Uganda - Demographic and Health Survey - 1996

Publication date: 1996

Uganda Demographic and Health Survey 1995 Statistics Department Ministry of Finance and Economic Planning ®DHS Demographic and Health Surveys Macro International Inc. World Summit for Children Indicators: Uganda 1995 Value BASIC INDICATORS Infant mortality Infant mortality rate (direct estimation) I 81 per 1,000 Infant mortality rate (indirect estimation) I 97 per 1,000 Under-five mortality rate 147 per 1,000 Maternal mortality Maternal mortality ratio 506 per 100,000 Childhood undernutrition Percent stunted 38.3 Percent wasted 5.3 Percent underweight 25.5 Clean water supply Percent of households within 15 minutes of a safe water supply 2 I 1.0 Sanitary excreta disposal Percent of households with flush toilets or VIP latrines 3.1 Basic education Percent of women 15-49 with completed primary education 23.4 Percent of men 15-49 with completed primary education 38.1 Percent of girls 6-12 attending school 65.9 Percent of boys 6-12 attending school 68.8 Percent of women 15-49 who are literate 52.6 Children in especially Percent of children who are orphans (both parents dead) 1.9 difficult situations Percent of children who do not live with their natural mother 23.5 Percent of children who live in single adult households 12.1 SUPPORTING INDICATORS Women's Health Birth spacing Sal~ 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 27.8 91.2 13.7 37.8 35.4 65.9 Family planning Contraceptive prevalence rate (any method, married women) 14.8 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 29.0 24.9 Percent of mothers with low BM[ 9.9 Percent of births at low birth weight (of those reporting numeric weight) 13.1 Percent of children under 4 months who are exclusively breastfed 70.1 Percent of households with iodised salt 69.0 Nutrition Maternal nutrition Low birth weight Breastfeeding Iodine Child Health Vaccinations Diarrhoea control Acute respiratory infection Percent of children whose mothers received tetanus toxoid vaccination during pregnancy Percent of children 12-23 months with measles vaccination Percent of children 12-23 months fully vaccinated Percent of children with diarrhoea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) 80.0 59.6 47.4 49.2 Percent of children with acute respiratory infection in preceding 2 weeks who were seen by medical personnel 61.4 I See Chapter 7 Ibr details. 2 Piped, well, and bottled water Uganda Demographic and Health Survey 1995 Statistics Department Ministry of Finance and Economic Planning Entebbe, Uganda Macro International Inc, Calverton, Maryland USA August 1996 This report summarises the findings of the 1995 Uganda Demographic and Health Survey (UDHS) conducted by the Statistics Department in the Ministry of Finance and Economic Planning. Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Development (USAID) and the Government of Uganda. The UDHS 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 Uganda survey may be obtained from the Statistics Department, P.O. Box 13, Entebbe, Uganda (Telephone: 20320 or 20165; Fax: 20147). Additional information about the DHS programme may be obtained by writing to: DHS, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (Telephone: 301-572-0200; Fax: 301-572- 0999; E-mail: reports@macroint.com; Internet: http://www/macroint.com/dhs/). Recommended citation: Statistics Department [Uganda] and Macro International Inc. 1996. Uganda Demographic and Health Survey, 1995. Calverton, Maryland: Statistics Department [Uganda] and Macro International Inc. CONTENTS Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Map of Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx CHAPTER 1 1.1 1.2 1.3 1.4 1.5 1.6 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography, History, and the Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Demographic Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Family Planning Programmes and Population Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Objectives of the 1995 Uganda Demographic and Health Survey . . . . . . . . . . . . . . . . . 4 Survey Organisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CHAPTER2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . 9 2.1 Population by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Population by Age from Selected Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.4 Fosterhood and Orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.5 Educational Level of Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.6 School Enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.7 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.8 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.9 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.10 Characteristics of Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 2.11 Educational Level of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 2.12 School Attendance and Reasons for Leaving School . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.13 Exposure to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2.14 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2.15 Employer and Form of Eamings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.16 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.17 Person who Decides on Use of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.18 Child Care While Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Current Fertility Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Differentials in Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Retrospective Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 iii 3.6 3.7 Page Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 CHAPTER 4 FERT IL ITY REGULAT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.1 Knowledge of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.2 Trends in Contraceptive Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.3 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.4 Current Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.5 Number of Children at First Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.6 Effect of Breastfeeding on Conception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.7 Somce of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.8 Intention to Use Family Planning Among Non-users . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.9 Reasons for Non-use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 4.10 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.11 Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.12 Acceptability of Electronic Media to Disseminale Family Planning Messages . . . . . . 63 4.13 Exposure to Family Planning Messages Through the Print Media . . . . . . . . . . . . . . . . 64 4.14 Contact of Non-users with Family Planning Providers . . . . . . . . . . . . . . . . . . . . . . . . . 65 4.15 Attitudes Towards Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 4.16 Problems with Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 4.17 Knowledge of Family Planning Logo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 4.18 Knowledge of Protector Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 PROXIMATE DETERMINANTS OF FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . 73 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . . . . . . . 81 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 CHAPTER 6 6.1 6.2 6.3 6.4 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 CHAPTER 7 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 7. l Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 iv 7.2 7.3 7.4 7.5 Page Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Socio-economic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . 100 Demographic Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 CHAPTER 8.1 8.2 8.3 8A 8.5 8.6 8.7 8.8 8 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Tetanus Toxoid Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Assistance and Medical Care at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Childhood Immunisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l I 1 Immunisation by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Immunisations by First Year of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Childhood Illness and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 CHAPTER 9 9.1 9.2 9.3 MATERNAL AND CHILD NUTRIT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Maternal Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 CHAPTER 10 MATERNAL MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 10.1 Assessment of Data Completeness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 10.2 Direct Estimates of Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 10.3 Direct Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 10.4 Indirect Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 10.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 CHAPTER 11 AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES . . . . . . . . . . . . . 141 11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 11.2 Awareness of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 11.3 Prevalence of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 I 1.4 AIDS Knowledge and Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 11.5 Perception of the Risk of Getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 CHAPTER 12 12.1 12.2 12.3 AVAILABIL ITY OF FAMILY PLANNING AND HEALTH SERVICES . . . . . 161 Service Availability Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Availability of Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Availability of Health Services to Women and Children . . . . . . . . . . . . . . . . . . . . . . 168 Page REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 APPENDIX A SAMPLE IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 APPENDIX C DATA QUAL ITY TABULAT IONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 APPENDIX D PERSONS INVOLVED IN THE 1995 UGANDA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 vi Table 1.1 Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16 Table 2.17 Table 2.18 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 3.11 Table 3.12 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6.1 Table 4.6.2 Table 4.7.1 Table 4.7.2 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 TABLES Page Demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Educational level of the female and male household population . . . . . . . . . . . . . . . . . 13 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Differential characteristics between spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Level of education by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 School attendance and reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Decisions on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Current fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Age-specific fertility rates from various sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Trends in fertility by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Trends in fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Adolescent pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Children born to adolescent women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Knowledge of contraceptive methods among couples . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Knowledge of contraceptive methods by background characteristics . . . . . . . . . . . . . . 45 Trends in knowledge of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Current use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Current use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Current use of contraception by background characteristics: women . . . . . . . . . . . . . . 52 Current use of contraception by background characteristics: men . . . . . . . . . . . . . . . . 53 Trends in current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Reason for selecting current sources of supply for contraceptive methods . . . . . . . . . . 59 vii TaMe 4.13 Table 4.14 Table 4.15 TaMe 4.16 TaMe 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 TaMe 4.22 Table 4.23 TaMe 4.24 TaMe 4.25 Table 5.1 Table 5.2 TaMe 5.3 TaMe 5 A Table 5.5 Table 5.6 Table 5.7.1 TaMe 5.7.2 Table 5.8 Table 5.9 Table 5.10 Table 6. l Table 6.2 TaMe 63 TaMe 6A Table 6.5 Table 6.6 TaMe 6.7 TaMe 6.8 Table 6.9 Table 7.1 Table 7.2 TaMe 7.3 Table 7A Table 8.1 Table 8.2 Table 8.3 Table 8.4 TaMe 8.5 Table 8.6 TaMe 8.7 TaMe 8.8 TaMe 8.9 TaMe 8.10 Table 8.11 Page Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Preferred method of contraception for futme use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Exposure to family planning messages through the media . . . . . . . . . . . . . . . . . . . . . . 63 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Contact of non-users with family planning providers . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Wives ' perceptions of their husbands' attitudes toward family planning . . . . . . . . . . . 67 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Spouse's perception of spouse's approval of family planning . . . . . . . . . . . . . . . . . . . . 68 Disadvantages of the pill/IUD/injec tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Knowledge of family planning logo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Knowledge of "Protector" condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Postpartum amenorrhoea, 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . . . . . . . . 88 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . 93 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . 101 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . 102 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . 107 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . . . . I 11 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Vaccinations in first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Prevalence ~nd treatment c f acute respiratory infection and prevalence of fever . . . . 117 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 viii Table 8.12 Table 8.13 Table 8.14 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 9.8 Table 9.9 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table I I.l.1 Table 11.1.2 Table I 1.2.1 Table I 1.2.2 Table 11.3 Table 1.4.l Table 1.4.2 Table 1.5.1 Table 1.5.2 Table 1.6. I Table 1.6.2 Table 1.7 Table 1.8.1 Table 1.8.2 Table 1.9 Table 1.10 Table 1.11 Table 1.12.1 Table 1.12.2 Table 12.1 Table 12.2.1 Table 12.2.2 Table 12.3 Table 12.4 Table 12.5 Table 12.6 Table 12.7 Page Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Types of food received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . 127 Types of food received by children in preceding week . . . . . . . . . . . . . . . . . . . . . . . . 128 Types of food received by children by background characteristics . . . . . . . . . . . . . . . 129 Nutritional status of children by background characteristics . . . . . . . . . . . . . . . . . . . . 131 Trends in nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Nutritional status of mothers by background characteristics . . . . . . . . . . . . . . . . . . . . 134 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Adult mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Indirect estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Knowledge of sexually transmitted diseases: women . . . . . . . . . . . . . . . . . . . . . . . . . 142 Knowledge of sexually transmitted diseases: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Self-reporting of sexually transmitted diseases in the last year: women . . . . . . . . . . 145 Self-reporting of sexually transmitted diseases in the last year: men . . . . . . . . . . . . . 146 Action taken by respondents who reported a sexually transmitted disease in the last 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 HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Knowledge of ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Awareness of AIDS health issues: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Awareness of AIDS health issues: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Personal acquaintance with AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Perception of the risk of getting AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Perception of the risk of getting AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Perception of the risk of getting HIV/AIDS among couples . . . . . . . . . . . . . . . . . . . . 156 Reasons for perception of small/no risk of getting HIV/AIDS . . . . . . . . . . . . . . . . . . 156 Reasons for perception of moderate/great risk of getting HIV/AIDS . . . . . . . . . . . . . 157 AIDS prevention behaviour: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 AIDS prevention behaviour: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Distance to nearest family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Distance to family planning services by type of facility . . . . . . . . . . . . . . . . . . . . . . . 163 Time to family planning services by type of facility . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Distance to family planning services by type of method . . . . . . . . . . . . . . . . . . . . . . . 165 Distance to nearest family planning services by use of family planning . . . . . . . . . . . 166 Distance to family planning services by type of method and need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Distance and time to nearest facility providing antenatal care according to type of facility, residence and region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Distance and time to nearest facility providing delivery care according to type of facility, residence, and region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I69 ix Page Table 12.8 Table 12.9 Table 12.10 TabTe A.1 Table A.2 Table B.1 Table B.2.1 Table B.2.2 Table B.3. l Table B.3.2 Table B.4.1 Table B.4.2 Table B.5. l Table B.5.2 Table B.6.1 Table B.6.2 Table B.7.1 Table B.7.2 Table B.8.1 Table B.8.2 Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Distance and time to nearest facility providing immunisation services according to type of facility, residence, and region . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Distance to nearest selected health sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Distance to nearest maternal and child health services for children . . . . . . . . . . . . . . 172 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 List of selected variables for sampling errols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Sampling errors - National sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Sampling errors - National sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Sampling errors - Urban sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Sampling errors - Urban sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Sampling errors - Rural sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Sampling errors - Rural sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Sampling errors - Central region sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Sampling errors - Central region sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Sampling errors - Eastern region sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Sampling errors - Eastern region sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Sampling errors - Northern region sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Sampling errors - Northern region sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Sampling errors - Western region sample: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Sampling errors - Western region sample: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Age distribution of eligible and interviewed women and men . . . . . . . . . . . . . . . . . . 202 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 X Figure 2.1 Figure2.2 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure4.3 Figure 4.4 Figure 5.1 Figure6.1 Figure 6.2 Figure 6.3 Figure6.4 Figure7.1 Figure 7.2 Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4 Figure9.1 Figure 10.1 Figure l0.2 Figure 11.1 FIGURES Page Distribution of the household population by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Percentage of the population age 6-24 enrolled in school by age and sex . . . . . . . . . . . 15 Age-specific fertility rates by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Total fertility rates by residence, region, and education . . . . . . . . . . . . . . . . . . . . . . . . 33 Adolescent childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Current use of specific contraceptive methods among currently married women . . . . . 51 Contraceptive use of currently married women 15-49 by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Trends in current contraceptive use among currently married women 15-49 . . . . . . . . 55 Distribution of current users of modem contraceptive methods by source of supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Percent of married women in polygynous unions by background characteristics . . . . . 75 Fertility preferences of currently married women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . 86 Fertility preferences of married women by number of living children . . . . . . . . . . . . . 87 Percent of married women with four children who want no more children by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Ideal family size among women and men by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Trends in infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Under-five mortality by selected demographic characteristics . . . . . . . . . . . . . . . . . . 102 Percent distribution of births by antenatal care and delivery characteristics . . . . . . . . 106 Percentage of children age 12-23 months who have received all vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Trends in vaccination coverage among children age 12-23 months . . . . . . . . . . . . . . 115 Prevalence of respiratory illness and diarrhoea in the last two weeks by age of the child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Nutritional status of children under four years, mean z-scores by age in months . . . . 132 Female adult mortality for the period 0-9 years before the survey, by age, from various sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Male adult mortality for the period 0-9 years before the survey, by age, from various sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Changes in behaviour after leaming about HIV/AIDS, among men and women . . . . 160 xi PREFACE The 1995 Uganda Demographic and Health Survey (UDHS) was conducted in all of the districts of the country except Kitgum District. This was a considerable improvement over the first UDHS which was conducted in 1988-89 and excluded nine districts. The major objectives of the 1995 UDHS were to collect and analyse data on fertility, mortality, family planning, and health. Compared to the 1988-89 UDHS, the present survey was significantly expanded in scope and included questions on the awareness and behaviour regarding AIDS. The 1995 UDHS will therefore provide more detailed findings in addition to updating indicators derived from the 1988-89 UDHS. In the past, Population and Housing Censuses were the only sources of demographic statistics in Uganda. There have been no national demographic surveys and the vital registration system is not yet satisfactorily operational. This emphasises the importance of the two UDHSs in filling the existing gaps in demographic and health statistics. Many government departments contributed to the successful completion of the 1995 UDHS and the prompt publication of this report. However, mention should be made of the staff of the Statistics Department who participated in the planning and the implementation of this survey. The Ministry of Health provided experts who participated in the training of field workers and drafted some of the chapters of the report. A number of the field workers were nurses who were provided by government health institutions. Special thanks go to the Population Secretariat for chairing and hosting all the meetings of the Steering and Technical Committees. Many of the members of these committees were from the Population Secretariat. We also acknowledge the active participation of some international agencies whose contribution led to the success of this survey. The United States Agency for International Development (USAID) provided funds for this survey. Macro International Inc. provided technical and material support. UNICEF contributed greatly in the discussions to determine the content of the questionnaires. I am grateful to the endeavours of government officials at all levels of administration. Finally, special gratitude goes to all the respondents for having spared their valuable time to attend to the interviews which were sometimes lengthy. Commissioner for Statistics Statistics Department Ministry of Finance and Economic Planning xiii SUMMARY OF FINDINGS The 1995 Uganda Demographic and Health Survey (UDHS) is a nationally-representative survey of 7,070 women age 15-49 and 1,996 men age 15-54. The UDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. Fieldwork for the UDHS took place from late-March to mid-August 1995. The survey was similar in scope and design to the 1988-89 UDHS. Survey data show that fertility levels may be declining, contraceptive use is increasing, and childhood mortality is declining; however, data also point to several remaining areas of challenge. FERTILITY Fertility Trends. UDHS data indicate that fertility in Uganda may be starting to decline. The total fertility rate has declined from the level of 7.1 births per woman that prevailed over the last 2 decades to 6.9 births for the period 1992-94. The crude birth rate for the period 1992-94 was 48 live births per I000 population, slightly lower than the level of 52 observed from the 1991 Population and Housing Census. For the roughly 80 percent of the country that was covered in the 1988-89 UDHS, fertility has declined from 7.3 to 6.8 births per woman, a drop of 7 percent over a six and a half year period. Fertility Differentials. Some women are apparently leading the fertility decline. For example, fertility levels are substantially lower among urban women (5.0 children per woman on average) than among rural women (7.2 children). Moreover, women who have received some secondary education have the lowest level of fertility, with a total fertility rate of 5.2, compared to a rate of over 7 children per woman for those with either no education or with only primary education, a difference of nearly two children. Age at First Birth. Childbearing begins early in Uganda, with just under half of women becoming mothers by the time they reach age 18 and two-thirds having had a child by the time they reach age 20. The result is that the median age at first birth falls between 18 and 19 years and shows no clear trend over the past three decades. A similar observation was made from data from the 1988-89 UDHS strengthening the conclusion that there has been no real trend in age at first birth in Uganda. Moreover, 43 percent of teenage women (age 15-19) have begun childbearing, with 34 percent having had a child already and 9 percent carrying their first child. There is some evidence that, instead of declining over time, fertility rates among teenagers may in fact be increasing. This remains a challenge to policymakers since UDHS data show that children born to young mothers suffer higher rates of morbidity and mortality. Birth Intervals. The majority of Ugandan children (72 percent) are born after a "safe" birth interval (24 or more months apart), with 30 percent born at least 36 months after a prior birth. Nevertheless, 28 percent of non-first births occur less than 24 months after the preceding birth, with 10 percent occurring less than 18 months since the previous birth. The overall median birth interval is 29 months. Fertility Preferences. Survey data indicate that there is a strong desire for children and a preference for large families in Ugandan society. Among those with six or more children, 18 percent of married women want to have more children compared to 48 percent of married men. Both men and women desire large families. Half of all women report five or more children as ideal and another 30 XV percent want to have four children. Only 6 percent of women report a two-child family as ideal. Men are even more pronatalist than women. Overall, women report a mean ideal number of children of 5.3, compared to 5.8 for men. Despite high fertility preferences, the data indicate that there has been a significant decline in ideal family size among women in Uganda, from an average of 6.5 children in 1988-89 to 5.3 in 1995. Women's desire for additional children has also declined noticeably over the past six years. In 1988-89, 39 percent of married women wanted another child within the next two years compared with only 23 percent of women in 1995. The proportion of women who want no more children increased from 19 percent in 1988-89 to 31 percent in 1995. Unplanned Fertility. Despite the increasing level of contraceptive use, UDHS data indicate that unplanned pregnancies are still common. Overall, almost one-third of births in the three years prior to the survey were reported to be unplanned--22 percent were mistimed (wanted later) and 8 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in Uganda would be 5.6 births per woman instead of the actual level of 6.9. FAMILY PLANNING Knowledge of Contraceptive Methods. Knowledge of contraceptive methods is nearly universal with 92 percent of all women age 15-49 and 96 percent of all men age 15-54 knowing at least one method of family planning. Knowledge of contraceptive methods has increased considerably since the 1988-89 UDHS (which covered about 80 percent of the country). In 1988-89, only 82 percent of all women had knowledge of at least one family planning method compared with 92 percent in 1995. There has also been a large increase over the last six years in the proportion of women who know specific family planning methods. For example, the proportion of women who have heard of condoms has increased from 33 percent in 1988-89 to 78 percent in 1995, and the proportion who have heard of injectables increased from 40 percent to 70 percent during the same period. Increasing Use of Contraception. The contraceptive prevalence rate in Uganda has tripled over a six-year period, rising from about 5 percent in approximately 80 percent of the country surveyed in 1988-89 to 15 percent in 1995. Use of modem methods has increased particularly fast, from 3 percent of married women in 1988-89 to 8 percent in 1995. Use of traditional methods increased from 2 to 4 percent. Methods which have increased the fastest are the pill, injectables, and periodic abstinence. Differentials in Family Planning Use. Differentials in current use of family planning by the four regions of the country are large. One-quarter of married women in the Central Region are current contraceptive users compared to less than 14 percent of women in other regions. Modem method use is highest in the Central Region (16 percent) and lowest in the Northern Region (3 percent). Urban women are much more likely to be using contraceptive methods (35 percent) than rural women (12 percent). The difference between urban and rural women is most pronounced for modem method use (28 percent and 5 percent, respectively), while they are almost equally likely to use traditional and folk methods (6 and 7 percent). There are large differentials in current use by level of education. Eight percent of currently married women with no formal education are currently using a method compared with 38 percent of those with some secondary education. Source of Contraception. Half of current users (47 percent) obtain their methods from public sources, while 42 percent use non-governmental medical sources, and other private sources account for the remaining 11 percent. Govemment hospitals (30 percent) and private hospitals and clinics (30 percent) are the most common sources of contraceptive methods. Forty percent of women say they use their xvi current source because it is close to home, while one-third of women say that they know of no other source for their method. Family Planning Messages. One reason for the increase in level of contraceptive awareness is that family planning messages are prevalent. One-third of the women and over half of the men interviewed reported that they had heard a family planning message in the six months prior to the survey, mostly on the radio. Women in the Northern Region are at a disadvantage, however, with only 14 percent having heard a family planning message compared to 59 percent of women in the Central Region. Unmet Need for Family Planning. UDHS data show that there is a considerable unmet need for family planning services in Uganda. Overall, 29 percent of currently married women are in need of services--18 percent for spacing their next birth and 11 percent for limiting births. If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 15 to 44 percent of married women. Currently, 34 percent of this "total demand" for family planning is being met. Availability of Family Planning Services. Family planning services are quite widely available in Uganda. Almost half of married women live within 5 kilometres of a source of family planning and 16 percent live in places with community-based distribution programmes. Fifty-six percent of all family planning users live within 5 km of fixed facilities offering family planning services compared to 45 percent of non-users. However, these programmes do not necessarily provide all contraceptive methods, and women generally have to travel farther to obtain clinical methods such as the IUD and sterilisation than they do to get supply methods such as pills and condoms. Only 5 percent of non-users were visited by a community-based distribution agent during the 12 months before the survey. MATERNAL AND CHILD HEALTH High Childhood Mortality. Although childhood mortality in Uganda is still quite high in absolute terms, there is evidence of a significant decline in recent years. Currently, the direct estimate of the infant mortality rate is 81 deaths per 1,000 births and under five mortality is 147 per 1,000 births, a considerable decline from the rates of 101 and 180, respectively, that were derived for the roughly 80 percent of the country that was covered by the 1988-89 UDHS. Although encouraging, the 1995 UDHS rates show that almost one in seven children born in Uganda dies before reaching the fifth birthday, an indication that there is still much improvement to be made. Childhood Vaccination Coverage. One possible reason for the declining mortality is improvement in childhood vaccination coverage. The UDHS results show that 47 percent of children age 12-23 months are fully vaccinated, and only 14 percent have not received any vaccinations. This is an improvement from the 31 percent of children who were estimated to have been fully vaccinated in 1988- 89. Nonetheless, a large proportion of children obtain one or two vaccinations but fail to complete the full course. If dropout rates could be reduced, the level of full coverage could be improved still further. Childhood Health. UDHS data indicate high levels of childhood illness. Approximately one in four children under age four had a respiratory illness during the two weeks before the survey. Of these, 61 percent were taken to a health facility for treatment. Almost half of the children under four were reported to have had a fever and one-fourth were reported to have had diarrhoea in the two weeks preceding the survey. Two-thirds of the children with diarrhoea received some sort of oral rehydration treatment (fluid made from an oral rehydration salts (ORS) packet, a homemade solution, or increased fluids). Almost three out of four mothers know about the use of sugar-salt-water solutions; yet when asked about specific eating and drinking regimes for sick children, only two-thirds say that a child who xvii is sick with diarrhoea should get more to drink and more than half say a child with diarrhoea should be given less to eat than usual. Breastfeeding Practises. The UDHS results indicate that breastfeeding is almost universally practised in Uganda, with a median duration of almost 20 months. Since breastfeeding has beneficial effects on both the child and the mother, it is encouraging to note that supplementation of breast milk starts relatively late in Uganda. In the first two months, only 17 percent of children have received supplements other than water and breast milk. Within 4-5 months, 57 percent of children are given some form of food supplementation. Also encouraging is the fact that there is negligible use of infant formula and that bottlefeeding is not commonly practised. Childhood Nutritional Status. Overall, 38 percent of Ugandan children under age four are classified as stunted (low height-for-age) and 15 percent as severely stunted. About 5 percent of children under four in Uganda are wasted (low weight-for-height); 1 percent are severely wasted. Comparison with other data sources shows little change in these measures over time. Maternal Health Care. UDHS data point to several encouraging areas regarding maternal health care as well as to some areas in which improvements could be made. Results show that most Ugandan mothers receive antenatal care, 10 percent from a doctor and 82 percent from a nurse or trained midwife. Similady, tetanus toxoid coverage is relatively widespread in Uganda; for 80 percent of births in the four years before the survey, the mothers received at least one tetanus toxoid injection during pregnancy. Somewhat less encouraging is the fact that two out of three births in Uganda are delivered at home and over one-third are assisted by relatives or friends. Less than 40 percent of births are assisted by medically trained personnel. Proper medical attention during pregnancy and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness for either the mother or the newborn. AIDS. Virtually all women and men in Uganda are aware of AIDS. About 60 percent of respondents say that limiting the number of sexual partners or having only one partner can prevent the spread of disease. However, knowledge of ways to avoid AIDS is related to respondents' education. Safe patterns of sexual behaviour are less commonly reported by respondents who have little or no education than those with more education. Results show that 65 percent of women and 84 percent of men believe that they have little or no chance of being infected. Availability of Health Services. Roughly half of women in Uganda live within 5 km of a facility providing antenatal care, delivery care, and immunisation services. However, the data show that children whose mothers receive both antenatal and delivery care are more likely to live within 5 km of a facility providing maternal and child health (MCH) services (70 percent) than either those whose mothers received only one of these services (46 percent) or those whose mothers received neither antenatal nor delivery care (39 percent). xviii UGANDA ZAIRE BUNDIBUGYO RUKUNGIRI NTUNGAMO RWANDA SUDAN KAPOHOK'WA KALANGALA 6" ~.=, L~ke V~ KENYA TANZANIA Region Central Eastern Illllll[ltlll Western Northern I - -7 Part of Northern not surveyed XX CHAPTER1 INTRODUCTION 1.1 Geography, History, and the Economy Geography The Republic of Uganda is in East Africa within the equatorial zone with the equator cutting across part of the country. It is a landlocked country bordering Kenya in the East, Tanzania and Rwanda in the South, Zaire in the West and Sudan in the North. The country has an area of 241,039 square kilometres, 18 percent of which is open water and swamps and 12 percent forest and game parks. Uganda has a favourable climate because of its relatively high altitude. The Central and Western Regions of the country have two rainy seasons in a year, with heavy rains from March to May and light rains between September and December. The level of rainfall diminishes towards the North turning into just one rainy season a year. The soil composition varies accordingly, being generally fertile in the Central and Western Regions and becoming less fertile as one moves to the East and the North. Due to these combinations of climatic conditions, Uganda varies between tropical rain forest vegetation in the South and savannah woodlands and semi-desert vegetation in the North. These climatic conditions determine the agricultural potential and thus the land's population carrying capacity, with high population densities in the Central and Western Regions and declining densities towards the North. History Uganda became independent of British colonial rule in October 1962. Uganda had close economic linkages with the other two East African countries of Kenya and Tanzania. This was partly because all three countries were British colonies and used English as an administrative language and partly because the three countries formed the East African Community in the late 1960s. Although the Community broke up in 1977, it was revived in early 1996. The country is composed of many tribal groupings of Bantu, Nilotics, Nilo-Hamites, and those of Sudanese origin. Some of these tribal groupings cut across the boundaries with neighbouring countries causing another natural linkage. Some tribal groups historically constituted monarchies or kingdoms which were abolished in the 1960s, but were recently re-introduced. Luganda is the most widely spoken language, followed by Swahili and English. English is the officiaI language of the country. At present, Uganda is divided into four statistical (not administrative) regions--Central, Eastern, Northern and Western (see map). The country is further divided into 39 administrative districts t, which do not necessarily represent tribal groups. Districts are further divided into counties, sub-counties and parishes. In most cases, parishes are divided into sub-parishes. The above system is administered by appointed chiefs. There is also a system of elected administrators which runs parallel to the above hierarchy called the Local Councils (LCs). Their equivalency is as follows: J At the time of the survey design, there were 38 districts. Ntungamo district was gazetted later. Economy District County Sub-county Parish Village or group of villages - Local Council 5 (LC5) - Local Council 4 (LC4) - Local Council 3 (LC3) - Local Council 2 (LC2) - Local Council 1 (LCI). District - Local Council 5 (LC5) i ne ecofibmy is preuomlnanuy agrlcmturaL With river ")~'perc6ht'tft" (i'id'pupulautm uepenuem un subsistence farming and light agro-based industries. Coffee, tea, and cotton are the major earners of Uganda's foreign exchange. The country is self-sufficient in food. During the period of independence from 1962 to 1970, Uganda had a flourishing economy with a gross domestic product (GDP) growth rate of 5 percent per annum, compared to a population growth rate of 2.6 percent per annum. Between 1979 and 1985, Uganda faced a period of civil and military unrest resulting in the destruction of the economic and social infrastructure. This seriously affected the growth of the economy and the provision of social services such as education and health care. Since 1986, however, the National Resistance Movement Government has introduced and implemented a recovery programme which is steadily moving the country towards economic prosperity. For example, during 1994-95, the economy was projected to have grown by 10 percent per annum, much higher than the previous year when the economy grew by 5.5 percent. In the same period, agricultural production increased by 6.1 percent per annum, of which food crop production increased by 7.7 percent per annum. The manufacturing sector grew by 17.7 percent in 1994-95 compared to 15.2 percent in 1993-94 (Statistics Department, 1995d). 1.2 Demographic Statistics In the past, most demographic statistics in Uganda were derived from population censuses which started in 1948. National surveys have not been major sources of demographic statistics due to the small number that have been conducted. Two relevant surveys are the Demographic and Health Surveys of 1988- 89 and of 1995. Other institutions, particularly Makerere University, have conducted small-scale surveys mainly for research purposes. Civil registration has not frequently been used as a source of demographic statistics because its coverage is incomplete, although it was made compulsory in 1973. Efforts to streamline the system were made between 1974 and 1978, but the achievements that were realised were later frustrated by the economic and civil instability between 1979 and 1985. Concrete plans to revive the civil registration system are now underway. Table 1.1 gives the demographic indices as compiled from the censuses since 1948. The table shows that Uganda's population is growing at a high rate because fertility is still high. Mortality is seen to be declining. Table 1.1 Demographic characteristics Selected demographic indicators, Uganda 1948-1991 Census year Index 1948 1959 1969 1980 1991 Population (thousands) 4,958.5 6,536.6 9,535.1 12,636.2 16,671.7 lntercensal growth rate - 2.5 3.9 2.7 2.5 Sex ratio 100.2 100.9 101.9 98.2 96.5 Crude birth rate 42 44 50 50 52 Total fertility rate 5.9 5.9 7.1 7.2 7.1 Crude death rate 25 20 19 20 17 Infant mortality rate 200 160 120 115 122 Percent urban - 4.8 7.8 8.7 I 1.3 Density (pop/kin 2) 25.2 33.2 48.4 64.4 85.0 Source: Statistics Department, 1995b: 27, 56, 139 1.3 Family Planning Programmes and Population Policy Family planning activities in Uganda started in 1957 with the establishment of the Family Planning Association of Uganda (FPAU), an affiliate of the International Planned Parenthood Federation. Since the inception of the FPAU, family planning services have been largely limited to urban centres, despite the fact that over 80 percent of the population resides in rural areas. With the acceptance and introduction of its primary health care strategy, the government since 1984 has integrated family planning into the overall maternal and child health programme as a means of reducing maternal morbidity and mortality in Uganda. Currently, family planning services are provided through clinics administered by FPAU, government, and non-government health institutions. Available data indicate that most users use oral contraceptives, female sterilisation, injectables and condoms, while few couples use IUDs. Natural family planning has gained some support in Uganda. A natural family planning programme organised by the Uganda Catholic Medical Secretariat covers most dioceses in Uganda and provides services through health units and home visits. In 1994, an integrated reproductive health project catled the Delivery of Improved Services for Health (DISH) was initiated by the Ministry of Health with United States Agency for International Development (USAID) funding. The project goals are to reduce total fertility rates and decrease the incidence of HIV infection in 10 of Uganda's 39 Districts. 2 The objective of the project is to increase the availability and utilisation of basic reproductive health services including family planning, diagnosis and treatment of sexually transmitted diseases, HIV testing and counselling, and maternal health services. In 1995, Uganda adopted the National Population Policy which has as its overall goal to influence future demographic trends and patterns in desirable directions in order to improve the quality of life and standard of living of the people. The policy aims at increasing the contraceptive prevalence rate from 7.8 percent to 15 percent by 2000 (Population Secretariat, 1995:28). The policy has separate targets for demographic trends, for health services, and for other social services. 2 The 10 DISH districts are Jinja, Kampala, Kamuli, Kasese, Luwero, Masaka, Masindi, Mbarara, Ntungamo (included in Mbarara District in the UDHS), and Rakai. 1.4 Health Priorities and Programmes According to the National Population Policy, the goal of achieving adequate health services for the entire population is likely to be made more difficult by the prevailing high levels of fertility and mortality and the recent surge in the acquired immune deficiency syndrome (AIDS) epidemic. The difficulty will be exacerbated by the expected rapid growth in the population of high risk groups, such as children under age five and women of childbearing age. The geographical distribution of health personnel and health facilites in Uganda does not reflect actual needs. The government runs 60 percent of the 1,398 health institutions, but some of the government- run institutions are in-equipped and in a poor state of repair. The policy also notes that other indices of general health care, such as the number of persons per doctor, sources of antenatal care, the number of babies delivered by trained personnel, and the annual average per capita expenditure on health, are still unsatisfactory. 1.5 Objectives of the 1995 Uganda Demographic and Health Survey The 1995 UDHS was a follow-up to a similar survey conducted in 1988-89. In addition to including most of the same questions included in the 1988-89 UDHS, the 1995 UDHS added more detailed questions on AIDS and maternal mortality, as well as incorporating a survey of men. The general objectives of the 1995 UDHS are to: provide national level data which will allow the calculation of demographic rates, particularly fertility and childhood mortality rates; analyse 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 four; antenatal visits; assistance at delivery; and breastfeeding; assess the nutritional status of children under age four and their mothers by means of anthropometric measurements (weight and height), and also child feeding practices; and assess among women and men the prevailing level of specific knowledge and attitudes regarding AIDS and to evaluate patterns of recent behaviour regarding condom use. 1.6 Survey Organisation The 1995 UDHS was conducted between March and August 1995 by the Statistics Department of the Ministry of Finance and Economic Planning in collaboration with the Population Secretariat and the Ministry of Health. Technical assistance was provided by the Demographic and Health Surveys (DHS) Programme of Macro International Inc. in Calverton, Maryland. Financial assistance was provided by USAID. The Ugandan Government provided office accommodation, transport, computers, and professional personnel. 4 Sample Design A sample of 303 primary sampling units (PSU) consisting of enumeration areas (EAs) was selected from a sampling frame of the 1991 Population and Housing Census. For the purpose of the 1995 UDHS, the following domains were utilised: Uganda as a whole; urban and rural areas separately; each of the four regions: Central, Eastern, Northern, and Western; areas in the USAID-funded DISH project to permit calculation of contraceptive prevalence rates. Districts in the DISH project area were grouped by proximity into the following five reporting domains: I. II. III. IV. V. Kasese and Mbarara Districts Masaka and Rakai Districts Luwero and Masindi Districts Jinja and Kamuli Districts Kampala District The sample for the 1995 UDHS was selected in two stages. In the first stage, 303 EAs were selected with probability proportional to size. Then, within each selected EA, a complete household listing and mapping exercise was conducted in December 1994 forming the basis for the second-stage sampling. For the listing exercise, 11 listers from the Statistics Department were trained. Institutional populations (army barracks, hospitals, police camps, etc.) were not listed. From these household lists, households to be included in the UDHS were selected with probability inversely proportional to size based on the household listing results. All women age 15-49 years in these households were eligible to be interviewed in the UDHS. In one-third of these selected households, all men age 15-54 years were eligible for individual interview as well. The overall target sample was 6,000 women and 2,000 men. Because of insecurity, eight EAs could not be surveyed (six in Kitgum District, one in Apac District, and one in Moyo District). An additional two EAs (one in Arua and one in Moroto) could not be surveyed, but substitute EAs were selected in their place. Since one objective of the survey was to produce estimates of specific demographic and health indicators for the areas included in the DISH project, the sample design allowed for oversampling of households in these districts relative to their actual proportion in the population. Thus, the 1995 UDHS sample is not self-weighting at the national level; weights are required to estimate national-level indicators. Due to the weighting factor and rounding of estimates, figures may not add to totals. In addition, the percent total may not add to 100.0 due to rounding. Appendix B contains examples of sampling errors for some of the survey variables. Questionnaires Four questionnaires were used in the 1995 UDHS. A Household Schedule was used to list the names and certain individual characteristics of all usual members of the household and visitors who had spent the previous night in the household. Some basic information was collected on characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. In addition, the Household Questionnaire collected information on characteristics of the household's dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various consumer and durable goods. The Women's Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following topics: Background characteristics (education, residential history, etc.) Reproductive history Knowledge and use of family planning methods Fertility preferences Antenatal and delivery care Breastfeeding and weaning practices Vaccinations and health status of children under age four 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 Adult mortality including maternal mortality Height and weight of children under age four and their mothers. The Men' s Questionnaire was used to collect information from a subsample of men age 15-54 (those living in every third household). The Men's 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. The Service Availability Questionnaire was used to collect community level information on the health and family planning services near each selected LC 1 (see section 1.1 for explanation). An enumeration area sometimes consists of more than one LC1. In such cases, one questionnaire was completed for each of the LC I s within the selected enumeration area. The questionnaires were developed in English by a Steering Committee which was chaired by the Population Secretariat. All except the Service Availability Questionnaire were translated into and printed in six major languages (Ateso, Luganda, Lugbara, Luo, Runyankole/Rukiga, and Runyoro/Rutoro). Training and Fieldwork The 1995 UDHS questionnaires were pretested in November 1994. Fourteen interviewers (seven teams of one female and one male interviewer) were trained for two weeks to implement the pretest. The pretest field work in the six local languages was carried out in seven districts for three days. Approximately 150 pretest interviews were conducted, debriefing sessions were subsequently held with the pretest field staff, and modifications to the questionnaire were made based on lessons drawn from the exercise. Training of field staff for the main survey was conducted over a three-week period in March 1995. Permanent staff from the Statistics Department, guest lecturers, and staff and consultants from Macro International Inc. trained 94 interviewers and data entry operators. Computer operators participated in interviewing during the first rounds of fieldwork to acquaint themselves with the questionnaires. The training course consisted of instruction in general interviewing techniques, field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in areas outside the 1995 UDHS 6 sample points. 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. Fieldwork for the 1995 UDHS started in the fourth week of March and ended in mid- August 1995. Ten interviewing teams were deployed, each consisting of one supervisor/team leader, one female field editor, three female interviewers, one male interviewer, one reserve interviewer of either sex, and a driver. In addition, a senior officer from the Statistics Department was assigned to each of the major languages. Data Processing All the questionnaires for the UDHS were returned to the Statistics Department 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. Data entry and editing were accomplished using the computer program ISSA (Integrated System for Survey Analysis) that was specially designed for the DHS programme. Data processing was performed during April-October 1995. Response Rates A summary of response rates from the household and individual interviews is shown in Table 1.2. Out of 8,093 households selected, 7,671 were occupied, the shortfall being a result mostly of vacant houses. Of the existing households, 7,550 were interviewed, for a response rate of 98 percent. The main reason for non-response was the interviewer's failure to find a respondent at home after at least three visits. In the interviewed households, 7,377 eli- gible women were identified and of these, 7,070 were interviewed, yielding a response rate of 96 percent. In the subsample of households selected for the man's interview, 2,224 eligible men were identified, of which 1,996 were successfully inter- viewed (90 percent response). The principal rea- son for non-response among both eligible men and women was the failure to find them at home de- spite repeated visits to the household. The lower response rate among men than women was due to the more frequent and longer absences of men. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, Uganda 1995 Residence Result Urban Rural Total Household i n te rv iews Households sampled 2,682 5,411 8,093 Households occupied 2,483 5,188 7,671 Households interviewed 2,410 5,140 7,550 Household response rate 97. I 99.1 98.4 Individual interviews Number of eligible women 2,573 4,804 7,377 Number of eligible women interviewed 2,439 4,631 7,070 Eligible woman response rate 94.8 96.4 95.8 Number of eligible men 766 1,458 2,224 Number of eligible men interviewed 657 1,339 1,996 Eligible man response rate 85.8 91.8 89.7 The response rates are lower in urban areas due to long absence of respondents. One-member households are more common in urban areas and are more difficult to interview as they keep their houses locked up most of the time. In urban settings, neighbours often do not know the whereabouts of such people. CHAPTER2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter presents information on some of the socio-economic characteristics of the household population and the individual survey respondents, such as age, sex, marital status, religion, urban-rural residence, and regional distribution. The chapter also considers the conditions surrounding the households in which the survey population live, including source of drinking water, availability of electricity, sanitation facilities, building materials, and persons per sleeping room. 2.1 Population by Age and Sex The 1995 UDHS included a questionnaire to be completed for each household. A household was defined as a person or group of persons that usually live and eat together. Individual socioeconomic characteristics were recorded for all usual residents and visitors who had spent the previous night in the selected households. Table 2.1 shows the distribution of the household population by five-year age groups, according to sex and urban-rural residence. Uganda's population is typically young, showing larger proportions of the population in the younger age groups as clearly seen in the population pyramid (Figure 2.1 ). This implies that as the increasingly larger numbers of women in the younger age groups move into the peak childbearing Table 2.1 Household population by age, residence and sex Percent distribution of the de facto household population by five-year age groups, according to urban-rural residence and sex, Uganda 1995 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 19.4 17.3 18.3 20.1 19.9 20.0 20.0 19.6 19.8 5-9 14.3 15.8 15,1 18.1 17.5 17.8 17.7 17.3 17,5 10-14 11.7 14.0 12.9 15.1 13.8 14.4 14.7 13.9 14.3 15-19 10.4 12,7 11.6 9.0 8.7 8.9 9.2 9.2 9.2 20-24 10.9 12.2 11,6 6.8 8.4 7.6 7,3 8.9 8.1 25-29 9.9 10,1 10,0 6.3 6.8 6.6 6.7 7.2 7.0 30-34 7.3 6.0 6,6 4.8 5.5 5.1 5,1 5.5 5.3 35-39 5.7 4.1 4.9 4.3 4.4 4.4 4.5 4.4 4.4 40-44 3.2 2.4 2.8 3.2 2.6 2.9 3,2 2.6 2.9 45-49 2.3 1.2 1,7 2.3 1.8 2.0 2,3 1.7 2.0 50-54 1.4 1.6 1.5 2.2 3.3 2.8 2.1 3.0 2.6 55-59 0.9 0,7 0.8 2.0 2.0 2.0 1.8 1.8 1.8 60-64 0.8 0.5 0.7 1.7 1.9 1.8 1.6 1.7 1.7 65-69 0.5 0.5 0.5 1.5 1.2 1.3 1.4 1.1 1.2 70-74 0.2 0.3 0.3 0.9 0.9 0.9 0.8 0.8 0.8 75-79 0.1 0.1 0,1 0.6 0.5 0.5 0.5 0,5 0.5 80+ 0.3 0.3 0.3 0.9 0.7 0.8 0,8 0.6 0.7 Missing/Don't know 0.6 0.3 0.4 0.2 0.1 0.2 0.3 0.1 0.2 Total 100.0 100,0 100,0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,002 2,261 4,265 15,238 16,062 31,336 17,240 18,323 35,601 Note: Totals include a small number of persons whose sex was not stated. Figure 2.1 Distribution of the Household Population by Age Age 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 10 5 0 5 10 Percent UDHS 1995 years and start their families, the result will be a high population growth rate for some time to come: The data also show that there are more women than men in Uganda, with women forming 51 percent of the population and men 48 percent. The irregular bulge of women at age 50-54 is indicative of women from ages 45-49 being pushed to the 50-54 age group, perhaps to reduce the workload of the interviewer. There is also an unusually large number of girls age 14 relative to the number age i5 (see Appendix Table C.1), which is presumably due to the same phenomenon. This pattern has been observed in other DHS surveys (Rutstein and Bicego, 1990), but at the levels observed in the UDHS, it probably has little effect on the results. 2.2 Population by Age from Selected Sources The population distribution by broad age groups in Table 2.2 shows that more than half of the population is below 15 years, with a median age of just over 14. Previous censuses or surveys show fairly similar distributions by age. This young population will not only pose constraints on the incomes of their parents, but also on social services like health and education. The dependency ratio I calculated from the 1995 UDHS is 122, which means that there are 1.2 persons under 15 years or over 64 years in Uganda for every person age 15-64 years. 1 The dependency ratio is defined as the sum of all persons under age 15 years and age 65 and over divided by the number of persons age I5-64, multiplied by 100. 10 Table 2.2 Population by age from selected sources Percent distribution of the population by age group, according to selected sources, Uganda, 1969-1995 1995 1995 1969 1988-89 1989-90 199I 1992-93 UDHS UDHS Age group Census UDHS HBS Census IHS (de facto) (de jure) <15 46.2 49.0 50.5 47.3 49.7 51.5 51.4 15-64 50.0 48.6 46.3 49.4 47.0 45.0 45.2 65+ 3.8 2.4 3.2 3.3 3.3 3.3 3.3 Not stated 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Median age 17.2 NA 14.8 16.3 15.7 14.4 14.4 Dependency ratio 100 106 I 16 102 I 13 122 121 NA = Not applicable UDHS = Uganda Demographic and Health Survey HBS = National Household Budget Survey IHS -- National Integrated Household Survey Sources: Statistics Department, 1995b:72 Statistics Department, 1994: Section 1.51.07; Statistics Department, 1991: Table 2.10. 2.3 Household Composition Information about the composition of house- holds is given in Table 2.3. In both urban and rural areas, about three-quarters of the households are headed by males and about one-quarter are female-headed. Households with one or two members constitute one- quarter of all households. This category of households is more common in urban areas (32 percent) than in ru- ral areas (22 percent). There are consistently higher per- centages of larger households in rural than in urban areas. Hence, the mean household size is higher in rural areas (4.8) than in urban areas (4.2). Overall, the aver- age household size is 4.8, identical to the figure deter- mined from the 1991 population and housing census (Statistics Department, 1995c:9). One-quarter of households have foster children, that is, children under age 15 living in a household with neither their biological mother nor father present. The high proportion of households with foster children cer- tainly intensifies the economic burden on the heads of these households. With the current high prevalence of AIDS, the percentage of households with foster children in Uganda is likely to rise even higher. Table 2,3 Household composition Percent distribution of households by sex of head of household, household size, and whether household includes toster children, according to urban-rural residence, Uganda 1995 Characteristic Residence Urban Rural Total Household headship Male 72,3 76.1 75.6 Female 27.7 23.8 24.4 Number of usual members 1 16.3 9.9 10.7 2 16.1 11.6 12.2 3 15.8 14.4 14.6 4 13.0 14.7 14.5 5 12.3 12.8 12.8 6 8.3 11.9 I 1.4 7 6.5 8.8 8.5 8 4.4 6.0 5.7 9+ 7.3 9.8 9.5 Total Mean size 100.0 100.0 100.0 4.2 4.8 4.8 Percent with foster children 26.1 25.0 25.1 Note: Table is based on de jure members, i.e., usual residents. 11 2.4 Fosterhood and Orphanhood Information regarding fosterhood and orphanhood of children under 15 years of age is presented in Table 2.4. Fifty-seven percent of children under 15 years of age are living with both their parents, 18 percent are living with their mothers (but not with their fathers), 6 percent are living with their fathers (but not with their mothers) and 17 percent are living with neither their natural father nor natural mother. Of children under 15 years of age, 10 percent have lost their fathers and 5 percent have lost their mothers. Two percent of children have lost both their natural parents. Table 2.4 Fosterhood and orphanhood Percent distribution of de facto children under age 15 by survival status of parents and child's living arrangements, according to selected background characteristics, Uganda 1995 Living Living with mother with father Not living with Missing/ but not father but not mother either parent Don't Living know if with Father Mother father/ Number both Father Father Mother Mother Both only only Both mother of Characteristic parents alive dead alive dead alive alive alive dead alive Total childlen Age 0-2 72.1 19.6 2.0 I.I 0.3 3.5 0.1 0.4 0.1 0.7 100.0 4.278 3-5 62.2 13.3 3.7 4.5 1.0 10.2 1.3 1.9 0.9 0.9 100.0 4,169 6-8 54.5 10.7 4.5 5.3 2.3 13.5 1.5 4.3 19 1.4 100.0 3,773 9-11 48.1 10.1 6.2 6.0 2.9 15.1 1.6 4.4 3.7 1.9 100.0 3,061 12+ 42.6 9.2 7.8 6.2 3.3 14.5 2.3 6.9 3.6 3.6 I00.0 3,067 Sex Male 57.5 12.9 4.8 4.8 2.1 9.8 1.3 3.3 1.9 1.6 100.0 9,1126 Female 57.2 13.1 4.4 4.1 1.5 11.8 1.2 3.3 1.9 1.6 100.0 9,291 Residence Urban 50.0 14.6 4.7 6.0 1.6 12.2 2.1 4.0 2.9 1.9 100.0 1,977 Rural 58.2 12.8 46 42 1.8 10.7 12 3.2 1.7 1.5 100.0 16,371 Region Central 46.7 13.9 4.6 6.1 2.1 15.4 2.4 4.3 2.9 1.5 100.0 4,794 Eastern 60.9 13.3 27 4.1 1.6 10.9 0.8 2.5 1.2 2.0 100.0 4,421 Northern 61.7 13.3 4.8 2.1 1.8 9.1 0.8 4.0 12 1.2 100.0 3,461 Western 60.7 11.9 59 4.7 1.7 8.0 1.0 2.7 1.9 1.5 100.0 5,672 Total 57.3 13.0 4.6 4.4 1.8 10.8 1.3 3.3 1.9 1.6 100.0 18,348 Note: By convention, fiJster children are those who are not living with either parent. This includes orphans, i.e. children whose parents are both dead. Total includes a few persons whose sex was not stated. 2.5 Educat iona l Level of Household Populat ion Education has many positive effects on an individual's way of life. It affects many aspects of life, including demographic and health behaviour. As will be seen in the rest of this report, educational level is strongly associated with reproductive behaviour, contraceptive use, fertility, and infant and child mortality. Table 2.5 shows the distribution of female and male household members age six and above by the highest level of education ever attended (although not necessarily completed), and the median number of years of education completed according to selected background characteristics. 12 Table 2.5 Educational level of the female and male household population Percent distribution of the de facto female and 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, Uganda 1995 Don't Median Background No edu- know/ years of characteristic cation Primary Secondary missing Total Number schooling FEMALE Age 6-9 36.6 62.3 0.0 1.0 100.0 2,451 0.7 10-14 15.0 82.7 2.0 0.3 100.0 2,539 2.8 15-19 18.6 64.8 16.0 0.7 1{30.0 1,685 5.0 20-24 22.7 60.3 16.3 0.7 100.0 1,626 4.9 25-29 33.7 50.0 15.7 0.6 100.0 1,328 4.3 30-34 43.2 44.9 I1.1 0.8 100.0 1,011 2.7 35-39 40.6 49.2 8.5 1.7 100.0 803 3.0 40-44 49.9 41.8 7 8 0.5 I 0O.0 471 1.0 45-49 55.5 38.3 4.4 1.8 100.0 318 0.0 50-54 73.6 23.2 1.0 2.2 100.0 559 0.0 55-59 79.6 18.8 0.5 I.I 100.0 336 0.0 60-64 76.4 19.6 0.6 3.4 100.0 320 0.0 65+ 85.2 12.7 0.2 1.9 100.0 555 0.0 Missing/Don't know 55.8 283 0.0 15.9 100.0 20 0.0 Residence Urban 15.2 57.7 25.5 17 10O.0 1,795 53 Rural 386 55.8 4.7 0.8 100.0 12,227 1.4 Region Central 20.5 64.6 13.5 1.4 100.0 3,809 3.8 Eastern 34.9 57.5 6.6 1.0 100.0 3,339 1.9 Northern 52.0 438 3.6 0.6 100.0 2,721 0.0 Western 39.2 55.1 49 0.8 100.0 4,154 1.2 Total 35.6 561 74 1.0 100.0 14,022 1.9 MALE Age 6-9 34.0 65.3 0.0 0.7 100.0 2,368 0.7 10-14 9.6 88.7 17 0.0 100.0 2,527 2.9 15-19 7.4 73.6 188 0.3 100.0 1,582 5.4 20-24 86 63.4 26.9 1.1 100.0 1,258 6.5 25-29 107 60.3 27.5 1.5 100.0 1,160 6.6 30-34 14.1 55.9 28.2 1.9 100.0 873 6.5 35-39 166 60.4 21.5 1.6 100.0 777 6.1 40-44 17.8 59.6 18.9 3.7 100.0 554 6.1 45-49 18.4 61.6 18.6 1.4 100.0 390 6.0 50-54 22.3 67.5 7.8 2.4 100.0 370 4.7 55-59 32.2 59.3 7.1 1.4 100.0 319 4.2 60-64 40.1 55.3 2.2 2.4 100.0 279 2.7 65+ 54.8 40.2 2.6 2.4 100.0 607 0.0 Missing/Don't know 15.8 37.1 15.6 31.4 100.0 45 5.8 Residence Urban 7.6 54.3 35.2 2.9 100.0 1,540 6.8 Rural 20.2 69. I 9.7 1.0 100.0 11,569 3.4 Region Central 13.5 63.8 19.7 3.0 100.0 3,501 4.4 Eastern 17.1 702 118 0.9 100.0 3,152 3.7 Northern 20.9 68.1 10.7 0.2 100.0 2,590 3.7 Western 23.4 67.7 8.4 0.4 100.0 3,867 3.1 Total 18.7 67.4 12.7 1.2 100.0 13,110 3.7 13 There is a strong differential in educational attainment between the sexes, especially as age increases. More than one-third of women (36 percent) in Uganda have never been to school, compared to only 19 percent of men. The median number of years of schooling is 1.9 for women and 3.7 for men. Moreover, in almost every age group, there are smaller proportions of men than women with no education and larger proportions of men than women with secondary education. However, over time, the sex differential has been narrowing; differences in educational attainment between school-age boys and girls have become almost insignificant. Education has become more widespread over time in Uganda. This is apparent from the differences in levels of educational attainment by age groups. A steadily decreasing percentage of both males and females have never attended school in the younger age groups. For men, the proportion who have never attended school decreases from 55 percent in the oldest age group (65 years or more) to 10 percent among those age 10-14; for women the decline is more striking, from 85 percent to 15 percent. The relatively high proportion of girls and boys age 6-9 who have never been to school is presumably due to hindrances like long distances to the nearest school and parents who consider these children to be too young to start schooling. Uganda has not yet attained compulsory universal primary education. Educational attainment is higher in urban areas than in rural areas. The percentage with no education is lower and the percentage with secondary education is higher for urban than for rural women and men. Also the median number of years of schooling is higher in urban than rural areas (5.3 vs. 1.4 percent, respectively for women, and 6.8 vs. 3.4 percent for men). The Central Region has the most educated population, with the lowest proportion of both women and men with no education and the highest proportion with secondary education. Interestingly, the Northern Region appears to be the least advantageous for women, with over half of the women in this region having no education. However, men living in the Northern region are not significantly disadvantaged educationally, while those in the Western region have the lowest educational attainment. 2.6 School Enrolment Table 2.6 presents the school enrolment ratios by age group, sex, and residence of the population age 6-24 years. A school enrolment ratio is the number of enrolled persons at a specific age group per hundred persons in that particular age group. Sixty-eight percent of the population age 6-15 are in school; urban Table 2.6 School enrolment Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban- rural residence, Uganda 1995 Age group Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-10 79.5 63.6 65.1 75.9 60.8 62.5 77.5 62.2 63.7 11-15 77.4 77.4 77.4 67.9 67.9 67.9 71.9 72.9 72.8 6-15 78.6 69.6 70.4 72.2 63.7 64.8 75.0 66.7 67.6 16-20 40.5 38.1 38.5 22.7 12.5 14.3 30.1 24.5 25.4 21-24 15.0 11.8 12.4 4.6 2.8 3.1 9.4 6.7 7.2 14 enrolment (75 percent) is higher than rural enrolment (67 percent). Urban enrolment is also higher for those in age group 16-24. Figure 2.2 shows that the ratio of school enrolment is nearly the same for boys as well as girls in age group 6-10, but that girls tend to drop out at an earlier stage than boys. By age 21-24, 3 percent of women and 12 percent of men are still in school. Figure 2.2 Percentage of the Population Age 6-24 Enrolled in School by Age and Sex Percent IO0 80 6O 40 20 0 6-10 11-15 '~6-20 21-24 Age Group UDHS 1995 2.7 Housing Characteristics Respondents were asked questions about certain characteristics of their households, including electricity, source of drinking water, time to water source, type of toilet facility, floor materials, number of rooms used for sleeping, use of iodised salt, and basic assessment of consumption. Information on these characteristics is useful from a public health point of view, as well as indirectly in reflecting the household' s socio-economic status. This information on housing characteristics is given in Table 2.7. Only 7 percent of Ugandan households have electricity. Access to electricity is concentrated in urban areas, where 40 percent of the households have electricity, compared to a mere 2 percent of rural households. The source of drinking water is important since waterborne diseases, including diarrhoea and dysentery, are numerous in Uganda. Sources of water expected to be relatively free of these diseases are piped water, boreholes, springs, rainwater, and bottled water. Other sources like wells, rivers and streams, ponds and lakes, and gravity water are more likely to carry one or more of the above diseases. Table 2.7 shows that only 7 percent of all households in Uganda have access to piped water; 45 percent of urban 15 Table 2.7 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Uganda 1995 Residence Characteristic Urban Rural Total Electricity Yes 40.2 1.5 6.8 No 59.7 98.4 93.2 Missing/Don't know 0.1 0.1 0.1 Total 100.0 100.0 100.0 Source of drinking water Piped into residence 12.7 0,1 1.8 Public tap 31.9 1.0 5.2 Well ill residence 0.8 0.1 0.2 Public well 17.9 23.2 22.5 Borehole 13.5 17.0 16.6 Spring 17.8 25,8 24.7 River/stream 1.3 15.3 13.4 Pond/lake 1.0 15.2 13.3 Gravity flow scheme 1.2 1.5 1.5 Rainwater 0.4 0.4 0.4 Bottled water 0.2 0.0 0.0 Other 1.4 0.2 0.4 Missing/Don't know 0.0 0,1 0.1 Total 100.0 100.0 100.0 Time to water source (minutes) <15 minutes 49.6 16.3 20.8 Median time to source 15.0 30.6 30.5 Sanitation facility Own flush toilet 6,3 0.1 0.9 Shared flush toilet 3.0 0.2 0.6 Traditional pit toilet 80,1 76.2 76.8 Vcntilaled improved pit latrine 6.2 0.9 1.6 No lacilily/bush 2,8 21.9 19.4 Olhcr 1.6 0.5 0,6 Missing/Don't know 0.1 0.1 0.1 Total 100.0 100.0 100.0 Floor material Earth/sand 27.7 69.3 63.7 Dung 5.2 23.4 20.9 Parquet/polished wood 0.3 0,0 0.1 Vinyl/asphalt strip 0.7 0.0 0.1 Ceramic tiles 0.2 0.0 0.0 Cement 65.5 6.8 14.7 Other 0.1 0.1 0.1 Missil'~g/Don't know 0.2 0.4 0.3 Total 100.0 100.0 100.0 Table 2.7--Continued Percent distribution of households by housing characteristics, according to urban-rural residence, Uganda 1995 Characteristic Residence Urban Rural Total Persons per sleeping room 1-2 47.0 51.7 51.1 3-4 34.1 33.4 33.5 5-6 13.5 10.2 10.6 7+ 4.6 3.9 4.0 Missing/Don't know 0.7 0.8 0.8 Total 100.0 100.0 100.0 Mean persons per room 3.0 2.9 2.9 Iodine reading (parts per million) 0 8.5 34.4 30.9 25 3.3 8.0 7.3 50 7.3 9.2 9.0 75 44.9 25.3 27.9 100 32.5 19.2 21.0 Missing/Don't know 3.6 3.9 3.8 Total 100.0 100.0 100.0 Level of household food consumption Surplus 4.0 2.2 2.4 Not surplus or deficit 38.0 21.5 23.7 Occasionally deficit 37.0 39.1 38.8 Always deficit 20.6 37.0 34.8 Don't know 0.0 0.1 0.1 Missing 0.4 0.2 0.2 Total 100.0 100.0 100.0 Number of households 1,020 6,530 7,550 16 households and only one percent of rural household have access to piped water. Over 40 percent of rural households get their drinking water from boreholes and springs, while 31 percent use less safe sources such as rivers, ponds, and lakes. In urban areas, half of the households can draw water within 15 minutes, compared to only 16 percent of rural households. Households with no toilet facilities are more exposed to the risk of diseases like dysentery, diarrhoea, and typhoid fever. Overall, about one in five Ugandan households have no toilet facilities. This problem is more common in rural areas, where 22 percent of the households had no toilet facilities, as compared to 3 percent of households in urban areas. Most households (77 percent) in Uganda use traditional pit toilets; this is true in both urban and rural areas. The type of material used for the floor may be viewed as an indicator of the quality of housing as well as an indicator of health risk. Some flooring materials like earth, sand, and cow dung may pose a health problem since they may be breeding grounds for pests like ticks and jiggers and may be a source of dust. They are also difficult to keep clean since they are not washable. Almost all rural households (93 percent) have floors made of earth, sand, or cow dung, compared to only 33 percent of urban households. On the other hand, 66 percent of the households in urban areas have cement floors, compared to only 7 percent of the households in rural areas. In general, rural households have poorer quality floors than urban households. The more luxurious floors such as those made from tiles, vinyl, or wood account for a negligible percentage of the households. The 1995 UDHS collected data on the number of rooms used for sleeping. The number of persons per sleeping room is a measure of overcrowding. There is an average 2.9 persons per sleeping room. Lack of a sufficient amount of iodine in the diet can lead to major nutritional deficiencies such as goiter, nutritional stunting, mental retardation, and cretinism. Many foods, particularly in the mountainous and flood-prone districts, lack natural iodine such that the population has started showing the effects of iodine deficiency and an increased prevalence of goiter. The government therefore initiated a campaign in December 1994 to introduce iodine in salt in order to overcome this deficiency. In order to evaluate this program, UDHS interviewers tested salt from each household for its iodine content. 2 The tests indicated that 31 percent of Ugandan households use un-iodised salt, while 69 percent of households use salt with iodine content. Among the urban households surveyed, the proportion that use iodised salt is 88 percent compared with 62 percent in rural households. The Ugandan government has undertaken a campaign to implement iodine coverage in 90 percent of the households by the year 2000. In the 1995 UDHS, respondents were asked whether they thought their household was a surplus or deficit household in terms of food consumption. Over one-third of Ugandan households indicated that they always have a shortage of food, while another 39 percent have occasional deficits. Only one in four households in Uganda were reported as having either enough or a surplus of food. Food deficits are more common among rural than urban households. Thirty-seven percent of rural households reported that their level of food supply was always in deficit, compared to 21 percent of urban households. 2.8 Household Durable Goods Respondents were asked about the household ownership of particular durable goods. Ownership of radio and television is a measure of access to mass media; telephone ownership measures access to an 2 Tests involved putting a small amount of salt on a piece of paper and then putting a drop of a special solution onto the salt and recording the intensity of the blue color that appears. Test kits were supplied by UNICEF/Uganda. 17 efficient means of communication; 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. Radio is a more widespread medium in Uganda than television, with almost 40 percent of households having a radio, compared to only 3 percent with a television. Both radio and television ownership is higher in urban than rural households; 67 percent of urban households and 33 percent of rural households own a radio and 17 percent of urban households and less than 1 percent of rural households own a television. Telephone service and ownership of refrigerators are extremely low and only available in urban households. Table 2.8 shows that slightly over one-third of households own bicycles. Bicycles are more common in rural areas, while cars and motorcycles are almost exclu- sively owned by urban households. About half of the ru- ral households and 27 percent of the urban households do not own any of the above durable goods. 2.9 Background Characteristics of Respondents Background characteristics of the 7,070 women and 1,996 men interviewed individually in the UDHS are presented in Table 2.9. 3 The age distribution of the respondents shows a similar pattern for women and men, with the proportion of respondents in each group declining with increasing age. Forty-five percent of women and 38 percent of men are in the range 15-24, and 32 percent of women and 31 percent of men are in the 25-34 year age group. Table 2,8 Household durable goods Percentage of households possessing various durable consumer goods, by urban-rural residence, Uganda 1995 Residence Durable good Urban Rural Total Radio 67.2 32.8 37.5 Television 17.3 0.6 2.9 Telephone 2.4 0.1 0.4 Refrigerator 4.8 0.1 0.7 Bicycle 24.5 35.7 34.2 Motorcycle 1.7 0.6 0.7 Private car 5.4 0.7 1.3 None of the above 26.8 51.0 47.7 Number of households 1,020 6,530 7,550 About 85 percent of both women and men live in rural areas, while 15 percent live in urban areas. Respondents are roughly equally divided among the four regions, with slightly more living in Central region. Three in I 0 respondents live in areas covered by the DISH project (see Chapter I for description of the DISH project). The proportion of women who have never attended school is more than twice that of men (31 vs. 12 percent). Seventy-three percent of women, compared with 63 percent of men are either currently married or living with partners. Male respondents were much more likely than female respondents to have never married (30 vs. 16 percent). Forty-four percent of women respondents are Catholic, while 40 percent are Protestant and 12 percent are Muslim; male respondents had a similar distribution by religion. 3 Throughout the report, comparisons between men and women are affected by the different age limits used. 18 Table 2.9 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Uganda 1995 Women Men Number of women Number of men Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted Age 15-19 22.7 1,606 1,624 19.4 387 375 20-24 22.0 1,555 1,567 18.4 367 379 25-29 18.0 1,270 1,323 18.0 359 381 30-34 13.8 976 987 13.0 259 256 35-39 11.1 783 743 12.5 250 249 40-44 7. I 499 475 8.1 162 158 45-49 5.4 380 351 5.9 118 109 50-54 NA NA NA 4.7 95 89 Residence Urban 14.9 1,055 2,439 14.1 281 657 Rural 85.1 6,015 4,631 85.9 1,715 1,339 Region Central 27.8 1,967 2,218 28.5 568 641 Eastern 24.6 1,738 1,911 24.9 497 546 Northern 19.7 1,398 1,136 21.0 419 331 Western 27.8 1,968 1,805 25.6 51 I 478 DISH project region Kasese, Mbarara (I) 8.0 564 632 7.9 159 175 Masaka, Rakai (It) 6.7 476 520 6.9 138 152 Lawero, Masindi (Ill) 3.1 222 197 3.6 672 63 Kamuli, Jinja (IV) 4.8 341 601 4.2 85 164 Kampala (V) 7.1 502 541 7.1 141 155 Non-DISH district 70.2 4,494 4,579 70.2 1,401 1,287 DISH district 29.8 2,106 2,491 29.8 595 709 Education No education 30.6 2,161 1,808 I 1.6 232 199 Primary 56.0 3,956 3,901 63.1 1,259 1,174 Secondary+ 13.5 952 1,361 25.3 504 623 Current marital status Never married 15.7 1,107 1,272 29.7 592 610 Currently in union 72.6 5,134 4,898 62.7 1,252 1,241 Past union I 1.7 825 899 7.6 152 145 Missing 0.1 5 1 0.0 0 0 Religion Catholic 43.8 3,096 2,994 46.7 931 900 Protestant 40.4 2,853 2,860 40.6 811 833 Muslim 1 1.8 836 899 9.7 193 199 Seventh Day Adventist 1.3 93 108 0.9 18 22 Other 2.7 189 206 1.9 38 37 Total 100.0 NA = Not applicable 7,070 7,070 100.0 1,996 1,996 t9 2.10 Characteristics of Couples Because the men who were interviewed indi- vidually in the UDHS were selected from the same households 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 repre- sent all married (or cohabiting) couples in Uganda, since not all couples live together. Nevertheless, the sample of 1,109 couples can be viewed as a reasonable reflection of men and women who are living together. Table 2.10 presents data on the age and education at- tainment between spouses? In one-third of Ugandan couples, the husband is 0-4 years older than his wife, while in 37 percent of couples, the husband is 5-9 years older than his wife. In only 8 percent of the couples, the wife's age was older than her husband's. On average, men are a little more than six years older than their wives. In the majority of couples (60 percent), both spouses have at least some education. In 29 percent of couples, the husband has some education and the wile has none, while in only 4 percent of the couples, the wife has some education and the husband none. Cases in which neither spouse has been to school make up 7 percent of all the couples. Table 2.10 Differential characteristics between spouses Percent distribution of couples by differences between spouses in age and level of education, Uganda 1995 Number Percent/ of Years couples Age difference (percent) (husband minus wife) Wife older 8.0 88 0-4 years 33.5 371 5-9 years 37.1 411 10-14 years 15.4 171 15 years + 6.1 67 Mean age difference (years) 1st wife 6,2 1,073 2nd wile+ (10.1) 36 Education (percent) Both husband and wife not educated 7.4 82 Wife educated, husband not 4.2 46 Husband educated, wife not 28.5 315 Both husband and wife educated 60.0 665 Total 100.0 1,109 Note: Figures in parentheses are based on 25-49 unweighted cases. 2.11 Educational Level of Survey Respondents Table 2.11 shows the percent distributions of female and male respondents by highest level of education attended, according to age, urban-rural residence, and region. The percentage of women with no education rises with age, from 17 percent in the 15-19 age group to 53 percent in the age group 45-49. This means that the younger women have had better chances of education than the older women. This is again reflected by the higher percentage of you nger women with some secondary education ( 16 percent), compared with the 45-49 age group (4 percent). Rural women are educationally disadvantaged compared to urban women. Over one-third of rural women age 15-49 have no education, compared to only 11 percent of urban women. Conversely, 40 percent of urban women have been to secondary school, compared to only 9 percent of rural women. Women living in the Central region are better educated than those living in other regions, while those living in the Northern region are the least well-educated. As mentioned before, men are generally better educated than women. While 31 percent of women age 15-49 have had no formal education, only 12 percent of men age 15-54 have had no schooling. Unlike 4 Data on age and educational attainment were taken from the respondent's questionnaire and not from what his/her spouse reported. 20 Table 2.11 Level of education by background characteristics Percent distribution of respondents by highest level of education attended, according to 1995 age, residence, and region, Uganda Level of education: women Level of education: men Background No Number No Number characteristic education Primary Secondary+ Total of women education Primary Secondary+ Total of men Age 15-19 16.5 67.2 16.2 100.0 1,606 4.4 67.7 27.9 100.0 387 20-24 22.2 61.8 16.0 100.0 1,555 10.0 60.1 29.9 100.0 367 25-29 31.6 52.8 15.7 100.0 1,270 I 1.7 64.6 23.8 100.0 359 30-34 38.8 49.2 12.0 100.0 976 9.6 56,5 33.9 100.0 259 35-39 41.9 48.5 9.6 100.0 783 16.2 61.1 22.7 100.0 250 40-44 48.2 44.7 7.1 100.0 499 17.7 63.5 18.8 100.0 162 45-49 53.3 42.4 4.3 I00.0 380 21.6 65.3 13.1 100.0 118 50-54 NA NA NA NA NA 17.7 70.6 11.7 100.0 95 Residence Urban 10.6 49.8 39.7 100.0 1,055 5.4 37.5 57.2 100.0 281 Rural 34.1 57.0 8.9 100.0 6,015 12.6 67.3 20.1 100.0 1,715 Region Central 14.4 62.0 23.6 100.0 1,967 9.7 52.3 38.0 100.0 568 Eastern 29.6 58.4 12.0 100.0 1,738 12.2 65.1 22.7 100.0 497 Northern 47.6 46.0 6.5 100.0 1,398 9.8 69.3 20.9 100.0 419 Western 35.6 54.8 9.5 100.0 1,968 14.7 68,1 17.2 100.0 511 Total 30.6 56.0 13.5 100.0 7,070 I 1.6 63.1 25.3 I00.0 1,996 NA = Not applicable women, the proportion of men with no education does not seem to follow any clear pattern by age group, although the proportion with some secondary education does show a clear increase among younger men. The urban-rural distribution of educational attainment for males is similar to that of females. Similar to women, men in the Central Region are most likely to be educated; however, men in the Western Region appear to be the least educated. 2.12 School Attendance and Reasons for Leaving School Women age 15 to 24 years who had ever been to school, but who were not currently attending school were asked in the UDHS why they had stopped attending school. One of the most important determinants of a woman's social and economic status is her level of education. Knowledge of the reasons why women leave school can provide guidance for policies designed to enhance women's status. Table 2.12 shows the percent distribution of women age 15-24 who had ever been to school by whether they were currently attending school and if not, the reason for stopping, according to the highest level of school attended. Of those who left school, the vast majority reported that they left because they could not afford the fee. This is especially tree for those women who left without completing primary school and those who completed primary but did not continue. Once women start attending secondary school, school costs are still the primary reason for leaving, but 15 percent of women who left school after starting secondary did so because they were pregnant. 21 Table 2.12 School attendance and reasons for leaving school Percent distribution of women age 15-24 who have ever attended school by whether currently attending school and, if not, the reason tot leaving school, according to highest level of education attended, Uganda 1995 Educational attainment Reason for Incomplete Complete Incomplete leaving school primary primary secondary Total Currently attending 8.6 6.6 42.9 14.9 Got pregnant 4.0 6.4 14.5 6.3 Got married 4.4 7.0 2.5 4.3 Take care of younger children 2.2 0.0 0.4 1.6 Family need help 1.7 0.4 0.0 1.2 Could not pay school fees 68.0 70.7 31.6 61.4 Need to earn money 0.3 0.8 0.3 0.4 Graduated/enough school 0.0 0.0 2.3 0.4 Did not pass exams 0.5 1.8 1.3 0.8 Did not like school 3.1 3.0 1.0 2.7 School not accessible 0.3 0.0 0.0 0.2 Other 4.8 2.5 1.8 4.0 Don't know/missing 2.1 0.8 1.4 1.8 Total 100.0 100.0 100.0 100.0 Number 1,757 285 483 2,525 Note: Excluded are 22 women who completed secondary school. 2.13 Exposure to Mass Media In the 1995 UDHS, respondents were asked if they usually read a newpaper at least once a week and how often they watch television and listen to the radio. It is important to know which groups of people are more or less likely to be reached by the media for purposes of planning health and family planning programmes. Table 2.13 shows the percentage of female and male respondents exposed to different types of mass media by age, urban-rural residence, region, and level of education. Results show that 19 percent of women and 34 percent of men read newspapers or magazines at least once a week, while only 6 percent of women and 4 percent of men watch television at least once a week and 33 percent of women and 61 percent of men listen to the radio every day. Three percent of respondents (both male and female) access all three media. However, 60 percent of women and 32 percent of men do not use any of these mass media. Access to media is somewhat higher among younger women and men and among those living in urban as opposed to rural areas. As expected, educated persons are more likely to read the newspaper, watch television, and listen to the radio than less educated persons. 22 Table 2.13 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 radio daily, by selected background characteristics, Uganda 1995 Women Men Mass media Mass media Read Watch Listen Read Watch Listen No news- tele- to All Number No news- tele- to All Number Background mass paper vision radio three of mass paper vision radio three of characteristic media weekly weekly daily media women media weekly weekly daily media men Age 15-19 56.8 22.7 8.2 33.4 4.1 1,606 31.4 28.5 4.8 43.6 2.4 387 20-24 58.1 19.2 5.7 35.3 3.5 1,555 31.3 32.7 5.5 46.0 5.0 367 25-29 57.3 19.7 5.9 36.1 3.5 1,270 34.8 31.6 2.7 35.7 2.5 359 30-34 61.5 17.9 4.3 33.3 3.0 976 25.7 46.3 4.4 44.9 3.0 259 35-39 62.3 19.5 3.5 30.2 2.3 783 32.9 36.7 4.0 42.9 3.2 250 40-44 64.9 14.5 3.1 29.4 1.6 499 36.2 31.6 2.0 37.9 1.2 162 45-49 65.4 14.3 1.9 28.3 1.4 380 28.6 32.8 1.5 48.0 1.5 118 50-54 NA NA NA NA NA NA 43.9 31.0 1.4 38.0 1.4 95 Residence Urban 26.7 45.1 26.2 59.4 14.9 1,055 7.8 68.8 23.7 73.5 18.8 281 Rural 65.2 14.8 1.8 28.8 1.1 6,015 36.3 28.1 0.6 37.1 0.3 1,715 Region Central 28.4 39.4 15.3 60.8 9.6 1,967 17.3 45.0 10.0 59.6 7.5 568 Eastern 67.4 12.0 3.5 26.8 1.5 1,738 42.1 23.6 2.8 40.6 2.3 497 Northern 80.5 8.4 0.1 15.5 0.0 1,398 35.4 42.6 0.0 27.1 0.0 419 Western 68.6 13.6 1.1 24A 0.6 1,968 36.7 24.0 1.1 36.9 0.6 511 Education No education 84.4 0.8 0.5 15.(I 0.0 2,161 61.6 0.4 0.2 23.0 0.0 232 Primary 55.4 19.5 4.3 36.6 2.1 3,956 36.1 25.1 1.4 35.8 0.8 1,259 Secondary+ 19.9 60.7 21.4 61.7 14.9 952 9.3 70.8 I 1.5 67.2 9.4 504 Total 59.5 19.3 5.5 33.4 3.2 7,070 32.3 33.8 3.8 42.2 2.9 1,996 NA = Not applicable 2.14 Employment The 1995 UDHS collected information from women regarding their current employment situation. Table 2.14 shows that 39 percent of women are not working, while 61 percent are employed, with 42 percent employed all year, 16 percent employed seasonally, and 3 percent employed occasionally. There are proportionally more women who work seasonally in rural areas (17 percent) than in urban areas (9 percent). However, urban and rural women are almost equally likely to be working full-time (40 vs. 38 percent). Regional differences show that women in the Northern Region are by far the least likely to be working, with over three-quarters not currently employed. Regular full-time work tends to increase and seasonal work decreases with increasing level of education. 23 Table 2.14 Employment Percent distribution of women by employment status and continuity of employment, according to background characteristics, Uganda 1995 Not currently employed Currently employed Did not work Worked All year in last in Background 12 last 12 5+days <5 days Season- Occasion- characteristic months months per week per week ally ally Missing Total Number Age 15-19 47.5 4.8 29.5 2.7 12.8 2.6 0.1 100,0 1,606 20-24 37,3 2.8 36.9 4.2 16.6 2.2 0.0 100.0 1,555 25-29 34,5 2.1 40.3 3.8 15.7 3.6 0.1 100.0 1,270 30-34 29.2 2.3 42.4 3.9 19.5 2.8 0.0 100.0 976 35-39 28.7 1.3 43.2 5.6 18.0 3.2 0.0 100.0 783 40-44 33.9 0.6 42.1 5.1 16. I 2.1 0.2 100.0 499 45-49 29.9 0.4 46.6 4.3 15.7 2.9 0.1 100.0 380 Residence Urban 40.9 3.4 39.9 3.6 8.6 3.3 0.3 100.0 1,055 Rural 35.6 2.5 37.9 4.0 17.3 2.7 0.0 100.0 6,015 Region Central 32.8 3.9 45.4 3.3 l 1,9 2.6 0.1 100.0 1,967 Eastern 18.9 1.3 43.2 2.9 31.3 2.4 0,1 100.0 1,738 Northern 74.9 1.7 4.8 2.8 10.2 5.5 0.0 100.0 1,398 Western 281 3.1 50.2 6.4 10.9 1.3 0.0 100,0 1,968 Education No education 39.4 1.3 35.5 3,4 17,9 2.5 0,0 100.0 2,161 Primary 34.9 2.7 38.4 4.4 16.5 2.9 0.1 100.0 3,956 Secondary+ 35.8 5. I 43.0 3.4 9.9 2.6 0. I 100.0 952 Total 36.4 2,6 38.2 4.0 16.0 2.8 0.1 100.0 7,070 2.15 Employer and Form of Earnings According to Table 2.15, two-thirds (67 percent) of employed women age 15-49 are self-employed, about half of whom earn cash and half of whom do not. Nine percent of women are employed by non- relatives and almost all earn cash. Twenty-two percent of employed women work for relatives; half of them earn cash for their work. Urban women who work are less likely to be self-employed and more likely to work for non-relatives than are rural women. Working women in the Western region are much more likely to be self-employed (85 percent) than women in the other regions (47-71 percent) and women in the Central region are most likely to earn cash for their work. About 70 percent of employed women with no education or with primary education are self-employed, compared to less than half of those with secondary or higher education. 24 Table 2.15 Employer and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to background characteristics, Uganda 1995 Employed by Employed by Self-employed a non-relative a relative Does Does Does Background Earns notearn Earns notearn Earns notearn characteristic cash cash cash cash cash cash Missing Total Number Age 15-I9 25.3 27.9 7.5 0.7 13.2 17.2 8.2 100.0 765 20-24 31,3 35.8 7.5 l.l 12.2 11.8 0.4 100.0 931 25-29 31.6 37.4 9.9 0.8 I 1.6 8.7 0.0 100.0 805 30-34 34.1 38.6 9.0 1.2 9.4 7.7 0.0 100.0 669 35-39 36.3 36.9 8.8 1.0 9.9 7.1 0.0 100.0 549 40-44 31.5 40.5 6.6 0.0 l 1.3 9.5 0,6 100.0 327 45-49 39.0 35.9 3.9 0.0 I 1.2 9.9 0. l 100.0 265 Residence Urban 38.2 12.5 33,2 0,7 8.4 4.3 2.6 100.0 586 Rural 30.8 39.3 4.1 0.8 I 1.9 I 1.6 1.4 100.0 3,724 Region Central 42.2 5.2 17.3 0.3 24.6 6.9 3.6 100.0 1,245 Eastern 32.0 39.2 3.3 1.8 5.0 17.5 1.2 100.O 1,386 Northern 34.7 22.8 10.9 0.5 18.7 12.4 0.0 100.0 326 Western 21.4 63.1 3.8 0.5 4.1 6.6 0.6 100.0 1,353 Education No education 27.2 45.2 3.9 0.9 10.0 12.8 0.0 100.0 1,281 Primary 34.5 34.9 5.3 0.9 I2.5 10.8 l.l 100.0 2,466 Secondary+ 30.8 17.0 29.6 0.4 9.8 4.9 7.5 100.0 563 Total 31.8 35.6 8.1 0.8 11.4 10,6 1.6 100.0 4,310 2.16 Occupation Table 2.16 gives the percent distribution of women age 15-49 who are employed by current occupation and the type of agricultural land worked, according to background characteristics. Most employed women (72 percent) are occupied in agriculture, almost all of whom work on family land or their own land. Only 27 percent of working women have non-agricultural jobs and half of these women are engaged in sales or services. As expected, employment in non-agricultural occupations is relatively more common among women who live in urban areas and among those who have more formal education. Around 85 percent of the women in the Eastern and Western Regions are engaged in agriculture, compared to 53 percent in the Central Region. In the Northern Region, only 37 percent of employed women are engaged in agriculture, though it should be noted that less than one in four women in the Northern Region are employed. 25 Table 2.16 Occupation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of non- agricultural employment, according to background characteristics, Uganda 1995 Agricultural Non-agricultural Prof. Household Number Background Own Family Rented Other's tech./ Sales/ Skilled and of characteristic land land land land manag, services manual domestic Other Missing Total women Age 15-19 10.7 49.5 4.3 3.0 0.3 12.4 6.0 3.4 10.0 0.4 100.0 765 20-24 17.7 48.6 5.0 4.2 3.5 13.3 5.5 1.0 0.5 0.8 100.0 931 25-29 14.2 41,6 4.9 6.1 5.4 17.8 8.8 0.2 0.2 0.9 100.0 805 30-34 18.4 40.7 6.3 6.6 4.1 14.3 8.0 0.5 0.0 1.0 100.0 669 35-39 16.0 48.5 6.2 4.5 5.5 12.2 5.4 0.6 0.0 1.1 100.0 549 40-44 19.5 48.9 5.7 1.4 5.7 12.0 5.6 0.0 0.0 1.4 100.0 327 45-49 24.4 51.0 4.5 4.4 1.5 7.3 6.2 0.1 0.4 0.1 100.0 265 Residence Urban 2.8 9.1 1.1 2.9 15.0 45.7 11.1 5.5 4.1 2.7 100.0 586 Rural 18.4 52.2 5.9 4.8 1.9 8.5 5.9 0.3 1.6 0.5 100.0 3,724 Region Central 9.7 36.7 0.8 5.8 6.5 22.6 9.4 2.6 4.1 1.7 100.0 1,245 Eastern 22.1 47.3 12.1 3.1 2.1 7.7 3.2 0.4 1.4 0.6 100.0 1,386 Northern 7.2 23.6 1.0 5.4 6.3 30.3 24.9 0.1 0.4 0.8 100.0 326 Western 18.4 59.8 3.3 4.6 2.1 7.2 3.1 0.4 0.9 0.2 100.0 1,353 Education No education 20.8 54.1 5.6 5.8 0.3 7.0 5.0 0.5 0.1 0.8 100.0 1,281 Primary 16,0 48.6 5.9 4,0 0.8 14.1 7.3 1.4 1.3 0.8 100.O 2,466 Secondary+ 6.8 18.8 1.7 4.2 24.0 26.1 7.3 0.6 9.3 1.2 100.0 563 Total 16.2 46.4 5.2 4.5 3.7 13.6 6.6 1.0 2.0 0.8 100.0 4,310 Note: The "professional, technical, managerial" category includes professional, technical, clerical and managerial occupations. 2'.17 Person who Decides on Use of Earnings Information on who decides how to use the cash earned by employed women can be used as a measure of the status of women, particularly independence in decision making and control over resources. Table 2.17 shows that the majority of women who receive cash for work (65 percent) decide for themselves on how to spend the money, while 17 percent decide jointly with their partners as to how to spend their salaries. In only 14 percent of the cases, women say that the decision as to how to spend their money is made by their partners. As expected, urban and more educated women are more likely to decide for themselves how to spend their earnings. 26 Table 2.17 Decisions on use of earnings Percent distribution of women receiving cash earnings by person who decides on use of earnings, according to background characteristics, Uganda 1995 Person who decides how earnings are used Jointly with Jointly Background Self Husband/ husband/ Someone with characteristic only partner partner else someone Missing Total Number Age 15-19 56.4 17.2 12.0 7.3 6.5 0.6 100.0 351 20-24 59.5 17.2 21.0 0.7 1.6 0. I 100.0 474 25-29 65.7 14.5 19.2 0.0 0.5 0.1 100.0 427 30-34 69.0 12.6 17.5 0.0 0.5 0.4 100.0 351 35-39 67.0 15.1 16.7 0.2 0.9 0.0 100.0 302 40-44 76.1 5.6 17.0 1.4 0.0 0.0 100.0 162 45-49 74.8 8.9 14. I 0.0 2.2 0.0 100.0 143 Residence Urban 83.3 6.1 7.9 1.3 1.0 0.5 100.0 468 Rural 60.0 16.5 19.8 1.5 2.1 0.1 100.0 1,743 Region Central 71.7 10.1 14.2 1.3 2.5 0A I00.0 1,046 Eastern 55.3 20.0 21.6 1.7 1.5 0.0 100.0 559 Northern 65.5 19.0 12.0 2.5 0.8 0.3 100.0 210 Western 60.4 14.8 22.3 0.8 1.2 0.5 100.0 396 Education No education 56.9 20.2 20.0 0.9 1.7 0.3 100.0 527 Primary 65.2 13.1 17.4 1.9 2.2 0.1 100.0 1,289 Secondary+ 74.7 10.3 13.4 0.7 0.7 0.2 100.0 395 Marital status Currently married 54.7 20.0 24.5 0.1 0.5 0.2 100.0 1,564 Not married 89.6 0.5 0.0 4.8 5. I 0.1 100.0 647 Total 64.9 14.3 17.3 1.4 1.8 0.2 100.0 2,211 2.18 Child Care While Working Table 2.18 presents the distribution of employed women by whether they have a child under six years of age, and if so, the type of caretaker used by the mother while at work. Sixty-three percent of employed women have a child under six years of age. About half of these women look after their own children while at work, while 23 percent leave their children in the care of another child, either female or male. Fourteen percent of working mothers with pre-school age children have relatives who look after their children. In urban areas, 17 percent of employed mothers have servants or hired child caretakers, compared with only one percent of those in rural areas. Educated women are more likely to have employed a child caretaker than less educated women. Over one-third of working women in the Eastern and Northern Regions leave their pre- school age children with other children. 27 Table 2.18 Child care while working Percent distribution of employed women (i.e., worked in the last 12 months) by whether they have a child under six years of age, and the percent distribution of employed mothers who have a child under six by person who cares for child while mother is at work, according to background characteristics, Uganda 1995 Employed women Child's caretaker, among employed mothers who have children <6 years Child One or is in more Hns- school/ Number No chil- Re- band/ Other insti- Other Other of Background child dren spond- part- rela- Neigh- Hired tu6onal female male employed characteristic <6 <6 eat net tire bor Friend help care child child Other Missing Total mothers Residence Urban 51.4 48,6 39.1 08 17.7 65 I.I 16.9 2.0 76 2.0 1.8 4.6 1000 586 Rural 34.5 65.5 51.0 11 140 2.3 0.2 1,4 0.4 17,8 6.9 2,4 2.5 100 .0 3.724 Region Central 43.0 57.0 59.5 03 13.5 3.7 0.3 5.8 0,7 7.7 4.0 1.6 2.7 1000 1.245 Eastern 33.2 66.8 41.3 09 15,1 2,6 0.5 1.8 0.2 22.4 8.4 4.1 2.8 100.0 1.386 Northern 38.7 61.3 29.2 1.3 22.3 3.0 0.0 2,0 0.4 28.1 8,2 2.9 2,7 100.0 326 Western 34.4 65.6 55.4 1.7 12.7 2.0 0.0 2.3 0.9 15.5 5.9 1.0 2.6 1/10.11 1,353 Education No education 35.1 64.9 49.2 13 11.9 2,4 0.4 08 0.0 21.6 7.4 1.5 35 100.0 1.281 Primary 36.2 63.8 51.6 IO 14.9 2,7 0.1 2.0 0.7 15.8 62 2,9 2.1 100 .0 2.466 Secondary+ 43.4 56.6 42.1 11,5 18.9 3.5 0.5 14.3 1.2 8.5 5.0 2.1 3.4 100.0 563 Work status For family member 37.8 62.2 51.9 08 16,4 I1 0.2 2.1 0.2 15.9 6,6 2.4 25 1000 950 For someone else 508 49.2 24.6 (1.8 26.4 7.9 0.6 15,1 1.7 8.5 5.7 4.6 4.1 100.0 383 Self-employed 33,2 66.8 51.6 1.2 126 2.7 03 2.2 0,6 17.8 6.4 2.1 2.6 100 .0 2.9111 Occupation Agricultural 31,9 68,1 51.7 0.9 13.4 2.2 02 0.7 0.4 18.8 7.4 2,4 2.0 100 .0 3.t20 Non-agricultural 50.1 49.9 42.8 1.6 18.3 4.6 0,6 I 1.4 1.3 9.3 2.3 2.3 5.4 100.0 1.155 Employment status All year. full-time 38.0 62.0 51.3 12 14.5 3,0 0.3 3.3 0.7 15.0 6.1 21 24 100 ,0 2,699 All year, part-time 37.5 62.5 40.2 1.5 18,5 1.8 0.0 4,6 0.0 18.7 6,1 4.0 4,7 1000 280 Seasonal 32.8 67.2 48.0 11.5 12,9 2.5 03 2.3 03 21.0 7.5 2.6 22 100.0 1.134 Occasional 42.6 57.4 53,5 2,4 17.2 1.0 06 1.7 0.5 10.8 4.3 I.I 6.9 100.0 195 Total 36.8 63.2 49.8 I I 14,4 2.7 0.3 3,0 0.6 16.7 6.4 2.4 2.7 1000 4.310 Note: Totals include 67 women with work status missing, 35 women with occupa on hissing, and 2 women with employment status missing. Figures may not add to 1130.0 due Io rounding. 28 CHAPTER3 FERTILITY The information in this chapter is based on the respective birth histories of women age 15-49 years interviewed in the 1995 UDHS. Each woman was asked the number of sons and daughters she had ever given birth to, distinguishing between those living with her, those living elsewhere, and those dead. 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, the age at death. If the child was still living, information was collected on the child's current age and whether the child was still living with the mother or not. The information from the birth history was cross- checked against the reported number of children ever bum for consistency. This information was used to obtain measures of fertility levels and trends, differentials in fertility by residence and education, information on the length of intervals between births, and the extent of childbearing among adolescents. 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 Levels The level of current fertility is important because of its direct relevance to population policies and programmes. In particular, Uganda's National Population Policy aims to reduce the level of current fertility from a total fertility rate (TFR) of 7.1 in 1991 to 6.5 live births per woman by the year 2000 (Population Secretariat, 1995:27). The indices used to study current fertility include age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate. The age-specific fertility rates (ASFR) are useful in understanding the age pattern of current fertility. The ASFR is the number of live births which occurred during the specified period to women in a particular age group at the time of the birth, divided by the number of woman-years lived in that age group during the specified period. The Tt'R is obtained by summing up the ASFRs for all ages of the reproductive age bracket (15-49 years). The TPR carl 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 rates. The TFR is regarded as a useful means of summarising the overall level of fertility. Other summary measures of fertility include the general fertility rate (the number of live births per 1,000 women of reproductive age), and the crude birth rate (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 from mid-1992 to mid-1995. 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 recall lapse, and obtaining enough cases to reduce the sampling errors. Estimates of current fertility for Uganda are given in Table 3.1. The results show a general fertility rate for the three-year period of 247 births per 1,000 women and a crude birth rate of 48 live births per 1,000 population. The latter figure is marginally lower than the crude birth rate of 52 per 1,000 population for 1990 estimated from the 1991 Population and Housing Census (Statistics Department, 1995b:87). It should be noted that the census estimates were obtained using indirect methods, hence part of the difference may be due to a difference in methodology. 29 Table 3.1 Current fertility rates Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by urban-rural residence, Uganda 1995 Residence Age group Urban Rural Total 15-19 153 215 204 20-24 253 332 319 25-29 244 322 309 30-34 161 257 244 35-39 92 188 177 40-44 76 90 89 45 -49 (16) 30 29 IPR 15-49 4.97 7.17 6.86 l ia r 15-44 4.89 7.02 6.71 GFR 190 257 247 CBR 47.7 47.8 47.8 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 woman-years of exposure. TFR: Total fertility rate, expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population The TFR indicates that a Ugandan woman would bear 6.9 children by the end of her reproductive lifetime, if she experiences the current age pattern of fertility. Fertility levels are substantially higher in the rural areas (TFR of 7.2 children) than in the urban areas (5.0). However, the lower fertility level in urban areas has a small impact on the overall level of fertility because of the small share of the urban population ( 15 percent). Similar residential differentials are observed for both the general fertility rate and the crude birth rate (Table 3.1). The age pattern of fertility indicates that childbearing in Uganda starts early in the reproductive ages. The ASFRs in Table 3.1 show that a woman will have given birth to 2.6 children (more than one-third of her lifetime births) by age 25, and to 4.2 children (two-fifths of her lifetime births) by age 30. At the current levels, at least one in five teenagers will give birth annually. The childbearing peak occurs in the ages 20-29 when almost one in three women gives birth annually. However, fertility declines sharply thereafter, with the ASFR being only 29 births per 1000 women at age group 45-49 (see Figure 3.1). This age pattern is similar to that observed in data from the 1991 Population and Housing Census and the 1988-89 UDHS. The major implication of this early childbearing pattern is that the younger women contribute a large proportion of all births, resulting in faster population growth. The age pattern of fertility is roughly similar by place of residence except at older ages. The ASFRs are lower in urban areas than rural areas irrespective of age, although the difference is much less among women age 40 and above (Figure 3.1). The results in Table 3.1 also show that fertility levels among teenagers are high. This has particular significance because this age group has high relative risks of morbidity and infant mortality. 30 Figure 3.1 Age-Specific Fertility Rates by Urban-Rural Residence 350 30O 250 ~50 IO0 5O Births per 1,000 Women v i i 15-19 20-24 25-29 30-34 35-39 40-44 Age Group 45-49 UDHS 1995 3.2 Differentials in Current Fertility Table 3.2 presents the TFR and the mean number of children ever born to women age 40-49 years (completed fertility) for major subgroups 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. Fertility rates are also subject to relatively large sampling errors (see Appendix B), so interpretation of differentials should be made cautiously. Various differentials in current fertility are notable from Table 3.2 and Figure 3.2. The TFR ranges from a low of 6.3 in the Central Region to a high of 7.4 in the Eastern Region, a difference of 1.1 births per woman. Women who received some secondary education have the lowest level of current fertility (5.2 births per woman), while those with primary education have the highest level (7.1), a difference of nearly two. It is noteworthy that the phenomenon of women with primary education having the highest TFR was also observed in the 1991 Census data. Fertility is higher in the non-DISH areas than in those areas covered by the DISH project (7.1 vs. 6.4, respectively--see Chapter 1 for a description of the project). Fertility differs greatly according to the DISH area, ranging from 7.2 in areas III and IV to a low of 4.8 in area V (Kampala). 31 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and mean number of children ever born to women age 40-49, by selected background characteristics, Uganda 1995 Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate ~ pregnant I age 40-49 Residence Urban 4.97 9.4 6.37 Rural 7.17 15.1 7.38 Region Central 6.28 13.0 7.30 Eastern 7.38 17.3 7.24 Northern 6.82 13.6 6.55 Western 6.98 13.3 7.73 Education No education Primary Secondary+ DISH area Group I and It 6.72 15.1 7.37 Group ill and IV (7.17) 16.6 6.82 Group V (4.76) 8.7 (6.91) Total DISH 6.37 14.0 7.14 Total non-DISH 7.05 14.4 7.34 Total 6.86 14.3 7.28 Note: Total fertility rates in parentheses are based on 500-999 women age 15-49; other figures in parentheses are based on 25-49 women. J Women age 15-49 years 7.04 14.5 7.27 7.12 15.1 7.42 5.15 10.5 6.55 The comparison of completed fertility (mean number of children ever born) with the TFR provides an indication 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 small decline in fertility levels in the country during this period as shown by a TFR of 6.9 births, compared to a mean number of children ever born to women age 40-49 of 7.3 children. This decline is confirmed by looking at trends in TFRs obtained from previous surveys (see section 3.4). The differentials in current fertility by place of residence described above are also evident in measures of completed fertility. The decline in fertility as shown by the above method has been relatively faster in urban areas than in rural areas. The Kampala District (Group V), which is entirely urban, exhibited the lowest TFR (4.8) and the lowest proportion currently pregnant. Among regions, comparison of completed fertility with current fertility suggests that there has been little change and perhaps even an increase in fertility in the Eastern and Northern Regions, compared with declines in the Central and Western Regions. Likewise, fertility has declined at all levels of educational attainment. The decline has been steeper among women with secondary education. 32 Figure 3,2 Total Fertility Rates by Residence, Region, and Education RESIDENCE Urban Rural REGION Central Eastern Northern Western EDUCATION No Education 5.0 ~.2 ::i::::ii::i::i:::i:: : i :? i i : :~ : +: : : :~:::i : : i :i:~: :: :: i:: ~ ~:! :16 .3 ;i!:iii:i:i: i : : i i i) i!) i :: ¸¸¸¸5 ? i f : :5:i i ! : i : : : : i:::ii: ::::i:i : : : : :17.4 !::i:i: S: :# : ! :: : : : : ) : : : : : : !:::!:!i: i!::i:il6,8 ?::i:::i:::::i:i:ii: : : : :<i ::: i i= i: ! i l i ¸¸¸¸¸I¸¸: :::i !: : i i ]7 .o 7.0 Seco 2 4 5 8 Total Fertility Rate UDHS 1995 3.3 Ferti l i ty Trends Table 3.3 examines the trend in current fertility in Uganda by comparing the results of the 1995 UDHS with those of previous surveys and censuses, in as much as they are comparable. The 1988-89 UDI-IS is difficult to make comparisons with since it is not representative of the entire country, having excluded nine Table 3.3 Age-specific fertility rates from various sources Age-specific and total fertility rates from various sources and the approximate time period to which the rates refer, Uganda 1969-1995 Age group All Uganda Areas covered by 1988-89 UDHS I 1969 1991 1995 1988-89 1991 1995 Census Census UDHS UDHS Census UDHS 1968 1990 1992-95 1984-88 1990 1992-95 15-19 198 152 204 187 153 208 20-24 341 329 319 325 331 319 25-29 322 324 309 319 327 308 30-34 253 275 244 273 278 235 35-39 189 207 177 224 209 179 40-44 87 95 89 96 97 84 45-49 35 32 29 36 29 29 TFR 7.1 7.1 6.9 7.3 7.1 6.8 1 The 1988-89 UDHS covered only approximately 80 percent of tile country's population, excluding nine districts in the North. Source: Kaijuka, et al., 1989: Table 3.4; Statistics Department, 1995b: Tables A.4.5, A.4.I0, and A.4.28. 33 districts in the North. However, results from both the 1991 census and the 1995 UDHS have been tabulated for the same areas covered in the 1988-89 UDHS, so as to more accurately reflect trends. Considering the whole country, it is found that the TFR remained at just over 7 births per woman between 1968 and 1990 and then declined to 6.9 in 1992-95. The difference seems too small to indicate any significant decline in fertility. This is not surprising given that serious fertility reduction programmes in Uganda were started less than a decade before the 1995 survey and take much time to have a sizable impact. The information, however, gives a clue to the trend of current fertility levels. For the areas covered by the 1988-89 UDHS, levels of current fertility have declined modestly over recent years, from 7.3 in 1984-88 to 6.8 in 1992-95, a drop of one-half child on average. The decline was greatest among women in their 30s, while it appears that fertility may have risen among women age 15-19. The fact that national levels of fertility have shown only a very slight decline, while those in the areas covered by the 1988-89 UDHS show a more sizable decline is puzzling. It is important to remember that fertility rates are subject to relatively high sampling errors, so it is best not to make strong conclusions based on them. Table 3.4 compares TFRs by region from the 1991 Census and the 1995 UDHS. Both the adjusted and reported TFRs are given for the Census. According to the adjusted 1991 Census findings, the highest TFR was in the Western Region, while the UDHS data rank the Eastern Region as having the highest TFR. This switch in ranking may be partially attributed to sampling variability in the survey (see Appendix B) or to the use of indirect techniques in adjusting the census data. The unadjusted (reported) TFRs from the 1991 Census are more consistent with those from the UDHS; they imply that there has been little change, if any, in all regions except Central, where fertility appears to have declined. Table 3.4 Trends in fertility by region Total fertility rates by region, selected sources, Uganda 1991-1995 1991 Census I Region Reported Adjusted 1995 UDHS Central 7.0 6.9 6.3 Eastern 7.2 6.8 7.4 Northern 6.8 6.8 6.8 Western 7.3 7.9 7.0 Total 7.1 7. I 6.9 Note: Rates from the census rel~r to approximately one year bel'c~re the census, i.e., 1990, while those from the 1995 UDHS refer to the three years preceding the survey. u Source: Statistics Department, 1995b: Table A.4.28 Table 3.5 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by women's age at the time, Uganda 1995 Number of years preceding the survey Women's age 0-4 5-9 10-14 15-19 15-19 198 188 201 214 20-24 315 330 327 318 25-29 307 331 319 317 30-34 252 284 290 [269] 35-39 180 212 [259] 40-44 93 [150] 45-49 [341 TFR 15-34 5.4 5.7 5.7 5.6 Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Yet another way to examine trends in fertility is to examine age-specific fertility rates from the 1995 UDHS for successive five-year periods preceding the survey, as given in Table 3.5. 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. The results show that, except for age 15-19, fertility declines marginally between the period 5-9 and 0-4 years prior to the survey. Teenage fertility gradually declines in the 5-9 years prior 34 to the survey, and then rises in the most recent five- year period. The cumulative fertility for women age 15-34 years is fairly constant (about 5.7 births per woman) for the periods 5-19 years prior to the survey and then reduces slightly to 5.4 births per woman in the five years preceding the survey. Table 3.6 gives fertility rates for ever-mar- ried 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 five years have not changed sig- nificantly over time, perhaps because newly mar- ried couples tend to start their families. There is somewhat more evidence of a decline in fertility rates among women at higher marital durations, al- though at some durations, the pattern is inconsis- tent. Table 3.6 Trends in fertility by marital duration Fertility rates for ever-married women by duration (years) since first marriage tot five-year periods preceding the survey, Uganda 1995 Number of years preceding the survey Marriage duration 0-4 5-9 10-14 15-19 0-4 359 368 363 367 5-9 328 339 347 349 10-14 270 318 330 299 15-19 235 272 263 [2521 20-24 155 190 [2261 25-29 78 [128] Note: Duration-specific l~rtility rates are per 1,000 women. Estimates in brackets are truncated. 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. In Uganda's case, as discussed earlier, there is no evidence of a significant decline. 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 (CEB) is given in Table 3.7 for all women as well as for women currently in a marital union (who constitute 73 percent of all women). The results for currently married women differ somewhat from those of all women due to the high number of women in the younger ages who have neither married nor had a birth; differences at the older ages are minimal. The mean number of children ever born is lowest among women age 15-19 (0.5 live births per woman). It increases by at least one birth at each five-year age group among women under age 40, so that women have given birth to more than three children by their late 20s and to more than six children by their late 30s. Thereafter, the mean number of children ever born continues increasing at a slower rate, reaching the highest level of 7.7 births for women at the end of the reproductive period (45-49 years). Women currently married show a similar pattern, although the figures are slightly higher. It is notable that one-third of women age 15-19 have already given birth. The high levels of fertility prevailing in Uganda are further reflected in the fact that almost one-third of women age 45-49 have borne 10 or more children. 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. Since voluntary childlessness is rare in Uganda, it is likely that most married women with no births are unable to bear children. Table 3.7 shows that primary sterility is low, less than 2 percent. The incidence of primary sterility seems to have declined from about 4-5 percent in the 1988-89 UDHS to 2 percent in the 1995 UDHS. 35 Table 3.7 Children ever born and living Percent distribution of all women and of currently married women age 15-49 by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Uganda 1995 Number of children ever born (CEB) Number Mean no. Mean no. Age of of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 65.9 25,3 6.9 18 0.0 Ol 0.0 00 0.0 O0 0.0 I00.0 1,606 0,45 039 20-24 15,3 25.8 310 19,3 5.8 22 it6 00 0.0 00 O,t) 100.0 1.555 1.83 1.58 25-29 70 9.7 157 20,0 204 164 7.2 2,3 I.I 0.2 1).0 1(10,0 1,270 3.34 285 30-34 46 43 5.5 8.5 13.3 185 16.9 14,8 88 3.7 09 100.0 976 5.06 422 35-39 34 31 5.3 53 7.2 10.4 13.2 166 143 10.4 10.8 I(X).O 783 6.29 5.19 40-44 2.2 4,2 45 4.4 7,4 69 10.4 13.4 L4,6 9.8 223 100.0 499 6.97 5.55 45-49 2.2 4,0 3.0 3.1 3.9 76 83 9.1 13,3 14.0 315 1000 380 7,69 6.15 Total 20.9 L46 13.0 10,5 8.3 8.0 6.4 5.7 47 3.1 4,6 CURRENTLY MARRIED WOMEN 1000 7,070 3.40 2.83 15 19 393 44.1 127 37 00 01 0.0 00 0.0 00 0.0 L000 756 0.81 070 21)-24 89 24.8 342 217 7.0 27 0.7 00 0.0 00 0.0 100.0 1,212 204 177 25-29 5.2 7,5 [4.7 211 219 179 80 24 1.2 0.2 00 I(X) t) 1,067 3.53 301 30-34 3.6 39 50 6.7 124 190 188 160 95 41 11 100.0 810 5.28 4.42 35-39 3.0 2,5 4.1 35 64 10.2 136 175 158 11.4 [20 1000 656 6.58 543 40-44 1.9 2.9 4.7 2.4 7.1 5.1 106 135 159 11.5 24.4 1000 367 7.33 585 45-49 1.6 48 21 2.1 3.4 8.(1 47 6.6 136 159 371 100.0 266 807 6.50 Total 101 153 14.8 I I 8 96 9.5 75 6.6 56 3.8 5,4 100.0 5,134 3.95 3,29 3.5 Birth Intervals 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 intervals of less than 24 months. Thus the study of birth intervals is important in understanding the health status of young children. Table 3.8 gives the distribution of births of second and higher order that occurred in the five years preceding the survey by the number of months since the previous birth, according to background characteristics; also presented is the median number of months since last birth. The table shows that the majority of Ugandan children (72 percent) are born after a "safe" birth interval (24 or more months apart), with 30 percent born at least 36 months after a prior birth. Nevertheless, 28 percent of non-first births occur less than 24 months after the preceding birth, with 10 percent occurring less than 18 months since the previous birth. The overall median birth interval is 29 months. Younger women tend to have shorter birth intervals than older women. The proportion of births with intervals less than 24 months declines steeply from 47 percent among women age 15-19 to a low of 20 percent among those age 40 and above. The median birth interval length increases with age from 25 to 35 months from the youngest to the oldest age groups, respectively. On the other hand, there is no significant differential in median birth interval by either birth order or sex of the previous child. In both cases, the differences are less than one month. The survival status of the previous birth has an impact on the length of the birth interval. Median birth intervals for births that follow a child who died are three months shorter than those for births following a surviving child. The percentage of births occurring after a very short interval (less than 18 months) is more 36 Table 3.8 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Uganda 1995 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-47 48+ Total Median number of Number months since of previous birth births Age of mother 15-19 23.5 23.9 39.7 7.9 5.0 100.0 24.6 172 20-29 10.7 19.5 44.3 15.3 10.1 100.0 28.3 3,105 30-39 9.3 15.2 40.4 19.3 15.8 100.0 30.7 2,189 40+ 7.3 12.9 32.2 20.3 27.3 100.0 35.0 471 Birth order 2-3 10.7 18.3 42.0 17.0 12.1 100.0 29.0 2,387 4-6 9.5 17.2 42.7 16.2 14.5 100.0 29.3 2,151 7 + 10.8 17.0 40.0 18.0 14.2 100.0 29.7 1,398 Sex of prior birth Male 9.4 17.2 41.9 17.8 13.7 I00.0 29.4 2,881 Female 11.1 17.9 41.7 16.1 13.3 IO0.O 29.2 3,056 Survivalnfpriorbirth Living 8.4 17.5 43.5 17.3 13.4 100.0 29.7 5,034 Dead 20.9 18.1 32.4 14.9 13.7 100.0 26.5 903 Residence Urban 13.8 21.1 34.5 14.8 15.8 100.0 27.9 651 Rural 9.8 17.1 42.7 17.2 13.2 100.0 29.4 5,286 Region Central I 1.3 19.5 39.6 16.7 12.9 100.0 28.7 1,519 Eastern I 1.2 18.1 44.8 15.6 10.4 100.0 28.6 1,617 Northern 9.0 14.5 38.8 19.3 18.5 100.0 31.8 1,143 Western 9.3 17.5 42.9 16.9 13.5 100.0 29.3 1,657 Education No education 9.4 15.3 39.0 19.4 16.8 100.0 3 I. 1 2,054 Primary 10.4 18.2 43.8 16. I 11.5 100.0 28.8 3,297 Secondary+ 12.1 21.8 40.0 13.0 13.0 100.0 27.8 585 Total 10.3 17.6 41.8 16.9 13.5 100.0 29.3 5,937 Note: First births are excluded. The interval lbr multiple births is the number ol months since the preceding pregnancy that ended in a live birth. than twice as high among births whose previous sibling died than among those whose prior sibling survived. The shorter intervals for the former group is partially due to the shorter breastfeeding period for the previous birth, leading to an earlier return of ovulation and hence increased chance of pregnancy. The median birth interval in urban areas is only slightly shorter than that in the rural areas, with a difference of one and a half months. Thirty-five percent of the births in urban areas occur at intervals which are "too short" (less than 24 months), compared to 27 percent for the rural areas. Surprisingly, the percentage of births with an interval of four years or more is slightly higher for urban than rural births. 37 Births in the Northern Region exhibit a relatively higher median birth interval (32 months) than the other regions, all of which cluster around 29 months. The median length of the birth interval decreases gradually as the level of education of the mother increases, from 31 months among those with no education to 28 months among those with secondary education. 3.6 Age at First Birth The age at which childbearing starts has important consequences for the overall level of fertility as well as the health and welfare of the mother and the child. Today, teenage pregnancy and motherhood is 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, it is common for women to have children before getting married. Table 3.9 gives the distribution of all women by age at first birth according to age at the time of the survey. The data show that just under half (39 to 46 percent) of women become mothers by the time they reach age 18 and two-thirds have had a child before they reach age 20. Although the proportion of women who had their first birth before age 15 has declined steadily from 14 percent among women age 45-49 to 4 percent among women age 15-19, the proportion who have their first birth at ages 15-17 has remained roughly constant at about 32-35, excluding the youngest age group. The result is that the median age at first birth falls between 18 and 19 years for all age groups and shows no clear trend over the past three decades. Although the data from the 1988-89 UDHS are not strictly comparable since the survey covered only about 80 percent of the national population, the range of median ages at first birth was similar to the data presented in Table 3.9, strengthening the conclusion that there has been no real trend in age at first birth in Uganda. Table 3.9 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Uganda 1995 Current age Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 65.9 42 23.1 6,9 NA NA NA 100.0 1,606 a 20-24 15.3 7.2 31.9 273 14,2 4.1 NA 100.0 1,555 18.7 25-29 70 86 31,6 23+1 17.5 9,6 2.5 100.0 1,270 18,9 30-34 4.6 10.5 35.0 20.4 151 8.8 5.5 100.0 976 18,4 35-39 3.4 13.6 31.8 23.0 11.9 10.4 5.9 100.0 783 18.4 40-44 2.2 10.6 33.8 21.0 14,3 9.8 8.3 100.0 499 18.5 45-49 2.2 13.9 32.0 19.1 15.4 10.4 7.0 100.0 380 18.4 NA = Not applicable a Omitted because less than 50 percent of tile women in the age group x to x+4 have Itad a birth by age x In order to study differentials in age at first birth, Table 3.10 gives the median age at first birth for different subgroups of the population. The age group 15-19 is eliminated because less than half of these women have had a birth before age 15. The median age at first birth is slightly higher in urban areas than in rural areas, with a difference of 0.8 years among women 20-49 years old. Among the regions, the median ages are quite close, with the Western and Northern Regions having medians a few months higher than the Central and Eastern Regions. The median age at first birth shows an inverse relationship with educational attainment of the mother, being as low as 18 years for women with no education and increasing to 20 years for women with secondary education. 38 Table 3.10 Median age at first birth Median age at first birth among women age 20-49 years, by current age and selected background characteristics, Uganda 1995 Current age Background Age Age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 19.7 19.4 19.1 18.7 18.9 18.2 19.3 19.1 Rural 18.6 18,8 18.3 18,4 18.5 18.4 18.5 18.5 Region Central 18.7 18.4 18.6 18.2 18.3 18.0 18.5 18.4 Eastern 18.2 18.7 18.4 17,8 18.0 19.1 18.3 18.4 Northern 18.6 19.1 18.5 19.0 19.3 18.1 18.8 18.9 Western 19.3 19,3 18.1 18.6 18.5 18.6 19.0 18.8 Education No education 18.2 18.1 I7.8 18.3 18,4 17.7 18.1 18.0 Primary 18.5 18.8 18.5 18.2 18.4 18.9 18.5 18,6 Secondary+ a 20.3 19.8 19,6 19.7 " a 20.0 Total 18.7 18.9 18,4 18.4 18.5 18.4 18.6 18.6 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. a Omitted because less than 50 percent of the women in the age group x to x+4 have had a birth by age x Urban areas have shown a steady increase in the median age at first birth from 18 to 20 years over the 30 years prior to the survey, while the median age at first birth in the Central Region seems to have increased slightly from 18 to about 19 years. All the other population subgroups show no clear pattern over time. These time series should be interpreted with care, due to the small numbers of women in some subgroups. 3.7 Teenage Pregnancy and Motherhood As already mentioned, teenage pregnancy is important because of its association with higher morbidity and mortality for both the mother and child. In addition, teenage pregnancy has been associated with termination of education of the mothers, which in itself has a spiral effect on the socioeconomic status of the individual, and hence, the child. Table 3.11 and Figure 3.3 give 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, 43 percent of teenagers have begun childbearing, with 34 percent having had a child already and 9 percent carrying their first child. As expected, the percentage who have started the reproductive process increases with age due to longer exposure, from 8 percent among the 15-year-old teenagers to 71 percent--more than nine times higher--by the age of 19. Table 3.11 further shows that overall teenage parenthood is higher among rural women (45 percent) than their urban counterparts (31 percent). This is true for both the proportion who are already mothers as well as the proportion who are pregnant with their first child. Higher school attendance among urban adolescents, which tends to discourage early childbearing, may account for the lower levels of motherhood and pregnancy among urban teenagers; however, it is also possible that higher school attendance is due to the avoidance of early parenthood. 39 Table 3,11 Adolescent pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics; Uganda 1995 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child hearing women Age 15 4.6 3.1 7.7 290 16 12.9 9.2 22.1 340 17 33.1 10.2 43.3 281 18 51.6 13.1 64,7 392 19 64.3 6.5 70.8 304 Residence Urban 25.5 5.0 30.6 277 Rural 35.9 9.5 45.4 1,329 Region Central 35.0 7.7 42.7 502 Eastern 39.7 11.4 51.1 350 Northern 34.0 7,5 41.4 344 Western 28.4 8.8 37.2 411 Education No education 38.9 9.5 48.5 266 Primary 37.5 9.8 47.3 1,080 Secondary+ 15.1 3.6 18.7 261 Total 34.1 8.7 42.9 1,606 Percent Figure 3.3 Adolescent Childbearing 100 80 60 40 20 15 16 17 Age 18 19 UDHS 1995 40 On a regional basis, the Western Region has the lowest prevalence of teenage childbearing (37 percent), while the Eastern Region has the highest level (51 percent). The level of teenage childbearing is strongly associated with the level of education. Only 19 percent of teenagers who have secondary education have begun childbearing, compared to 49 percent for those with no education and 47 percent for those with primary education. This relationship is partially due to regulations that dictate the automatic discontinuation of schooling for pregnant women. Table 3.12 shows the distribution of teenagers by age and number of children ever born. The table shows that about two-thirds of the teenagers have never given birth. Most of the teenagers who have given birth have had one child; only 9 percent of teenagers have had more than one birth. The likelihood that a teenager will have had more than one birth increases with age, reaching a level of 24 percent among 19-year- olds. The mean number of children ever born to teenagers also increases with age from less than 0.1 children for women age 15 years to almost one child by age 19. Table 3.12 Children born to adolescent women Percent distribution of women 15-19 by number of children ever born (CEB), according to single years of age, Uganda 1995 Age 0 I 2+ Number of Mean children ever born number Number of of Total CEB women 15 95.4 4.6 0.0 I00.0 0.05 290 16 87,1 11.8 1.2 100.0 0,14 340 17 66.9 29.4 3.7 100.0 0.37 281 18 48.4 37.7 13.9 100.0 0.70 392 19 35.7 40.6 23.8 100.0 0.93 304 Total 65.9 25.3 8.8 100.0 0.45 1,606 41 CHAPTER4 FERTILITY REGULATION Knowledge of family planning methods and sources to obtain them are crucial elements in the decision of whether to adopt a contraceptive method and the choice of which method to use. A positive attitude towards family planning is an additional prerequisite for use. Data collected in the 1995 UDHS on contraceptive knowledge, attitudes, behaviour, and sources are presented in this chapter. While the focus is placed on women, 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 The level of knowledge of family planning methods was measured in two ways in the UDHS. 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. For each method recognised, respondents were asked if they had ever used it. Information was collected for eight modern methods: the pill, IUD, injectables, Norplant, vaginal methods (foam, jelly, cream, sponge, or diaphragm), condom, and female and male sterilisation; and three traditional methods: the rhythm method, natural family planning 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 who have heard about specific contraceptive methods. Knowledge of contraceptive methods is nearly universal, with 92 percent of all women age 15-49 and 96 percent of all men age 15-54 knowing at least one method of family planning. Over 90 percent of women and men have heard about a modem method. Women know about slightly more methods on average than men do (4.9 vs. 4.6); however, men are more likely to know about male methods such as condoms and male sterilisation, though oddly men are less likely than women to know about withdrawal. For currently married women, the pill (83 percent) and condom (78 percent) are the most widely known modem methods, followed by female sterilisation (72 percent), injectables (71 percent), and the IUD (31 percent). The least recognised modern methods are male sterilisation (19 percent) and vaginal methods (14 percent). The proportion of women who recognise Norplant is very low (6 percent), presumably because Norplant was only introduced in 1993 on a trial basis at Mulago hospital and only three sites (Mulago, Jinja and Mbarara hospitals) were providing the service at the time of the survey. Among currently married men, the most widely recognised method is the condom (90 percent), followed by the pill (85 percent), female sterilisation (71 percent), injectables (65 percent), male sterilisation (28 percent), and the IUD (23 percent). Vaginal methods and Norplant are not widely recognised. Traditional methods are less widely recognised than modem methods by both women and men, although men's knowledge of traditional methods was relatively higher. Three-fifths of married women and four-fifths of married men say they know of at least one traditional method. The most widely known traditional method is periodic abstinence, which is recognised by 54 percent of married women and 79 percent of married men. Although withdrawal is considered to be a "male method," it is known by a larger proportion of married women than men (34 vs. 12 percent). 43 Table 4.1 Knowledge of contraceptive methods Percentage of all women 15-49, of currently married women, of sexually active unmarried women, and of women with no sexual experience, and the percentage of all men 15-54, of currently married men, and of sexually active unmarried men who know specific contraceptive methods, by specific methods, Uganda 1995 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 Any method 92.0 93.4 98.2 76.8 96.2 98.2 97.9 Any modern method 90.4 91.6 98.2 74.9 93.9 95.2 97.0 Pill 82.1 83.0 95.5 62.4 83.1 84.5 90.3 IUD 30.4 30.9 42.7 15.3 19.5 22.5 23.0 lnjectables 69.2 70.8 82.8 44.0 60.5 65.3 69.6 Diaphragm/foam/jelly 14.3 14.3 20.7 9.7 17.9 17.9 21.5 Condom 78.0 77.9 93.8 66.2 88.4 89.5 94.1 Female sterilisation 69.5 71.7 79.8 43.0 67.7 71.4 80.9 Male sterilisation 17.7 18.5 16.4 10.1 25.7 27.9 31.0 Norplant 5.4 5.6 4.1 2.9 7.9 8.4 11.7 Any traditional method 60.3 61.6 69.0 39.0 72.5 81.4 71.6 Periodic abstinence 53.8 54.1 61.3 37.3 69.5 78.5 66.2 Withdrawal 31.8 33.6 41.7 12.0 10,0 11.5 12.9 Natural family planning 11.4 12.1 12.0 5.3 13.4 14.8 13.6 Folk method 24.2 26.2 27.9 9.2 1.3 1.2 2.0 Any traditional/folk method 67.5 69.7 74.3 42.3 72.5 81.5 71.6 Number of women/men 7,070 5,134 200 685 1,996 1,252 140 Mean number of methods 4.9 5.0 5.8 3.2 4.6 4.9 5.2 Table 4.2 shows the correspondence between the contraceptive knowledge of husbands and wives (1,109 couples) in the UDHS sam- ple. Knowledge of at least one method by both spouses is high (92 percent). For couples where only one part- ner knows of a method, hus- bands are more likely to know the method than their wives; exceptions are the IUD, injectables, withdrawal and folk methods, which wives are more likely than their husbands to know. Table 4.2 Knowledge of contraceptive methods among couples Percent distribution of couples by contraceptive knowledge, according to specific methods, Uganda 1995 Only Only Both husband wife Neither Contraceptive know knows knows knows method method method method method Total Any method 91.9 6.2 1.4 0.5 100.0 Any modern method 89.1 6.3 2.3 2.3 1(30.0 Pill 74.6 10.5 7.5 7.4 100.0 1UD 10.8 12.4 16.6 60.1 100.0 lnjectables 51.7 14.6 19.7 14.0 100.0 Diaphragm/Foam/Jelly 4.9 13.4 9.0 72.7 100.0 Condom 73.4 16.3 4.4 5.9 100.0 Female sterilisation 55.2 16.7 16.4 11.8 100.0 Male sterilisation 8.3 20.0 9.1 62.6 100.0 Norplant 1.3 7.3 4.0 87.4 100.0 Any traditional method 48.4 32.8 10.4 8.3 100.0 Periodic abstinence 41.8 36.6 10.7 10.9 100.0 Withdrawal 4.2 7.3 26.2 62.3 100.0 Natural family planning 3.2 11.3 8.7 76.8 100.0 Folk method 0.4 0.8 27.3 71.4 100.0 Any traditional/folk method 55.8 25,5 11.4 7.3 100.0 44 Table 4.3 presents the percentage of currently married respondents who know of at least one modem method of contraception according to background characteristics. The data reveal that in general there are no large differences in knowledge of methods by background characteristics of currently married respondents. Differentials by region show that knowledge of methods among currently married respondents is highest in the Central Region, while those in the Northem Region are least likely to know of a method, especially a modem method. Respondents from the DISH districts are slightly more likely to know of contraceptive methods than respondents from non-DISH districts. The level of education is positively associated with knowledge of contraceptives. Knowledge of at least one method is universal among respondents with secondary or higher education. Table 4.3 Knowledge of contraceptive methods b'/background characteristics Percentage of currently married respondents who know at least one contraceptive method and at least one modern contraceptive method by selected background characteristics, Uganda 1995 Women Men Know Know Number Know Know Contraceptive any modern of any modern Number method method method women method method of men Age 15-19 93.0 91.4 756 (100.0) (89.7) 38 20-24 94.6 93.3 1,212 96.0 92.4 lg0 25-29 93.7 92.4 1,067 99.5 98.5 262 30-34 94.6 92.6 810 98.5 95.0 230 35-39 91.6 89.5 656 99.4 99.4 219 40-44 93.8 91.4 367 97.2 92.8 144 45-49 88.0 82.8 266 99.0 92. l 96 50-54 NA NA NA 95.3 90.9 83 Residence Urban 97.9 96.7 612 99.4 99.2 156 Rural 92.8 90.9 4,522 98.1 94.6 1,095 Region Central 99.3 98.4 1,242 99.4 99.0 317 Eastern 93.9 92.1 1,399 99.2 98.0 318 Northern 84.5 79.4 l,115 97.5 86.5 274 Western 94.7 94.6 1,378 96.8 96.0 343 DISH area Kasese/Mbarara (I) 92.3 92.0 402 97.9 97.0 113 Masaka/Rakai (ll) 99.6 99.6 298 98.6 98.6 71 Luwero/Masindi 0II) 97.8 97.1 167 (100.0) (94.4) 44 Kamuli/Jinja (IV) 98.2 97.6 274 100.0 100.0 60 Kampala (V) 98.4 96.7 282 98.7 98.7 71 Total DISH 96.8 96.2 1,423 98.8 97.8 359 Total non-DISH 92.1 89.8 3,711 98.0 94.2 893 Education No education 86.2 82.8 1,792 96.4 85.6 150 Primary 96.7 95.6 2,823 98.0 95.4 825 Secondary+ 100.0 100.0 520 100.0 100.0 277 Total 93.4 91.6 5,134 98.2 95.2 1,252 Note: Figures in parentheses are based on 25-49 unweighted cases. NA = Not applicable 45 4.2 Trends in Contraceptive Knowledge Knowledge of contraceptive methods has increased considerably since the 1988-89 UDHS. In 1988- 89, only 82 percent of all women had heard of at least one family planning method, compared with 93 percent ~ in 1995. There has also been a large increase over the last six years in the proportion of women who know specific family planning methods. For example, the proportion of women who have heard of condoms has increased from 33 percent in 1988-89 to 79 percent in 1995 and the proportion who have heard of injec- tables increased from 40 percent to 72 percent during the same period (Table 4.4). Table 4.4 Trends in knowledge of family planning methods Percentage of all women who know specific contraceptive methods, Uganda, 1988-89 and 1995 Contraceptive 1988-89 1995 method UDHS UDHS a Any method 81.9 92.6 Any modern method 76.5 90.9 Pill 66.4 84.5 IUD 20.2 33.3 lnjectables 39.7 72.4 Condom 32.5 78.8 Diaphragm/tbam/jelly 11.3 14.8 Female sterilisation 59.1 68.9 Male sterilisation 8.2 19.6 Norplant NA 5.8 Any traditional method 58.6 59.1 Periodic abstinence 42.6 52.0 Withdrawal 20.5 32.6 Other methods b 31.1 25.3 Any traditional/folk method NA 67.1 Number of women 4,730 5,946 a Analysis is restricted to 1988-89 UDHS areas. b Includes herbs and other folk methods. NA = Not applicable 4.3 Ever Use of Family Planning Methods All women and men interviewed in the 1995 UDHS who said that they had heard of a method of family planning were asked if they had ever used it. Ever use of family plan- ning methods thus refers to use of a method at any time with no distinction between past and current use. Table 4.5 shows the percentage of women who have ever used family plan- ning, according to method and age. One-third of currently married women reported having used a method of family planning at some time; 16 percent have used a modem meth- od, 19 percent have used a traditional method, and 8 percent have used a folk method. Among currently married women, the pill is the modem method that has been most frequently ever used (10 percent), followed by injectables (5 percent) and condoms (4 percent). Sexually active unmarried respondents are more likely to report ever use of modem methods (37 percent) than married respondents ( 16 percent); this difference is explained by much greater use of condoms and to a lesser extent the pill, among unmarried women. Ever use of traditional methods, mainly periodic abstinence, is high among all groups of women, and among currently married women, exceeds the level of ever use of modem methods. Because the 1988-89 survey did not cover the entire country, the data from 1995 have been tabulated for only the areas that were covered in the 1988-89 UDHS. 46 4~ Table 4.5 Ever use of contraception Percentage of all women, currently married women, and sexually active unmarried women who have ever used any contraceptive method, by specific method and age, Uganda 1995 Modern method Traditional method Any Diaphragm/ Female Any Natural Any tradi- Number Any modem Foam/ sterili- traditional Periodic With- family Folk tional/folk of Age method method Pill IUD lnjectables Jelly Condom sation method abstinence drawal planning method method women ALL WOMEN 15-19 16.5 7.2 2.5 01 0.5 00 4.9 0.0 10.0 8.9 1.4 0.8 1.6 11.3 1,606 20-24 33.4 16.3 9.1 0.2 2.i 0.4 7.8 0.0 20.2 174 6.0 1.5 5.1 24.0 1.555 25-29 37.2 20.8 15.1 1.0 5.2 0.5 7.3 0.6 20.4 17.5 4.8 1.0 6.1 24.3 1,270 30-34 40.6 21.0 13.7 1.3 6.9 1.0 5.5 1 4 20.6 16.5 5.7 1.6 8.8 26.2 976 35-39 36.8 18.6 10.8 1.7 8.8 0.7 3.0 3.2 17.0 13.4 6.1 1 .I 10.3 24.0 783 40-44 36.6 17.0 9.7 1.3 7.2 0.7 2.8 4.3 19.7 16.3 4.8 2.1 10.2 26.9 499 45-49 33.7 11.4 4.5 0.8 3.8 0.7 0.5 5.1 I5.7 13.4 3.2 0.9 13.7 26.0 380 Total 31.9 15.7 9.3 0.7 4.1 0.5 5 5 1.2 17.3 14.6 4.5 1.2 6.4 21.8 7,070 CURRENTLY MARRIED WOMEN 15-19 24.2 8.6 3.9 0.1 0.7 0.0 4.6 0.0 14.8 12.9 2.1 1.4 3.4 17.4 756 20-24 321 14.4 9.3 0.3 2.4 0.4 4.9 0.0 19.7 16.6 6.2 1.6 57 23.8 1,212 25 29 34.5 18.1 13.7 0.9 5.3 0.5 5.1 0.5 19.2 16.0 4.9 1.1 6.2 23.3 1,067 30-34 40.0 19.7 13.3 1.2 6.5 1.1 4.2 1.5 20.7 16.4 5.9 18 9.2 26.4 810 35-39 37.1 17.7 9.8 1.7 8.3 0.6 2.6 3 4 17.8 14.4 6.0 1.3 11.2 25.5 656 40-44 379 17.3 9.2 1.4 7.1 0.8 1.9 5.3 19.2 15.3 5.4 2.1 12.6 28.2 367 45 49 34.7 9.6 3.9 0.6 3.2 0.1 0.7 4.9 15.9 13.6 28 0.7 16.3 28.4 266 Total 33.9 15.5 9.8 0.8 4.5 0.5 4.1 1.4 18.6 15.4 5.0 1 5 7.8 23.9 5,134 SEXUALLY ACTIVE UNMARRIED WOMEN Total 51.5 37.0 17.3 0.6 3.8 1.4 26.3 0.8 24.9 212 6.3 1.2 3.1 27.4 200 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 also 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 among population sub-groups with particular emphasis on the method mix among users. Trends in family planning use in Uganda are also described. Information on the service providers from which users obtained methods is also presented. The contraceptive prevalence rate (CPR)--the percentage of currently married women who are using a method of family planning--is 15 percent (Table 4.6.1). Just over half of the current users are using a modem method. The CPR for modem methods is 8 percent, while 4 percent and 3 percent of currently married women were using traditional and folk methods, respectively (Figure 4.1). The most popular methods are periodic abstinence, the pill and injectables, which are each currently used by about 3 percent of married women. One percent of currently married women have been sterilised. Modem method use rises with age from 4 percent among married women age 15-19 to a peak of 12 percent among those age 30-34, after which it falls to 6 percent among women 45-49 years. Table 4.6.1 also shows that current use of modern methods is more than three times higher among sexually active unmarried women (27 percent) than among currently married women (8 percent). The difference is largely attributable to the much greater use of condoms among unmarried women (15 percent) than currently married women (1 percent). This suggests that the intention for extramarital contraceptive use involves more than pregnancy prevention and probably indicates motivation to avoid sexually transmitted diseases, especially human immunodeficiency virus (HIV). Data on current use of contraception by male respondents are presented in Table 4.6.2. The use of family planning method by men is higher than that by women. The CPR for any method for currently married men age 15-54 is 25 percent, and for modem methods the CPR is 10 percent. About one-third of sexually active unmarried men are using a modern method. Like sexually active unmarried women, sexually active unmarried men reported much higher levels of condom use (32 percent) than their married counterparts (3 percent). In fact, they seem to use condoms almost exclusively, reporting less reliance on the pill, periodic abstinence, and folk methods than married men. Such heavy reliance on the condom may represent differing reproductive and health (disease prevention) strategies among the unmarried and married. The fact that sexually active unmarried women are reporting higher levels of pill use (7 percent) than their male counterparts (less than 1 percent) could mean that these men are not aware of their partners' pill use. Another discrepancy is apparent in the reported level of use of periodic abstinence, which is considerably higher among married men than married women. Higher levels of use of traditional methods among men than women is common, especially in East Africa (Ezeh, et al., 1996:19, 20) and may be due to misreporting by men of other method types for sexual abstinence, such as periodic abstinence. Of course, there is no reason to expect complete correspondence in contraceptive use between samples of married men and married women, since respondents are not confined to reporting about contraceptive use only with their spouses. 48 4x Table4.6.1 Current useofcontraception: women Percent distribution of all women, currently married women, and sexually active unmarried women who are currently using a contraceptive method by specific method, according to age, Uganda 1995 Modem method Traditional method Any Female Any Natural Not Number Any modem sterili- traditional Periodic With- family Folk currently of Age method method Pill IUD lnjectables Condom sation method abstinence drawal planning method using Total women ALL WOMEN 15-19 7.2 3,4 1.3 0.0 0.4 1.6 0.0 2.9 2.4 0.2 0.3 0.9 92.8 100.0 1,606 20-24 13.0 6.3 2.5 0 1 1.1 2 4 0.0 5.0 4.7 0.3 0.0 1.7 87.0 100.0 1,555 25-29 14 3 9.0 3.3 0.4 26 1.9 0.6 3.4 2.7 0.7 0.1 1.9 85.7 100.0 1.270 30-34 19.6 I 1 5 3.9 0.7 4.1 I 2 1.4 4.8 3 7 1.0 0.1 3.3 80.4 100.0 976 35-39 17.2 10.4 1.5 0.5 4 6 0.5 32 3.2 2.4 0.6 0.2 3.6 82.8 100.0 783 40-44 14.0 8.6 1.8 0.0 1.9 03 4.3 3.9 3 1 0.5 0.3 1.6 86.0 100.0 499 45-49 13.3 5.7 0.4 0.0 0.2 0.1 5 1 3.5 3.5 0.0 0.0 4.0 86.7 100.0 380 Total 13.4 7.4 2.3 03 2.0 1.5 1.2 3.9 3.2 0.5 02 2.1 86.6 100.0 7,070 CURRENTLY MARRIED WOMEN 15-19 9.9 3.8 2.4 0.0 0.7 0.7 0.0 4.3 3.2 0.3 0.7 1.8 90.1 100.0 756 20-24 12.2 5.3 2.9 01 1.2 0.9 0.0 5.0 4.7 0.3 0.0 1.9 87.8 100.0 1,212 25-29 13 4 8.0 3.0 0.5 2.9 1.1 0.5 3.1 2.2 0.8 0.1 23 86.6 100.0 1,067 30-34 20.7 11.8 4.0 0.9 4.3 0.9 1.5 5.1 3.7 1.2 0.1 3.8 79.3 100.0 810 35- 39 18.6 10.9 1.4 0.6 4.9 0.6 3.4 3.5 2.6 0.7 0.2 4.2 81.4 100.0 656 40-44 17.6 10.6 2.0 0. I 2.5 0.4 5.3 5.2 4.1 0.6 0.5 1.7 82.4 100.0 367 45-49 16.0 5.8 0.5 0.0 03 O. 1 4.9 4.5 4.5 0.0 0.0 5.6 84.0 100.0 266 Total 14.8 7.8 2.6 0.4 25 0.8 14 4.3 3.5 0.6 0.2 2.7 85.2 100.0 5,134 SEXUALLY ACTIVE UNMARRIED WOMEN Total 35.6 26.5 7.2 0.3 2.9 15.4 0.8 7.7 7.7 0.0 0.0 1.4 64.4 100.0 200 L/I cz) Table 4.6.2 Current use of contraception: men Percent distribution of all men, currently married men, and sexually active unmarried men who are currently using a contraceptive method by specific method, according to age, Uganda 1995 Modem method Traditional method Any Female Any Natural Not Number Any modern sterili- traditional Periodic With- family Folk currently of Age method method Pill IUD Injectables Condom sation method abslinence drawal planning method using Total men ALL MEN 15-19 7.8 50 08 00 0.0 4.2 0.0 2.7 26 0.1 0.0 0.1 922 100.0 387 20-24 24.5 15.0 I 1 0.2 0.5 13 2 0 1 7 9 6.8 0.7 0.4 1.7 75 5 100.0 367 25-29 19 7 97 3.6 0.0 09 5.2 00 8.7 8.0 0.7 0.0 1.3 80.3 100.0 359 30 34 28 8 10 8 3.5 0.7 1 4 4.6 06 17.0 16.2 0.8 0.0 1.0 71.2 100.0 259 35-39 27.0 13.6 2.9 03 3.6 3.6 2.9 9.6 8.7 05 0.4 3.8 73.0 100.0 250 40~44 20.3 11.2 3.3 0 0 4.2 2 2 1.5 5 9 4.1 18 0.0 3.2 79.7 100.0 162 45-49 21 1 7 9 0. I 0.0 2 5 2.0 3.3 8. I 6 7 0.0 1.4 5.0 78.9 100.0 118 50-54 13.7 96 0.6 0.0 6.3 0.0 2.5 3.8 3 2 0.3 0.3 0.3 86.3 100.0 95 Total 20.2 104 2.1 0.2 I 7 5.5 09 8.1 7.3 0.6 0.2 1.7 79.8 100.0 1,996 CURRENTLY MARRIED MEN 15-19 (288) (10.5) (7.6) (00) (0.0) (2.9) (0.0) (18.3) (18.3) (00) (0.0) (0.0) (71.2) 100.0 38 20-24 25.0 7.8 2.2 0.3 1.0 4.3 0 0 14.4 13 0 0.6 0.8 2.8 75.0 100.0 180 25-29 22.5 8.8 5.0 0 1 1.2 2.6 0.0 11.9 10 9 0.9 00 1.8 77.5 100.0 262 30-34 29.8 10.1 3.9 0.8 1.6 32 0.7 I9.0 18.1 0.9 0.0 0.6 70.2 100.0 230 35-39 298 14.5 3.3 0.3 41 3 1 3.3 109 10.0 0.5 0.5 4.4 70.2 100.0 219 40-44 21.0 10 8 3.7 0.0 47 0.6 1 7 6.6 4.6 2.1 0.0 3.6 79.0 100.0 144 45-49 24.4 8.3 02 0.0 3.0 1.0 4 1 10.0 8.2 0.0 1.8 6.2 75.6 100.0 96 50-54 15.3 10.9 0.7 00 7.1 0.0 2.9 40 3 6 0.4 0.0 0.4 84.7 100.0 83 Total 252 10.3 3.4 0.3 26 25 1.4 12.3 11.2 08 0.3 2.6 748 100.0 1,252 SEXUALLY ACTIVE UNMARRIED MEN Total 34.5 32.4 0.3 0 0 0.0 32.1 00 2.1 1 5 0.4 0.2 0.0 65.5 100.0 140 Note: Figures in parentheses are based on 25-49 unweighted cases Figure 4.1 Current Use of Specific Contraceptive Methods among Currently Married Women Supply Methods 3.4% .- . . Clinical Methods 2.9% ~ 5 ~ ' ~ ~ ] Female Sterilisation 1.4% \ ' ~ 7 ~ j ~ ~ " Tradit(onal/Fotk Methods 7.0% ~ Not currently using a method 85.2% Note: Supply Methods include the Pill (2.6%) and the Condom (0.8%); Clinical Methods include Injectables (2,5%) and the IUD (0.4%). UDHS 1995 Some women are much more likely to be using contraception than others (see Table 4.7.1 and Figure 4.2). Urban women are much more likely to be using contraceptive methods (35 percent) than rural women (12 percent). The difference is most pronounced for modern method use (28 vs. 5 percent, respectively), while urban and rural women are almost equally likely to use traditional and folk methods (6-7 percent). There are large differences in levels of contraceptive use by region. One-quarter of currently married women in the Central Region are current users, compared to less than 14 percent of currently married in other regions. Modem method use is highest in the Central Region (16 percent) and lowest in the Northern Region (3 percent), where use of traditional methods is the highest (8 percent). Over 40 percent of married women living in Kampala District (Group V of DISH areas) are using contraceptive methods, compared with only 7 percent in Group I (Kasese and Mbarara Districts). Overall, twice the proportion of women living in DISH districts are using modem methods as women living in non-DISH districts. There are large differentials in current use by level of education. Eight percent of currently married women with no formal education are currently using a method, compared with i5 percent with some primary education, and 38 percent of those with some secondary education. The differentials are similar for modem method use. Contraceptive use rises with the number of living children. It is expected that once individuals or couples achieve their reproductive goals, they would be sufficiently motivated to use a family planning method. The percentage of currently married women using any method increases rapidly from 5 percent among women with no children to 20 percent among those with four or more children. The results confirm that few women in Uganda begin to adopt contraception seriously until after they have had several children, perhaps so as to be sure of their survival. 51 t jr i,o Table 4.7.1 Current use of contraception by background characteristics: women Percent distribution of currently married women by contraceptive method currently used, according to selected background characteristics, Uganda 1995 Modem method Traditional method Any Female Any Natural Not Background Any modem stenli- traditional Periodic With- family Folk currently characteristic method method Pill IUD lnjectables Condom sa0on method abstinence drawal planning method using Total Number of WOl~C~n Residence Urban 34.5 28 1 10.5 2 2 6.9 3.6 43 4 5 3.2 1.0 0.3 1.9 65.5 100.0 612 Rural 12.2 5.1 1.6 0.1 1.9 0.4 10 4 3 3.5 0.6 0.2 2.8 87.8 100.0 4,522 Region Central 25.0 16.2 5.7 09 4.9 1.8 2.6 4 7 3.6 0.9 0.1 4.0 75.0 100.0 1,242 Eastern 114 5.5 1.4 0.3 1.7 0.7 1.4 2.5 2.0 0.5 0.0 3 4 88.6 1000 1,399 Northern 136 2.5 0.5 0.1 I 2 0.3 0.3 8.2 71 03 0.8 2.9 86.4 100.0 1,115 Western 103 6.9 2.9 0.2 2.2 0.3 13 2 6 19 0.7 0.0 0.8 89.7 100.0 1,378 DISH area Kasese/Mbarara (I) 74 5.7 I 5 0.2 2.3 0.6 I I 07 0.6 0.1 0.0 1.0 92.6 100.0 402 Masaka/Rakai (11) 145 5.6 0.4 0.4 27 17 03 39 3.2 0.8 0.0 5.1 85.5 100.0 298 Luwero/Mmsindi (Ill) 15.9 93 5.0 0.0 4.3 0.0 0.0 46 3 9 07 0.0 2 1 84.1 100.0 167 Kamuli/Jinja (IV) 16.7 90 3.7 0.8 2.6 0.5 1.4 2.5 2.2 0.3 0.0 5.2 83.3 100.0 274 Kampala (V) 405 34.9 13.5 29 82 43 49 3.6 2.0 1.0 07 2.0 59.5 100.0 282 Total DISH 18.2 12.5 4.5 0.9 3.9 1.5 1 6 2 8 2.1 0.5 0.1 3.0 81.8 100.0 1,423 Total non-DISH 13.5 60 1.9 0.2 2.0 0.5 13 49 4.0 0.7 0.2 2.6 86.5 100.0 3,711 Education No education 8.3 2.6 0.9 00 10 0.2 0.5 3.1 2.4 0.3 0.4 2.5 91.7 100.0 1,792 Primary 14.8 7.8 2.4 0.3 2.9 0.7 1.5 42 3 5 0.7 0.0 2.8 85.2 1{30.0 2,823 Secondary+ 376 25.5 10.1 1.9 5.6 37 39 90 7.2 1.2 0.7 3.0 62.4 100.0 520 Number of living children 0 5.0 1.9 0.7 0.0 0.2 1.0 0.0 3.1 20 0.2 0.9 0.0 95.0 100.0 627 1 9.7 4.6 2.6 0.0 0.8 0.7 0.3 4.3 3 8 0.4 0.1 0.9 90.3 100.0 901 2 156 7.2 3.2 0.4 2.2 1,0 03 5.0 4.5 0.4 0.0 3.4 84.4 100.0 834 3 13.7 7.0 3.0 0.6 1.6 0.9 08 44 3.9 0.6 0.0 2.3 86.3 100.0 690 4+ 20.1 115 2.9 0.5 43 0.7 3.0 4.4 3.3 0.9 0.2 4.3 79.9 100.0 2,081 Total 14.8 7.8 2.6 04 25 0.8 1.4 4.3 3.5 0.6 0.2 2.7 852 100.0 5,134 Table 4.7.2 Current use of contraception by background characteristics: men Percent distribution of currently married men by contraceptive method currently used, according to selected background characteristics, Uganda 1995 Modem method Traditional method Any Female Any Natural Not Number Background Any modem sterili- traditional Periodic With- family Folk currently of characteristic method method Pill IUD lnjectables Condom sation method abstinence drawal planning method using Total men Residence Urban 42.0 31.7 12.1 1.3 6.3 8.3 2.9 8.7 7.3 1.2 0.2 1.7 58.0 100.0 156 Rural 22.7 7.2 2.1 0.1 2.1 1.7 1.2 12.8 11.7 0.7 0.4 2.7 77.3 100.0 1,095 Region Central 26.7 19 4 5.9 0.5 5.3 6.0 1.4 4.8 3.3 1.0 0.4 2.6 73.3 100.0 317 Eastern 25.0 10.2 3.2 0.5 1.6 1.9 3.0 11.2 10.2 1.1 00 3.5 75.0 i00.0 318 Northern 34.1 3.8 1.7 0.0 0.5 1.6 0A 26 5 25.4 0.5 0.5 3.8 65.9 100.0 274 Western 16.7 7.0 2.6 0.0 2.9 0.6 0.9 9.0 8.1 0 5 0.4 0.7 83.3 100.0 343 DISH area Kasese/Mbarara (1) 12.7 6.5 1.5 0.0 3.6 1.2 0.0 52 5.0 0.2 0.0 1.0 87.3 100.0 113 Masaka/Rakai (II) 20.7 86 04 00 2.1 4.0 2.1 8.8 3.5 3.4 1.8 3.3 79.3 100.0 71 Luwero/Masindi (lit) (13.9) (11.4) (3.8) (0.0) (5.1) (2.5) (0.0) (2.5) (2.5) (00) (0.0) (0.0) (86.1) 100.0 44 Kamuli/Iinja (IV) 19.2 8.4 4.8 2.1 0.3 0.6 0.6 10.8 10.5 0.3 0.0 0.0 80.8 100.0 60 Kampala (V) 41.0 37.2 14.1 13 102 9.0 1.3 3.9 2.6 13 0.0 0.0 59.0 100.0 71 Total DISH 21.1 139 4.6 06 4.3 3.3 0.8 63 4.9 1.0 0.4 0.9 78.9 100.0 359 Total non-DISH 26.8 88 2.9 01 2.0 2.2 1.6 14.7 13.7 0.7 0.3 3.2 73.2 100.0 893 Education No education 10.6 21 0.0 0.0 0.6 0.0 1.5 6.3 6.3 0.0 0.0 2.2 89.4 100.0 150 Primary 223 6.5 23 0.1 1.8 13 H 13.0 115 0.9 05 2.8 77.7 100.0 825 Secondary+ 41.6 25.9 8.4 0.9 6.3 7.5 23 13.7 12.7 1.0 0.0 2.1 58.4 100.0 277 Number of living children 0 7.6 3.2 0.0 0.0 0.0 2.3 0.9 4.4 3.5 0.9 0.0 0.0 92.4 100.0 121 1 28.4 9.8 4.8 0.0 0.5 4.0 0.5 17.1 16,3 0.0 0.8 1.5 71.6 100.0 185 2 25.0 9.5 3.2 0.8 2.7 28 00 11.6 10.2 1.4 0.0 3.9 75.0 I00.0 176 3 23.2 6.1 2.0 0.4 0.I 2.1 1.4 13.5 13.2 0.3 0.0 3.6 76.8 100.0 147 4+ 28.1 13.0 4.0 02 4.4 2.2 2.1 123 10.9 1.0 0.4 2.8 71.9 100.0 622 Total 25.2 10.3 3,4 0.3 2.6 2.5 1.4 12.3 11.2 0.8 0.3 2.6 74.8 100.0 1,252 Note: Figures in parentheses are based on 25":19 unweighted cases. Figure 4.2 Contraceptive Use of Currently Married Women 15-49 by Background Characteristics RESIDENCE Urban Rural REGION Central Eastern Northern Western DISTRICT DISH Non-DISH EDUCATION No education Primary Secondary + "~"jJJ J J J~JjJfJ J J J J J j J J J~JJJ J~ ~JJJfJJJJJJJJJJJJ~ ~JffJJJJJJJJJJJJJJJJJ~ ~SJJJJJJJJJJJ~ 10 20 30 Percent 40 UDHS 1995 Table 4.7.2 shows the percent distribution of married men age t5-54 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 contraceptive methods, especially modem methods, than their counterparts in rural areas. Conversely, use of traditional methods is more common in rural areas than in urban areas. There are quite large differences in the prevalence of current contraceptive use among men in the various regions. For example, 19 percent of married men in the Central Region are using modem family planning methods, compared with only 4 percent in the Northern Region; 7 percent of married men in the Western Region and 10 percent of those in the Eastern Region are using modem contraception. Men living in the DISH districts are more likely to use any method but less likely to use modem methods than those living in non-DISH districts. Modem contraceptive use increases with increasing educational attainment, from 2 percent of married men with no formal education, to 7 percent of those with some primary education, and to 26 percent of those with at least some secondary education. The contraceptive prevalence rate in Uganda has tripled over a six-year period, rising from 5 percent in the areas of the country covered by the 1988-89 UDHS to 16 percent in 1995 for these same areas (see Table 4.8 and Figure 4.3). 2 The results not only show the overall increase, but also document the changes that have occurred with the method mix. Use of modem methods has increased faster than overall use, from 3 percent in 1988-89 to 9 percent in 1995. Use of traditional methods increased from 2 percent to 4 percent. Methods which have increased the fastest are the pill, injectables, and periodic abstinence. 2 The rate of 16 percent is calculated from the 1995 UDHS data fur only those areas of the country that were covered in the 1988-89 UDHS and is slightly higher than the national-level contraceptive prevalence rate of 14.8 (see Table 4.6.1 ). 54 Table 4.8 Trends in current use of contraception Percentage of currently married women who were using specific contraceptive methods at the time of the survey, Uganda, 1988-89 and 1995 Contraceptive 1988-89 1995 method UDHS UDHS l Any method 4.9 15,7 Any modern method 2.5 8.9 Pill 1.1 3.I IUD 0.2 0.4 lnjectables 0.4 2.8 Condom 0.0 0.8 Female sterilisation 0.8 1.6 Arty traditional method 2.4 3.8 Periodic abstinence 1.6 3.0 Withdrawal 0.3 0.7 Natural family planning NA 0.2 Other methods 0.4 3.0 Number of women 3,180 4,238 1 The 1995 UDHS figures are calct2lated for 1988-89 UDHS areas, NA = Not applicable Source: Kaijuka et ah, 1989:33 Figure 4.3 Trends in Current Contraceptive Use Among Currently Married Women 15-49 Any Method Any Modern Method Any Traditional Method IUD Injeetables Condom Pemale SterilJsation Periodic Abstinence ~-'~JJ~JJJfJ~-~'JJJJ~'~ t 5,7 ~J~J~'A~ZJ~'~-~ 8.9 ~ 3 , 8 ~ 3 , 1 1104 ~ 2.8 ~0.8 ~1.6 ~3.0 2 4 6 8 10 12 14 16 Percent Using Method 18 Note; 1995 UDHS data were adjusted for 1988-89 UDHS areas. 55 4.5 Number of Children at First Use of Family Planning Family planning methods may be used for either spacing births or limiting family size. The 1995 UDHS included questions on the number of children the woman had when she first used contraception. These data enable an examination of the cohort changes in the timing of adopting contraceptive use. Table 4.9 shows the distribution of ever-married women by age group and the number of children the women had when they first used contraception. The results indicate that Ugandan women are increasingly adopting family planning at an earlier stage of the family building process. Younger cohorts of women reported first use at lower parities than older cohorts of women. For example, the oldest cohorts (age 45-49) of ever-married women reported first using contraception after having a median of 4.6 births, compared with 1-2 births among the youngest cohorts (under age 30). From another perspective, 15 percent of ever-married women age 15-19 started contracepting before the birth of their first child, compared with only 3 percent of the 45-49 cohort. This pattern may also be a reflection of a recent increase in availability of family planning services. Table 4.9 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, and median number of children at first use, according to current age, Uganda 1995 Median Never Number of living children at time number of used of first use of contraception Number children contra- of at first Current age ception 0 I 2 3 4+ Missing Total women use 15-19 76.0 15.0 6.8 1.9 0.1 0.0 0.2 100.0 801 0.8 20-24 67.7 9.2 12.8 7.4 2.2 0.5 0.1 100.0 1,365 1.5 25-29 64.0 8.2 10.4 7.3 4.9 5.2 0.1 100.0 1,196 1.9 30-34 59.8 3.5 8.9 5.6 6.6 15.4 0.3 100.0 957 3.3 35-39 63.2 2.6 7.6 3.9 5.0 17.7 0.0 100,0 772 3.9 40-44 63.3 2.7 5.6 5.4 4.6 18.4 0.0 100.0 498 4.0 45-49 66.4 3.4 8.1 2.3 1.8 18.0 0.0 100.0 370 4.6 Total 65.8 7.1 9.3 5.4 3.7 8.5 0.1 100.0 5,959 2.1 4.6 Effect of Breastfeeding on Conception Information on knowledge of the contraceptive effect of breastfeeding as perceived by women is shown in Table 4.10. Over half of currently married Ugandan women believe that breastfeeding does not affect the chance of a woman becoming pregnant. Twenty percent correctly report that breastfeeding can reduce the risk of pregnancy, while 15 percent say that it depends. Differentials in knowledge of the contraceptive effect of breastfeeding by age group, place of residence and region are not large. Only 18 percent of currently married women have used breastfeeding in the past to avoid pregnancy and 8 percent are currently relying on breastfeeding as contraception. Seven percent of women meet the criteria for use of the lactational amenorrhoeic method (LAM) 3 of family planning. 3 LAM 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 breastmilk and plain water. 56 Table 4.10 Perceived contraceptive effect of breastfeeding Percent distribution of currently married women by perceived risk of pregnancy associated with breastfeeding, percentage who rely on breastfeeding to avoid pregnancy, and percentage who meet lactational amenorrhoeic method (LAM) criteria, according to selected background characteristics, Uganda 1995 Perceived risk of pregnancy associated with breastfeeding Reliance on breastfeeding to avoid pregnancy Don't Meet Number Background Un- In- De- know/ Previ- Cur- LAM of characteristic changed creased creased Depends Missing Total ously rently criteria women Age 15-19 55.5 2.2 18.5 11.6 12.4 100.0 7.8 4.8 10.0 756 20-24 55.5 2.0 20.1 15.1 7.3 100.0 16.0 8.8 8.2 1,212 25-29 55.8 2.3 21.1 16.5 4.4 100.0 19.5 9.9 8.1 ],067 30-34 51.7 2.7 22.6 16.6 6.5 100.0 24.0 11.0 6.3 810 35-39 61.0 1.7 18.0 16.0 3.2 100.0 17.2 7.6 4.2 656 40-44 53.9 1.6 24.3 16.7 3.5 100.0 22.6 4.9 4.9 367 45-49 59.8 1.8 18.0 15.7 4.7 100.0 20.6 2.3 0.0 266 Residence Urban 49.3 2.4 20.0 21.0 7.3 100.0 17.9 6.8 4.7 612 Rural 56.6 2.1 20.4 14.6 6.3 100.0 17.6 8.2 7.3 4,522 Region Central 54.0 1.6 17.8 22.7 3.9 100.0 19.7 7.5 6.3 1,246 Eastern 42.3 4,1 22.1 25.3 6.2 100.0 20.9 8.7 6.1 1,400 Northern 66.8 1.4 20.3 4.4 7.1 100.0 13.4 7.7 9.2 1,112 Western 62.2 1.2 20.9 7.6 8.1 100.0 15.8 8.1 6.6 1,376 Education No education 55.5 2.4 21.4 12.8 7.9 100.0 17.7 7.9 7.4 1,792 Primary 57.8 2.0 19.1 15.4 5.8 100.0 16.8 8.1 7.2 2,823 Secondary+ 45.8 1.7 23.8 24.4 4.4 100.0 21.7 7.8 4.5 520 Total 55,8 2.1 20.4 15.4 6.4 100.0 17.6 8.0 7.0 5,134 4.7 Source of Family Planning Methods Information on the source of modern contraceptives currently used is useful for family planning managers and implementers. In the 1995 UDHS, women who reported using a modern method of contra- ception at the time of survey were asked where they obtained the method the last time. Table 4.11 and Figure 4.4 show that about half of current users (47 percent) obtain their methods from public sources. Private medical sources are reported by 42 percent of current users, and other private sources account for the remaining 11 percent. Government hospitals (30 percent) and private hospitals and clinics (30 percent) are the most common sources of contraceptive methods. The source of family planning methods varies according to the type of method used. For example, more than half the pill users (55 percent) obtain their method from private medical sources, 38 percent from private hospitals and clinics, 10

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