- 92, only 40 percent of women had heard of the injectable contraceptive; by 1996, this figure had increased to 71 percent. Similarly, the proportion of women who know of condoms grew from 51 percent of married women in 1991-92 to 72 percent in 1996. 4.3 Ever Use of Family Planning Methods All women and men interviewed in the 1996 TDHS who said that they had heard of a method of family planning were asked if they had ever used that method. Ever use of family planning methods thus refers to use of a method at any time with no distinction between past and current use. Table 4.4.1 shows the percentage of women who have ever used family planning, according to method and age. Modem methods have been more frequently used (23 percent) than traditional/folk methods (15 percent). The modem methods commonly used by women are pills (15 percent), condoms (7 percent), and injectables (6 percent); while traditional methods frequently used are withdrawal (9 percent) and calendar/mucus (8 percent). Ever use of contraception is higher for sexually active unmarried women than currently married women. Table 4.4.2 shows that ever use of contraception among men is almost equal for modem (26 percent) and traditional methods (24 percent). The most frequently used methods among men are condoms (18 percent), calendar/mucus (17 percent), and withdrawal (14 percent). Ever use of modern methods is higher for sexually active unmarried men than currently married men (36 vs. 29 percent). This is due to the higher use of condoms by unmarried men than married men (35 vs. 16 percent). As with contraceptive knowledge, ever use of modem contraceptive methods has increased moderately since 1991-92. In 1991-92, 14 percent of all women had ever used any modem method, compared to 21 percent in 1994 and 23 percent in 1996. Increases in ever use were greatest for injectables. Among men, ever use of modem methods increased from 24 to 26 percent during 1994-96. 41 Table 4.3 Knowledge of contraceotive methods bv backeround chafi~cteristig~ Percentage of women and men who know at least one contraceptive method and at least one modem method by selected background characteristics, Tanzania 1996 Women Men Know Know Number Know Know Background any modem of any modern Number characteristic method method women method method of men Age 15-19 65.5 65.4 1,732 76.3 76.3 488 20-24 91.1 90.8 1,676 91.9 91.9 371 25-29 92.5 92. l 1.440 96.0 95.5 30 l 30-34 91.2 91.0 1,118 95.7 94.4 272 35-39 88.5 87.6 888 93.9 93.9 25 I 40-45 85.8 84.7 680 96.2 96.2 206 45-49 77.I 74,6 585 88.5 88.5 149 50-54 NA NA NA 91.I 89.7 118 55-59 NA NA NA 77,1 75.2 100 Residence Mainland 84.0 83.4 7,881 89.2 88.8 2,187 Total urban 93.9 93.9 1,811 95.8 95.8 509 Dar es Salaam city 95.9 95.9 563 98.2 98.2 171 Other urban 93.0 92.9 1,248 94.6 94.6 338 Total rural 81.0 80.2 6,070 87.2 86.7 1,678 Zanzibar 90.8 90.7 239 90.4 90.4 69 Pemba 86.8 86.8 92 92.6 92.6 28 Unguja 93.4 93.1 148 88.9 88.9 41 Region Dodoma 85.1 84.4 355 87.9 87.9 96 Arusha 62.3 59.7 589 74.5 71.3 156 Kilimanjaro 86.3 86.3 390 80.0 80.0 1 [ 9 Tanga 78.9 78,9 464 74.7 74.7 108 Morogoro 86.7 86.5 408 87.4 87.4 95 Coast 95.3 94.2 159 93.5 93.5 45 Dares Salaam 96.1 96.1 646 98.0 98.0 191 Lindi 92.1 91.5 187 98.6 98.6 54 Mtwara 87.5 86.4 355 98.0 98.0 96 Ruvuma 89.7 89.5 305 91.2 91.2 82 lringa 81.0 80.5 466 87.6 87.6 100 Mbeya 90.1 89.5 473 98.6 98.6 137 Singida 83.2 81.7 283 96.4 95.2 80 Tabora 90.4 90.4 225 98.1 98. I 82 Rukwa 82.2 81.6 242 96,2 94.9 71 Kigoma 86.6 86.4 351 94.3 94~3 95 Shinyanga 73.9 73.6 686 82.3 82.3 202 Kagera 88.4 87.0 467 97.1 95.7 139 Mwanza 84.2 84.2 573 85.9 85.9 176 Mara 84.1 84,l 257 78.2 78.2 64 Education No education 72.4 70.7 2,316 78.4 76.7 304 Primary incomplete 78.6 78.3 1,630 82.5 82.2 664 Primary complete 92.5 92.4 3,732 94.5 94.3 1,066 Secondary+ 96.6 96.6 441 99.1 99.1 222 Total 842 83.6 8,120 892 88.8 2,256 NA = Not applicable 42 4x Table 4.4.1 Ever use of contracention: women Percentage of all women, of currently marr ied women, and of sexually active unmarr ied women who have ever used any contraceptive method, by specific method and age, Tanzania 1996 Troditional/folk method Modern method Any Any Dim Female Male tradi- modern In- phragm/ stefi, steri- tional/ Cal- With- Number Any meth- ject- foam/ Con- lisa- lisa- folk endar/ draw- Absti- of Age method od Pill IUD ables jelly dora tion fion Implant method mucus al nence Other women ALL WOMEN 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 8.7 5.9 2.7 0.4 0.7 0.1 3.5 0.0 0.0 0.0 3.8 2.6 1.6 0.0 0.2 1,732 35.6 25.5 15.3 1.1 5.4 0.2 10.7 0.1 0.0 0.1 17.8 9.0 11.0 0.1 1.5 1,676 40.3 29.3 21.1 1.6 7.9 0.2 8.9 0.2 0.1 0.0 19.4 8.8 12.0 0.1 2.4 1,440 40.2 29.4 21.8 2.5 9.2 0.8 8.3 0.8 0.0 0.1 20.0 10.3 12.3 0.0 1.8 t,118 38.1 30.4 21.6 3.2 10.1 0.4 6.7 3.0 0.0 0.2 20.1 9.0 12.4 0.2 3.2 888 35.3 26.7 17.2 2.7 9.9 0.8 5.0 6.7 0A 0.0 16.8 7.5 10.8 0d 2.7 680 26.9 17.0 9.9 1.5 5.0 0.3 1.9 5.2 0.0 0.0 15.9 6.5 9.5 0.2 3.1 585 30.9 22.5 15.0 1.6 6.2 0.3 7.0 1.4 0.0 0.0 15.4 7.5 9.4 0.1 1.8 8,120 CURRENTLY MARRIED WOMEN 15-19 15.9 9.9 5.7 1.2 1.1 0.2 5.0 0.2 0.0 0.0 8.1 4.9 3.7 0.0 0.6 401 20-24 36.2 25.6 15.9 1.3 6.0 0.2 8.8 0.1 0.0 0.1 18.9 8.7 12.3 0.1 1.7 1,131 25-29 41.8 30.1 21.8 1.7 8.8 0.2 8.7 0.2 0.0 0.0 20.6 8.9 I3.0 0A 2.5 1,184 30-34 38.3 28.3 21.4 2.7 8.5 0.9 6.4 1.0 0.0 0.1 19.1 9.1 12.0 0.0 2.0 947 35-39 38.3 30.2 20.4 3.3 10.1 0.5 5.8 3.3 0.0 0.1 19.9 7.8 12.7 0.2 3.6 740 40-44 34.7 25.5 15.3 2.8 10.2 0.8 4.3 7.1 0.2 0.0 17.7 7.9 11.3 0.2 2.8 561 45-49 26.0 15.2 9.0 1.4 5.0 0.3 0.3 5.2 0.0 0.0 16.2 6.8 9.9 0.2 2.9 447 Total 35.6 25.6 17.4 2.1 7.6 0.4 6.5 1.9 0.0 0.1 18.3 8.2 11.5 0.1 2.3 5,411 SEXUALLy ACTIVE UNMARRED WOMEN Total 40.1 34.1 21.6 1.9 6.4 0.5 18.4 0.6 0.1 0.1 14.3 8.9 8.1 0.0 1.2 671 Table 4.4.2 Ever use of contracet~tion: men Percentage of all men, of currently married men, and of sexually active unmarried men who have ever used any contraceptive method, by specific method and age, Tanzania 1996 Any Any modem Age method method Pill ALL MEN Traditional/folk method Modern method Any Dia- Female tradi- In- phragm/ steri- tional Cal- With- Number ject foam/ Con- lisa- folk eedar/ draw- Absti- of IUD ables )elly dom tion Implant method mucus al nence Other men 15-19 11.7 I02 0.4 0.0 0.1 0.9 10.0 0.0 0.0 3.7 1.5 2.6 0.0 0.0 488 20-24 38.0 28.9 5.6 0.0 1.2 0.6 26.8 0.0 0.2 19.3 13.9 9.6 0.0 0.8 371 25-29 51.2 322 9.5 02 5.2 0.6 26.6 0.0 0.0 33.1 24.1 19.0 0.0 1.2 301 30-34 53.8 37.2 16.3 2.3 6.1 0.0 25.7 0.0 0.0 37.2 26.5 23.3 0.3 0.6 272 35-39 53.7 35.2 17.2 2.7 7.9 0.0 20.5 0.8 0.0 36.5 25.0 20,0 0.3 2.4 251 40~4 47.3 311 19.9 1.3 5.5 0.7 14.3 40 0.6 31.8 19.0 22.5 0.6 1.5 206 45~.9 37.6 20.3 13.4 1.7 7.6 04 8.1 0.4 0.0 27.8 17.1 12.5 1.6 3.3 149 50-54 40.3 20.3 7.5 1.6 5.2 0.0 9.6 2.7 0.0 31.3 25.8 14.2 0.5 3.1 118 55-59 29.7 13.1 78 0.0 0.9 00 5.5 2.1 0.0 243 14.2 9.2 0.0 5.5 I00 Total 38.3 25.5 96 0.9 3.9 0.5 18.1 0.7 0.I 244 167 13.7 02 1.4 2,256 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * * 6 20-24 51.2 26.5 11.9 0.0 1.5 0.7 22.2 0.0 0.7 37.7 26.6 17.5 0.0 1.0 91 25-29 52.3 25.9 10.5 0.3 4.8 1.0 17.4 0.0 0.0 37.4 28.7 19.5 0.0 1.8 196 30-34 55.6 37.5 I7.0 2.0 6.9 00 24.5 0.0 0.0 39.9 28.8 24.6 0.3 0.7 232 35-39 54.7 35.5 18.4 2.9 8.6 0.0 19.5 0.9 0.0 37.9 26.2 20.6 0.3 2.6 230 40-~4 48.2 31.1 21.1 1.4 5.9 0.3 13.2 4.3 0.7 33.2 20.I 23.4 0.6 1.6 194 4549 39.2 20.4 14.6 1.8 8.2 0.4 7.2 0.5 0.0 30.2 18.6 13.6 1.7 3.5 137 50-54 41.7 20.4 8.0 1.7 5.5 0.0 9.0 2.9 0.0 32.1 26.3 13.9 0.6 3.4 110 55-59 31.6 13.3 8.7 0.0 1.0 0.0 4.8 2.4 0.0 26.4 15.1 9.6 0.0 6.1 90 TO~I 48.7 28.6 14.8 t.5 5.9 0.3 16.1 1.3 0.1 35.2 24.5 19.2 0.4 2.3 1,288 SEXUALLY ACTIVE UNMARRIED MEN Total 40.7 36.0 4.2 0.4 2.7 1.7 35.2 0.0 0.0 17.4 11.8 11.5 0.0 0.4 355 Note: An asterisk indicates a figure is based on fewer than 25 men and has been suppressed. 100 80 Figure 4.1 Trends in Contraceptive Knowledge among Women 15-49 Percent of All Women 60 40 ~0 Any Method Any Modem Any Traditional Method Method 4.4 Current Use of Family Planning The level of current use of family planning is one of the indicators most frequently used to assess the success of family planning programme activities. It is widely used as a measure in the analysis of the determinants of fertility. This section focuses on the levels and differentials in family planning use with particular emphasis on the method mix among users. Trends in family planning use in Tanzania are also described. Information on the service providers from which users obtained methods is also presented. Sixteen percent of all women in Tanzania are currently using a contraceptive method and 12 percent are using modem methods (Table 4.5.1). The most widely used methods are the pills (5 percent) and injectables (4 percent). Female sterilisation and condoms are used by 1 percent of women. About 2 percent of women each use the calendar/mucus method or withdrawal. The use of contraception increases with age, reaching a peak at age 30-44 among all women. The pill is the most commonly used method among women under 35, while injectables is the most common method among women 35-39. Female sterilisafion tends to be used by older women (women in their 40s). Current contraceptive use among men is slightly higher than among women (Table 4.5.2). Twenty-two percent of men in Tanzania are currently using contraception, 14 percent using modem and 8 percent using traditional methods. The condom is the method most used by men (7 percent), followed by the calendar/mucus method (6 percent). The use of traditional methods is proportionately higher for men than women. The major difference in contraceptive use reported by men and women is higher use of the calendar/mucus method and of condoms by men. Current use of contraception is higher among the sexually active unmarried population than among all women and men. Condom use among sexually active unmarried respondents is notably higher especially among men (22 vs. 7 percent). In fact, condom use accounts for 86 percent of all use among sexually active unmarried men. This suggests that the intention of premarital contraceptive use involves more than pregnancy prevention and probably indicates motivation to avoid sexually transmitted diseases, especially human immunodeficiency virus (HIV). 45 Table 4.5.1 Current use ofcontraceotion: women Percentage of all women, of currently married women, and of sexually active unmarried women who are currently using a contraceptive method, by specific method, according to age, Tanzania 1996 Modern method Traditional/folk method Any Any trad. Not modem In- Female or Cat- With- cur- Number Any meth- ject- Cotx- stet~ti- folk etxdar/ draw- Absti- Other remly of Age method od Pill IUD ables dom sation method mucus al hence methods using Total women ALL WOMEN 15-19 4.7 3.1 1.3 0.2 0.6 1.0 0.0 1.6 1.1 0.4 0.0 0.0 95.3 100.0 1,732 20-24 18.0 13.0 6.6 0.3 3.8 2.2 0.1 4.9 2.1 2.7 0.0 0.I 82.0 100.0 1,676 25-29 19.8 144 8.1 0.4 4.2 1.6 0.2 5.3 27 2.2 0.0 0.4 80,2 100.0 1,440 30-34 21.0 I4.8 6.2 1.0 5.9 0.9 0.8 6.1 2.8 2.9 0.0 0.4 79.0 100.0 1,118 35-39 21.1 15.8 4.6 l.l 6.2 0.7 3.0 5.3 2.6 1.9 0.0 0.7 78.9 100.0 888 40~4 20.7 15.9 3.0 0.3 4.8 1.0 6.7 4.7 1.9 1.7 0.1 0.9 79.3 100.0 680 45-49 12.8 9.9 1.5 0.7 1.9 0.7 5.2 2.8 0.8 1.2 0.0 0.8 87.2 100.0 585 Total 16.1 11.7 4.8 0,5 3.7 1.3 1.4 4.3 2.1 1.9 0.0 0.4 83.9 100.0 8,120 CURRENTLy MARRIED WOMEN 15 19 7.4 4.4 2.2 0.5 0.g 0.7 02 3.0 1.6 1.4 0.0 0.0 92.6 100.0 401 20-24 18.0 12.7 6,9 0.4 4.0 12 01 5.3 1.5 3.6 0.0 0.2 82.0 100.0 1,I31 25-29 19.9 14.5 8.0 0.3 4.6 1.3 0.2 5.4 2.6 2.5 0.0 0.3 80.1 100.0 1,184 30-34 20.2 14.0 6,1 1.2 5.3 03 10 6.2 2.4 3,3 0.0 0.4 79.8 100.0 947 35-39 21.2 15.9 4.3 0.9 6.6 0.7 3.3 52 2.2 2.1 0.0 0.9 78.8 100.0 740 40~4 22,1 17.1 3.5 0.4 5.1 0.8 7.1 5,0 2.0 2.1 0,2 0.7 77.9 I00.0 561 45-49 12.6 9.2 1.5 0.3 2.3 0.0 5.2 3.4 1.0 1.6 0.0 0.8 87.4 100.0 447 Total 18.4 13.3 5.5 0.6 4.5 0.8 1.9 5.1 2,0 2.6 0.0 0,4 81.6 100.0 5,411 SEXUALLY ACTIVE UNMARRIED WOMEN Total 26.2 21,4 9.5 1.0 38 6.3 0.6 4.8 4.0 0.5 0.0 0.2 73.8 I00.0 671 Some women are more likely to use contraception than others (see Table 4.6.1 and Figure 4.2). There are differences in the level of current use between the mainland and Zanzibar and more notably by regions, educational levels, and number of living children. Use of modem family planning methods is lower in Zanzibar (8 percent) than on the mainland (12 percent). Between the two islands, use of modem family planning methods is slightly higher in Unguja (9 percent) than Pemba (6 percent). In the mainland, urban women are much more likely to be using modem contraceptive methods (24 percent) than rural women (8 percent). Levels of current use of modem family planning methods are highest in the Kilimartjaro, Coast, and Dar es Salaam regions (23-24 percent) and lowest in the Shinyanga, Kagera, and Mara Regions (4-5 percent). Current use of modem family planning methods is less than 10 percent in 6 regions and more than 10 percent in 14 regions. Education is clearly related to the use of family planning. Women with some secondary and higher education are five times more likely to use modem methods than women without education (23 vs. 5 percent). The educational differentials are similar for any method use. As expected, contraceptive use rises with the number of living children. The percentage of women using any modem family planning method increases rapidly from 3 percent among women with no children to 16 percent among those with three or more children. The results show that few women in Tanzania adopt contraception until after they have had at least one child. 46 Table 4.5.2 Current use of contracention: men Percentage of all men, of currently married men, and of sexually active unmarried men who are currently using a contraceptive method, by specific method, according to age, Tanzania 1996 Any modern Any meth- Age method od Pill Modem method Traditional/folk method Any trad. Not In- Female or Cal- With- cur- Number jeer- Con- stetili- folk eodar/ draw- Absti- Other rently of IUD ables dora sation method mucus al hence methods using Total men ALL MEN 15-19 7,3 6.6 0.0 0.0 0.0 6.6 0.0 0.7 0.4 0.3 0.0 0.0 92.7 100.0 488 20-24 19,9 15.0 2.3 0.0 0.3 12.2 0.0 4.9 3.7 1.0 0.0 0.2 80.1 100.0 371 25-29 27.7 15.5 4.1 0.2 1.1 10.1 0.0 12.1 7.8 3.9 0,0 0.5 72.3 100.0 301 30-34 33.9 20.3 6.8 0.5 3.8 9.1 0.0 13.6 9.2 4.2 0.3 0.0 66.1 100,0 272 35-39 37.6 20,4 6.9 0.5 4.7 7.5 0.8 17.2 11.1 4.9 0.6 0.6 62.4 100.0 251 40-44 26.8 16.9 7.4 0.6 2.4 2.4 3.7 9.8 6.1 3.7 0.0 0.0 73.2 100.0 206 45-49 22.7 13.6 5.4 0.8 3.3 3.6 0.4 9.1 5.7 1.2 0.4 1.8 77.3 100.0 149 50-54 20.7 10.2 1.5 0.0 2.5 3.5 2,7 10.6 6.8 2.7 0.5 0.5 79.3 100.0 118 55°59 12.3 7.2 5,1 0.0 0.0 0.0 2.1 5.0 3,8 1.2 0.0 0.0 87.7 100.0 100 Total 22.4 14.0 3.9 0.2 1.8 7.3 0.7 8.4 5.5 2,4 0.2 0.3 77.6 100.0 2.256 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * * 100.0 6 20-24 27.1 14.8 7.3 0.0 0,0 7.5 0.0 12.3 11.7 0.7 0.0 0.0 72.9 100.0 91 25-29 30.0 12,1 6.3 0.3 1,7 3.8 0.0 17.8 11.5 5.6 0.0 0.7 70.0 100.0 196 30-34 35.4 19,7 7.7 0.6 4,5 6.9 0.0 15.7 10.8 4.6 0.3 0.0 64.6 100,0 232 35-39 39.1 21.0 7.5 0.5 5,1 7.0 0.9 18,0 11.8 4.9 0.6 0.7 60.9 100.0 230 40-44 28.4 17.9 7.9 0.6 2,6 2.6 4.0 10.4 6.5 3.9 0.0 0.0 71.6 100.0 194 45-49 24.2 14.3 5.9 0.9 3.6 3.4 0.5 9,9 6.2 1.3 0.4 1.9 75.8 100.0 137 50-54 20.9 9.5 1.6 0.0 2.6 2.4 2.9 11,3 7.3 2.9 0.6 0.6 79,1 100.0 110 55-59 13.7 8.1 5.7 0.0 0.0 0.0 2.4 5.6 4.2 1.4 0.0 0,0 86.3 100.0 90 TotM 29.4 15.8 6.6 0.4 3.0 4.6 1.2 13.6 9.2 3.7 0.3 0.5 70.6 100.0 1.288 SEXUALLY ACTIVE UNMARRIED MEN Total 25.2 22.5 0.5 0.0 0.2 21.6 0.0 2.8 1.4 1,2 0.0 0.2 74.8 100.0 355 Note: An asterisk indicates a figure is based on fewer than 25 men and has been suppressed. Table 4.6.2 shows the percent distribution of all men age 15-59 by the contraceptive method currently used, according to background characteristics. The differentials in contraceptive use by men resemble those among women. Men in urban areas are more likely to use contraception, especially modem methods, than their counterparts in rural areas on the mainland. There are quite large differences in the use of contraceptives among men in the various regions on the mainland. For example, 26 to 30 percent of men in the Mbeya, Singida, Dares Salaam, and Coast regions are using modern family planning methods, compared with only 1 to 5 percent in the Mwanza and Shinyanga regions. Greater contraceptive use was found to be associated with increasing level of education. Use of modem contraceptive methods increases from 4 percent among men with no formal education to 28 percent among those with at least some secondary education. 47 Table 4.6. I Current use of contraceotion bv background characteristics: women Percent distribution of all women by contraceptive method currently used, according to selected background characteristics, Tanzania 1996 Modem method Traditional/folk method Female Any Nol Any In- steri- trad. Ca]- cur- Number Background Any modern ject- Con- lisa- or folk endar/ With- Other rently of characteristic method method Pill IUD aries dom tion method mucus drawai methods using Total women Residence Mainland 16.2 11.9 4.8 0.5 3.7 1.3 1.4 4,4 21 1.9 0.4 83.8 100.0 7,881 Total urban 29.0 237 9,0 1.2 7.4 3.5 2.4 5.3 3.9 I.I 0.3 71.0 I000 1,811 Dares Salaam city 30.8 23.9 83 2,0 63 44 2.6 6.9 5.1 1.5 0.3 69.2 100.0 563 Other urban 28.2 236 9.3 0.8 7.8 3.1 2.4 4.6 3.4 0.9 04 71.8 100.0 1,248 Total rural 12.4 8.3 36 03 2.6 0.7 1.2 4.1 1.5 2.2 0.4 87.6 100.0 6,070 Zanzibar 9.9 7.9 3.8 0.2 26 03 t l 1.9 1.2 0.4 0.4 90.1 100.0 239 Pemba 7,t 5.g 2.0 0.0 20 0,3 1.4 1.4 0.7 0.7 0.0 929 t000 92 Ungula 11.6 92 49 03 2.9 0.3 0.9 2.3 1.4 0.3 0.6 88.4 100.0 148 Region Dodoma 13.0 11.4 5.1 06 4.4 0.3 10 1.6 1.0 0.6 0.0 87.0 100.0 355 Arusha 17.3 113 4.3 1.3 2.6 1.3 1.9 6.0 1.9 3.8 0.2 82.7 100.0 589 Killmanj aro 37.7 23.7 81 2.5 4.6 2.5 5.6 14.0 7.4 6.1 0.5 62.3 100.0 390 Ta~ga 22A t2,6 50 0.3 4.8 l.g 0g 9.8 2.5 6.3 1.0 77.6 t00.0 464 Morogoro 16,2 133 66 0.0 48 1.1 0.8 2.9 1.6 0.8 0.5 83.8 100.0 408 Coast 26,7 23 5 9.4 0.4 94 2.5 1.4 3.2 1.1 18 0.4 73.3 10~.0 159 Dares Salaam 29.8 23,0 8.4 2.0 6.3 3.8 22 6.8 5.2 1.3 0.3 702 100.0 646 Lindi 18,6 15.7 8.8 0.3 3.8 1.3 Ih 2.8 2.2 0.0 0.6 81.4 100.0 187 Mtwara 132 11.'~ 5.9 0.0 34 0.7 1.4 1.8 0.5 0.2 11 86.8 100.0 355 Ruvuma 18.5 15.2 75 00 4.5 17 1.5 3.2 1.9 0.4 0.9 81.5 100.0 305 Iring~. [1.1 7.7 4.1 03 18 0.8 08 3.3 1.5 1.3 0.5 88.9 100.0 466 Mbeya 18,8 11.5 5.4 0.0 3.5 1.0 16 7.3 0.6 6.1 0.6 81.2 [130.0 473 Singida 14.2 [2.9 5.3 03 5.6 0.8 1.0 1.3 0.5 0.8 0.0 85,8 1000 283 Tabora 167 111 45 0.0 4.5 1.0 1.0 5.6 5.6 0.0 0.0 83.3 I00.0 225 Rukwa 13.3 76 40 O0 2.3 0.3 1.1 5.7 0.3 4.5 0.8 867 100.0 242 Kigoma 136 i0.4 3.3 03 44 0,3 [9 33 27 0.3 0.0 86.4 [00.0 351 Shinyanga 4.3 4.0 0.8 0.3 13 0.3 1,3 0.3 0.0 0.3 0.0 95.7 100.0 686 Kagera 9.5 5.3 25 00 1,1 07 I./ 42 2.8 I.I 0.4 90.5 1(~9.0 467 Mwanza 94 8.4 2.3 00 32 26 0.3 10 1,0 0.0 0.0 90.6 100.0 573 Mara 6.9 54 14 0.0 3.6 04 0.0 14 07 04 0.4 93.1 1000 257 Education No education 6.8 47 1.6 0.0 1.9 0.2 0.9 2.1 0.5 1.2 0.4 93.2 10~.0 2,316 Primary incomplete 12.5 9.6 3.8 0.3 2.7 0.7 2.2 2.9 0.9 1.5 0.5 8%5 1000 1,630 Primary c~mplete 21.5 15.7 6g ¢*.7 5.1 1.7 1.3 5.9 2.9 26 04 78.5 100.~ 3,732 Secondary+ 315 23.1 8.0 2.l 4.5 5.5 28 8.4 7.4 1.0 0.0 685 100.0 441 No. of living children 0 3.9 2.5 08 00 0.1 1.4 0.0 1.5 1.4 0,1 0,0 96,1 100.0 2,197 1 17.0 I2,6 7.2 06 28 1.7 0.2 4.3 2.3 2.0 O0 83.0 10~.0 1,367 2 212 150 7.5 0.7 4.7 15 0.5 6,2 3.1 2.6 0.5 78.8 100.0 1,065 3 22.3 163 7.6 t.O 5.0 1.7 0.8 6.0 2.2 3.[ 0.7 77.7 t(K).~ 947 4+ 216 16.2 47 06 63 07 39 53 20 26 0.7 784 100,0 2,545 Total 16.1 117 4.8 0.5 3.7 1.3 1.4 4.3 2.1 1.9 0.4 83.9 100.0 8,120 48 Table 4,6.2 Current use of contracenfion by back,zround characteristics: men Percent distribution of all men by contraceptive method currently used, according to selected background characteristics, Tanzania 1996 Modem method Traditionnl/folk method Female Any Not Any In- steri- trod. Col- cur- Number Background Any modem jeer- Con- lisa- or folk endar/ With- Other rently of characteristic method method Pill IUD ables dom finn method mucus drawnl methods using Total men Residence Mainland 22.6 14.2 3.9 0.3 1.7 7,5 0.7 8.4 5.6 2.4 0.3 77.4 100.0 2,187 Total urban 29,6 23.9 5,2 0,6 1.6 15.2 1,0 5,7 4,2 1.3 0.1 70.4 100.0 509 Dares Saiaam city 32.0 27.2 5,1 1.1 2.2 16.9 L5 4.8 3.3 l.l 0,4 68.0 t00.0 171 Other urban 28.4 22.2 5,2 0.4 1.3 14.4 0.7 6.2 4.7 1.3 0.0 71.6 I00.0 338 Total rural 20.5 11.3 3.4 0.1 1.8 5.2 0.6 9.3 6.0 2.8 0.4 79.5 100.0 1,678 Zanzibar 14.0 7.0 4.1 0.0 1.9 1,1 0.0 7,0 4.8 2.2 0,0 86.0 100.0 69 Pemba 7.4 3.7 1.9 0.0 1,9 0.0 0.0 3.7 3.7 0.0 0,0 92.6 J~O.O 28 Unguja 18.5 9.3 5.6 0.0 1.9 1.9 0.0 9,3 5.6 3.7 0.0 81.5 100.0 41 Region Dodoma 16.4 13.6 2.9 0.0 1,4 9.3 0.0 2.9 1,4 0.7 0,0 83.6 100.0 96 Arusha 20.2 10,6 3.2 0,0 1.1 4.3 2.1 9.6 4.3 5.3 0.0 79.8 100,0 156 Kilimanjaro 26.7 15.4 3.1 1.5 1.5 8.2 1.0 11.3 4.6 5.6 0.0 73.3 100.0 119 Tango 28.0 17.3 4.0 0.0 1.3 12.0 0.0 10,7 4,0 6,7 0.0 72.0 100.0 108 Morogoro 17.5 13.3 4.9 0.7 1.4 5,6 0.0 4.2 0.7 2.1 1.4 82.5 100.0 95 Coast 30.6 25.8 9.7 0.0 4.8 11.3 0.0 4.8 1.6 3.2 0.0 69.4 100.0 45 Dares Salaam 31.9 27.0 5.3 1.0 2.3 16.4 1.6 4.9 3.3 1.0 0.7 68,1 100.0 191 Liodi 22.5 16.9 5.6 0.0 4.2 7.0 0.0 5.6 2.8 0.0 1.4 77.5 100.0 54 Mtw~a 14.9 12.9 10.9 0.0 1.0 1.0 0.0 2.0 0.0 2.0 0.0 85.1 100.0 96 Ruvuma 29.4 19.6 12.7 0.0 2.9 2.9 1.0 9.8 6.9 2.0 1.0 70.6 100.0 82 lringa 16.8 10.9 2.2 0,0 0.7 5.8 2.2 5.8 1.5 3.6 0.0 83.2 100.0 100 Mbeya 38,9 30.6 1.4 0.0 4,2 25.0 0.0 8.3 2,8 4,2 1,4 61,1 1(30.0 137 Singida 36.9 29.8 4.8 0.0 4.8 19.0 1.2 7.1 4.8 1.2 1.2 63.1 100.0 80 Tabora 16.7 5.6 1,9 0.0 1.9 1.9 0.0 11.1 IL l 0.0 0.0 83.3 100.0 82 Rukwa 52.6 17.9 5.1 0.0 3.8 7.7 1.3 34.6 23.1 11.5 0.0 47.4 100.0 71 Kigoma 32,9 I0,0 5.7 0,0 2.9 1.4 0.0 22.9 22.9 0.0 0.0 67.1 100.0 95 Shthyanga 6.1 4,9 0.6 0.6 0.0 3.0 0.6 1.2 0.6 0.6 0.0 93.9 100.0 202 Kagera 27.5 7.2 4.3 0,0 0.0 14 1.4 20.3 20.3 0.0 0.0 72.5 100.0 139 MwaJaza 1.3 1.3 0.0 0.0 0.0 1.3 0.0 0,0 0.0 0.0 0.0 98.7 100.0 176 Mara 14,5 7.3 0.0 0.0 1.8 5.5 0,0 7.3 5.5 1.8 0.0 85.5 100,0 64 Education No education 12.5 4.4 1.0 0.0 0,5 2.4 0.5 8.1 6.3 1.8 0.0 87.5 100.0 304 Primary thcomplete 11.8 6.8 1.7 0,1 0,9 3.5 0,6 5.1 3.4 1.2 0.2 88,2 100.0 664 primary complete 28.5 18.4 5.8 0.2 2.7 9.3 0.3 10.1 6.4 3.0 0.5 71.5 100.0 1.066 Second~ 38.3 27.6 5.3 1,1 1.8 16.0 3.2 10.7 6.8 3,9 0.0 61.7 100.0 222 No. of living children 0 10.9 9.2 0.4 0.0 0.1 8.7 0.0 1.7 1.0 0.6 0.1 89.1 100.0 974 1 27.0 16.8 3.9 0.3 1.3 11.1 0.3 10.2 6.9 2,3 0.6 73.0 100.0 228 2 27.6 15.2 5.9 1.5 1,] 6,7 0.0 12.4 7.7 4.7 0.0 72.4 ]00.0 206 3 42.8 26.0 11.6 0.0 3.2 10.4 0.7 16.8 13.4 3.4 0.0 57.2 100.0 188 4+ 30.2 16.2 6.1 0,3 4.2 3.4 2.1 14.1 8.8 4.1 0.7 69.8 100.0 661 Torn/ 22.4 14.0 3.9 0.2 1.8 7,3 0.7 8.4 5.5 2.4 0.3 77.6 ~00.0 2,256 49 Trends in Contraceptive Use Contraceptive use in 1996 has increased since the 1991-92 TDHS from 10 to 16 percent of all women using any method and from 6 to 12 percent using modem methods (Figure 4.3). Injectables had the highest increase from less than 1 percent to 4 percent in the same time period. Among men, use of modem methods increased from 8 percent to 14 percent for the same period of time. However, the 1996 TDHS data show a slight decline in the contraceptive use rate since the 1994 Tanzania Know- ledge, Attitudes and Practices Survey (TKAPS) (from 18 to 16 percent of all women) which is due to a decline in the use of traditional methods; use of modem methods has slightly increased since 1994. Thus, it appears as if use of modem methods of contraception increased rapidly between 1991-92 and 1994 and has leveled off since then. 4.5 Number of Children at First Use of Fami ly Planning Family planning methods may be used for either spacing births or limiting family size. The 1996 TDHS included questions on the number of children the woman had when she first used contraception. These data enable an examination of the cohort changes Figure 4.2 Modern Contraceptive Method Use among all Women 15-49 by Background Characteristics Mainland Urban -- Mainland Rural Zanzibar REGIONS KJlirn~Jc~ t Dares Salaam LJndi Ruvuma Singlda Mor oro Tabora Dcdoma Atusha Mtwara KJ orfla Mwarlza Ka era ~ara Shinyanga I l 5 10 15 Percent of All Women 20 25 TDHS I gg6 Figure 4.3 Trends in Contraceptive Use 1991-1996 All Women Any Method I 18 Any Modem Method ] 112 Any Traditional Method Atl Men Any Method 25 i Any Modem Metho~ ~ ~ " i ~ i Any Traditional Method ~ Z , ~ : 11 I 0 5 10 15 20 25 Percent !m1~991-92TDHS ~994TKAP IB1996TDH$ • in the timing of adopting contraceptive use. Table 4.7 shows the distribution of ever-married women and the number of children the women had when they first used contraception, according to age group. The results indicate that Tanzanian women are adopting family planning at an earlier stage of the family building process than before. Younger women report first use at lower parity than older women. For example, older (age 40-49) ever-married women reported first using contraception after having a median of 3.3-3.5 births, compared with about one living child among the youngest women (under age 30). This pattern may also be a reflection of a recent increase in the availability of family planning services. 50 Table 4.7 Number of children at first use of contracantion Percent distribution of ever-married women by number of living children at the time of first use of contraception, and median number of children at first use, according to current age, Tanzania 1996 Median Never Number of living children at time number of used of first use of contraception children Number Current contra- at first of age ception 0 1 2 3 4+ Missing Total use women 15-19 83.8 3.7 11.8 0.5 0.0 0.0 0.2 100.0 0.4 441 20-24 62.5 6.1 22.2 6.7 1.8 0.3 0.4 t00.0 0.6 1,266 25-29 59.3 2.9 16.1 11.9 6.0 3.5 0.3 100.0 1.1 1,334 30-34 60.5 1.1 13.6 9.4 5.7 9.1 0.6 100.0 1.5 1,067 35-39 61.9 0.6 8.4 7.3 7.1 14.2 0.4 100.0 2.4 873 40-44 65.0 1.0 4.0 5.9 4.7 19.4 0.1 100.0 3.5 670 45-49 73.0 0.4 5.5 3.5 3.2 13.9 0.5 100.0 3.3 582 Total 64.2 2.5 13.3 7.5 4.4 7.7 0.4 100.0 1.3 6,233 4.6 Effect of Breastfeeding on Conception Information on knowledge of the contraceptive effect of breastfeeding as perceived by women is shown in Table 4.8. Twenty-seven percent of currently married Tanzanian women believe that breastfeeding increases the chance of a woman becoming pregnant. Fourteen percent correctly report that breastfeeding can reduce the risk of pregnancy, while 12 percent say that it depends on the situation. Differentials in knowledge of the contraceptive effect of breastfeeding by age group and place of residence are not large. Large differentials are observed by regions. For example 29 percent of currently married women in the Kagera region correctly reported that breastfeeding can reduce the risk of pregnancy, compared with only 2 percent in the Ruvuma region. Only 8 percent of currently married women have used breastfeeding in the past to avoid pregnancy and 4 percent are currently relying on breastfeeding as a contraceptive method. Five percent of women meet the criteria for use of the lactationai amenorrhoeic method (LAM) 1 of family planning. 4.7 Sources of Family Planning Methods Women who reported using a modern method of contraception at the time of the survey were asked where they obtained the method the last time. It is likely that some women may misreport the type of place where they obtained the method, since the distinction between hospitals, chnics, and sometimes between public and private sources may not be clear to them. Table 4.9 and Figure 4.4 show that overall family planning users in Tanzania are more likely to obtain their methods from the public sector than from a private provider. About three-fourths of women currently using modern contraceptives obtained the method from the public sector, including government and districts hospitals (24 percent), government health centres (22 percent), and government dispensaries or parastatal facilities (28 percent). tLAM users are women who are breastfeeding a child under six months of age, are still postpartum amenorrhoeic, and are not feeding the child anything but breast mi lk and plain water. 51 Table 4.8 Perceived contracantive effect of breastfeedine Percent distribution of currently married women by perceived risk of pregnancy associated with breastfeeding and percentage who rely on breastfeeding to avoid pregnancy, and percentage who meet lactational amenorrhoeic method (LAM) criteria, according to selected background characteristics, Tanzania 1996 Perceived risk of pregnancy associated with breasffeeding Reliance on breastfeeding to avoid pregnaney Meet Number Background Un- In- De- Don't Previ- Cur- LAM of characteristic changed creased creased Depends know Missing Total ously renfly criteria women Age 15-19 12.7 17.9 6.9 5.0 57.2 0.2 100.0 2.3 1.7 8.2 401 20-24 17.4 27.6 13.3 9.7 32.0 0.1 100.0 4.9 2.6 6.6 1,131 25-29 19.5 29.6 I5.0 10.6 25.2 0.1 100.0 8.i 4.4 5.8 1,184 30-34 17.5 28.8 16.1 15.2 22.5 0.0 10t3.0 9.6 4.8 5.0 947 35-39 18.7 27.2 14.7 i5.6 23.7 0.0 100.0 10.1 5,2 3.3 740 40-44 16.8 24.2 17.5 13.1 28.0 0.4 100.0 12.3 3.3 1.1 561 45-49 13.2 28.6 13.9 15.6 28.5 0.2 100.0 8.1 1.3 1.2 447 Residence Mainland 16.9 27.2 14.6 12,3 28.8 0.i 100,0 8.1 3.7 4.8 5,245 Total urban 23.7 29.7 10.9 11.8 23.8 0.1 100.0 6.1 2.7 2.3 1,073 Dares Salaam city 36.6 20.9 10.0 7.7 24.6 0.2 100.0 5.2 2.2 0.7 340 Other urban 17.7 33.8 i 1.3 13.7 23.5 0.0 100.0 6.6 3.0 3.1 733 Total rural 15.2 26.6 15.6 12.5 30.1 0.1 100.0 8.6 4.0 5.4 4,172 Zanzibar 28.8 27.5 6.0 6.9 30.8 0.0 100.0 3.4 1.4 5.5 166 Region Dodoma 17.9 20.5 16.6 17.0 27.9 0.0 100.0 13.1 7.0 5.7 258 Arusha 11.8 10.3 15.0 15.0 48.0 0.0 100.0 6.2 1.9 6.2 403 Kilimanjaro 13.9 14.8 15.7 20.6 34.5 0.4 100.0 8.5 2.2 4.9 221 Tanga 9.1 15.3 10.7 15.7 48.8 0.4 100.0 3.7 0.4 3.7 282 Morogoro 15.2 26.2 8.0 17.3 33.3 0.0 100.0 3.4 1.3 3.8 257 Coast 40.4 19.3 6.4 5.3 28.7 0.0 100.0 3.5 1.2 1.8 98 Oar es Salaam 38.6 20.6 9.1 7.8 23.7 0.2 100.0 5.1 2.1 1.5 399 Lindi 24.8 28.1 7.6 5.7 33.8 0.0 100.0 2.4 1.4 3.8 123 Mtwara 19.5 37.0 6.5 8.1 28.9 0.0 100.0 0.0 0.0 5.2 248 Ruvuma 17.6 31.3 2.2 9.3 39.3 0.3 100.0 0.6 0.3 2.6 205 lringa 15.2 26.3 8.2 18.1 32.1 0.0 100.0 4.9 3.3 5.8 291 Mbeya I2.8 46.9 9.5 5.2 25.6 0.0 100.0 7.1 1.9 3.3 318 8ingida 13.0 30.4 14.1 8.9 33.7 0.0 100.0 11.1 3.7 4.8 194 Tabora 15.9 23.9 19.6 10.9 29.0 0.7 1013.0 16.7 7.2 5.1 157 Rukwa 6.2 39.4 11.6 19.3 23.6 0.0 100.0 15.1 6.9 5.0 177 Kigoma 13.9 14.3 20.9 12.7 37.3 0.8 100.0 16.8 11.1 7.8 233 Shinyanga 14.2 37.4 27.2 8.7 12.6 0.0 I00.0 I2.2 4.7 6.3 464 Kagera 15.6 19.0 29.3 17.1 19.0 0.0 100.0 17.1 8.3 6.3 337 Mwanza 14.0 42.1 18.7 7.9 17.3 0.0 100.0 5.6 4.7 5.1 395 Mara 20.3 37.1 13.7 15.7 13.2 0.0 100.0 7.1 3.6 4.1 183 Education No education 13.0 24.4 14.4 11.9 36.1 0.2 100.0 8.4 3.9 4.6 1,829 Primary incomplete 17.1 25.7 16.7 12.7 27.7 0.1 100.0 10.0 4.7 4.4 920 primary complete 19.2 29.5 I3.5 12.2 25.5 0.1 100.0 7.1 3.2 5.3 2,462 Secondary + 33.6 30.9 13.8 11.4 10.4 0.0 100.0 5.7 2,0 2.1 200 Total 17.3 27.2 14.4 12.2 28.9 0.1 100.0 8.0 3.6 4.8 5,411 52 Table 4.9 Source of supulv for modem eontracentive methods Percent distribution of women currently using modern contraceptive methods by most recent source of the method, according to specific methods, Tanzania 1996 Contraceptive method Female All Inject- sterili- modern Source of supply Pill IUD ables Condom sation methods Public 77.4 90.8 88.4 22.8 68.4 74.2 Government hospital 2.7 14.6 6.1 0.3 37.6 8.3 District hospital 11.7 35.5 16.0 10.9 22.0 15.4 Health centre 25.5 28.6 28.6 4.6 3.7 21.6 Dispensary/parastatal facility 35.9 12.2 36.6 6.5 5.1 28.0 Village health post 1.5 0.0 1.1 0.5 0.0 1.0 Medical private 17.9 5.0 8.4 36,4 28.1 17.7 Religious organisation facility 4.0 5.0 1.5 3.8 23.8 5.7 Private hospital/clinic 4.7 0.0 5.9 0.0 4.3 4.3 Pharmacy/medical store 6.6 0.0 0.0 29.3 0,0 5.9 CBD worker 2.6 0.0 I. i 3.4 0.0 1.8 Other private 2.0 2.1 i .7 30.8 0.7 4.9 Shop/kiosk 0.8 0.0 0.4 24.7 0.0 3.2 Church 0.3 0.0 0,0 0,8 0,0 0.2 Friends/relatives 0.4 0.0 0.0 4.6 0.0 0.7 Other 0.5 2.1 1.2 0,7 0.7 0.9 Don't know 0.3 0.0 0,0 2.0 0.0 0.3 Not stated 2.4 2.1 1,6 8.0 2.7 2.8 Total I00.0 I00.0 I00.0 I00.0 I00.0 i00.0 Number of users 389 40 298 105 116 954 ! CBD = Community-based distribution. i Note: The total inciudes 3 implant users, one diaphragm/foam/jelly user, and one male sterilisation user. Figure 4.4 Distribution of Current Users of Modem Contraceptive Methods by Source of Contraceptive Government and . 1 3 {er rmaoy/ 10135 )% D / f Health Post- Other / Facility 29% Missing 6% 5% TDH$1996 53 Private medical sources account for 18 percent of current users. Community-based distribution (CBD) workers supply nearly 2 percent of modem methods. The source of family planning methods varies according to the type of method used. The public sector is the principal source of the pill, IUD, injectables, and female sterilisation, while the private sector is the principal source for condom users; more than half of the condom users reported obtaining condoms from pharmacies and shops. There is little change in the sources of contraception since the 1991-92 TDHS. 4.8 Intention to Use Family Planning Among Nonusers An important indicator of the changing demand for family planning is the extent to which nonusers of contraception intend to use family planning in the future. Respondents who were not using contraception at the time of the survey were asked if they intended to use family planning methods in the future. The results are presented in Table 4.10. Almost half (48 percent) of women nonusers say they intend to use family planning at some time in the future, with 33 percent saying they intend to use in the next 12 months and 13 percent saying they intend to use later. Thirty-eight percent of women say that they do not intend to use, while 13 percent are unsure about their intention to use. Men are more likely than women to intend to use contraception in future. Fifty- six percent of men who are not using a method say that they intend to use family planning in the future (see last column in Table 4. ! 0). Table 4.10 Future use of contracer~tion Percent distribution of all women and men who are not using a contraceptive method by intention to use in the future, according to number of living childr

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