Uganda - Demographic and Health Survey - 2001

Publication date: 2001

2000-2001Demographic andHealth Survey U ganda 2000-2001 D em ographic and H ealth Survey Uganda Uganda Demographic and Health Survey 2000-2001 Uganda Bureau of Statistics Entebbe, Uganda ORC Macro Calverton, Maryland, USA December 2001 DFID Department forInternationalDevelopme nt This report highlights the findings of the 2000-2001 Uganda Demographic and Health Survey (UD HS), a nationally representative survey of households, women age 15-49, and men age 15-54. Interviews were successfu lly completed with 7,246 women age 15-49 and 1,962 m en age 15 -54. Information about children born to these women was also collected. Detailed questions about vaccination, breastfeeding, food supplementation, and illnesses were asked about children born in the five years before the survey. The primary objective of the survey is to provide policy makers and programme managers with detailed information on fertility , family planning, childhood and adu lt mortality, maternal and child health, nutrition, and knowledge and attitudes about HIV/AIDS. The 2000-2001 Uganda Demographic and Health Survey (UDHS) was conducted by the Uganda Bureau of Statistics. Funding for the survey was provided by the U.S. Agency for International Development (USAID), the Department for International Development (DFID/Uganda), UNICEF/Uganda, and UNFPA/Uganda. The UDHS is part of the worldwide Demographic and Health Surveys (DHS) project designed to collect, analyse, and disseminate data on fertility, family planning, maternal and child health, and HIV/AIDS. Additional information about the survey may be obtained from the Uganda Bureau of Statistics (UBOS), P.O. Box 13, Entebbe, Uganda (Telephone: (256-41) 320-741; Fax: (256-41) 320-147; e-mail: ubos@ infocom.co.ug). Additional information about the DHS programme may be obtained by writing to MEASURE DHS+ , ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (Telephone: 301-572-0200; Fax: 301-572-0999; e-mail: reports@macroint.com). Recommended citation: Uganda Bureau of Statistics (UBOS) and ORC Macro. 2001. Uganda Demographic and Health Survey 2000-2001. Calverton, Maryland, USA: UBOS and ORC M acro. Contents * iii CONTENTS Page Tables and figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Uganda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER 1 INTRODUCTION 1.1 Geography and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.3 National Population and Health Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.4 Objectives of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.5 Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6 Response Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND HOUSEHOLD MEMBERS 2.1 Population by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.3 Fosterhood and Orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.4 Educational Level of Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.5 Child Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.6 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.7 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3.1 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3.2 Educational Attainment by Background Characteristics . . . . . . . . . . . . . . . . . . 21 3.3 Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 3.4 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.5 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.6 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.7 Earnings, Employer, and Continuity of Employment . . . . . . . . . . . . . . . . . . . . 28 3.8 Control over Earnings and Women’s Contribution to Household Expenditure . . 30 3.9 Control over Earnings According to Contribution of Household Expenditure . . 33 3.10 Women’s Participation in Household Decisionmaking . . . . . . . . . . . . . . . . . . . 33 3.11 Women’s Agreement with Reasons for Wife Beating . . . . . . . . . . . . . . . . . . . . . 36 3.12 Women’s Agreement with Reasons for Refusing Sexual Relations . . . . . . . . . . . 36 3.13 Use of Tobacco and Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 iv * Contents Page CHAPTER 4 FERTILITY 4.1 Current Fertility Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.3 Trends in Age-Specific Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.4 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.5 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.6 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.7 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 CHAPTER 5 FERTILITY REGULATION 5.1 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.3 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5.4 Number of Children at First Use of Family Planning . . . . . . . . . . . . . . . . . . . . . 62 5.5 Knowledge of the Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.6 Source of Supply of Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.7 Informed Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.8 Future Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 5.9 Reasons for Nonuse of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 5.10 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . 67 5.11 Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 5.12 Contact of Nonusers with Family Planning Providers . . . . . . . . . . . . . . . . . . . . 68 5.13 Attitudes of Couples toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . 71 5.14 Discussion of Family Planning with Husband . . . . . . . . . . . . . . . . . . . . . . . . . . 72 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 6.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.3 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 6.4 Median Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 6.5 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 6.6 Median Age at First Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.7 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 6.8 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . 82 6.9 Median Duration of Postpartum Insusceptibility by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 6.10 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Contents * v Page 7.2 Desire to Limit Childbearing by Background Characteristics . . . . . . . . . . . . . . . 87 7.2 Demand for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 7.3 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 7.4 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Definitions, Methodology and Assessment of Data Quality . . . . . . . . . . . . . . . . 97 8.2 Early Childhood Mortality Rates: Levels and Trends . . . . . . . . . . . . . . . . . . . . . 98 8.3 Early Childhood Mortality by Socioeconomic Characteristics . . . . . . . . . . . . . 100 8.4 Early Childhood Mortality by Demographic Characteristics . . . . . . . . . . . . . . 102 8.5 Early Childhood Mortality by Women’s Status . . . . . . . . . . . . . . . . . . . . . . . . 103 8.6 Perinatal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 8.7 High-risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 CHAPTER 9 REPRODUCTIVE HEALTH AND CHILD CARE 9.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 9.1.1 Number of Antenatal Care Visits and Timing of First Visit Care . . . . . 111 9.1.2 Quality of Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 9.1.3 Place of Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 9.1.4 Tetanus Toxoid Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 9.2 Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 9.2.1 Assistance During Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 9.2.2 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 9.3 Postnatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 9.4 Women’s Status and Reproductive Health Care . . . . . . . . . . . . . . . . . . . . . . . 121 9.5 Childhood Immunisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 9.5.1 Childhood Immunisation by Background Characteristics . . . . . . . . . . 123 9.5.2 Vaccination Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 9.6 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 9.7 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 9.7.1 Hand-washing Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 9.7.2 Disposal of Children’s Stool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 9.7.3 Prevalence of Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 9.7.4 Knowledge of ORS Packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 9.7.5 Treatment of Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 9.7.6 Feeding Practices during Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . 134 vi * Contents Page 9.8 Women’s Status and Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 9.8.1 Women’s Status and Children’s Health Care . . . . . . . . . . . . . . . . . . . . 134 9.8.2 Women’s Problems in Accessing Health Care . . . . . . . . . . . . . . . . . . . 135 9.9 Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 9.9.1 Possession and Use of Mosquito Nets . . . . . . . . . . . . . . . . . . . . . . . . . 137 9.9.2 Insecticide Treatment of Mosquito Nets . . . . . . . . . . . . . . . . . . . . . . . 138 9.9.3 Malaria Prophylaxis During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 139 9.9.4 Type of Anti-Malarial Treatent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 9.10 Birth Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 CHAPTER 10 WOMEN’S NUTRITIONAL STATUS 10.1 Breastfeeding and Complementary Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . 143 10.1.1 Initiation of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 10.1.2 Age Pattern of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 10.1.3 Types of Complementary Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 10.1.4 Frequency of Foods Consumed by Children . . . . . . . . . . . . . . . . . . . . 148 10.2 Micronutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 10.2.1 Micronutrient Status of Young Children . . . . . . . . . . . . . . . . . . . . . . . 149 10.3 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 10.3.1 Measures of Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 10.3.2 Levels of Childhood Malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 10.3.3 Nutritional Status of Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 10.4 Prevalence of Anaemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 10.4.1 Prevalence of Anaemia in children . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 10.4.2 Prevalence of Anaemia in Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 10.4.3 Prevalence of Anaemia in Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 10.4.4 Anaemia in Children and Severity of Anaemia in Mothers . . . . . . . . . 161 10.5 Vitamin A Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 10.5.1 Methodology for Measuring Vitamin A . . . . . . . . . . . . . . . . . . . . . . . . 162 10.5.2 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Contents * vii Page CHAPTER 11 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 11.1 Knowledge of Ways to Prevent HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 11.1.1 Knowledge of Ways to Avoid HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . 167 11.1.2 Knowledge of Programmatically Important Ways to Avoid Contracting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 11.2 Knowledge of Other AIDS-related Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 11.3 Perceptions of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 11.3.1 Discussion of AIDS with Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 11.3.2 Stigma Associated with HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 11.3.3 Discussion of HIV/AIDS in the Media . . . . . . . . . . . . . . . . . . . . . . . . . 176 11.4 Knowledge of Symptoms of Sexually Transmitted Infections . . . . . . . . . . . . . 177 11.5 Reports of Recent Sexually Transmitted Infections . . . . . . . . . . . . . . . . . . . . . 179 11.6 Treatment Seeking and Protection of a Partner from Sexually Transmitted Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 11.7 Sexual Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 11.7.1 Number of Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 11.7.2 Payment for Sexual Relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 11.7.3 Condom Use for Disease Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . 186 11.8 Testing for HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 CHAPTER 12 ADULT MORTALITY 12.1 The Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 12.2 Direct Estimates of Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 12.3 Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 APPENDIX B SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 APPENDIX D PERSONS INVOLVED IN THE 2000-2001 UGANDA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . 227 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 APPENDIX F UNICEF WORLD SUMMIT FOR CHILDREN: END-DECADE INDICATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 viii * Contents Tables and Figures * ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Table 1.2 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND HOUSEHOLD MEMBERS Table 2.1 Household population by age, sex, and residence . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.2 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.3 Children’s living arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2.4 Educational attainment of household population . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.5 Children’s economic activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 2.6 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table 2.7 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Figure 2.1 Population Pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS Table 3.1 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 3.2 Educational attainment by background characteristics . . . . . . . . . . . . . . . . . . . 22 Table 3.3 Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 3.4 Exposure to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 3.5 Employment status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 3.6.1 Occupation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 3.6.2 Occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3.7 Type of employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 3.9 Control over earnings according to contribution to household expenditures . . . 33 Table 3.10 Women’s participation in decisionmaking . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 3.11 Women’s participation in decisionmaking by background characteristics . . . . . 35 Table 3.12 Women's attitude toward wife beating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 3.13 Women's attitude toward refusing sex with husband . . . . . . . . . . . . . . . . . . . . 38 Table 3.14 Smoking and alcohol consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Figure 3.1 Employment of women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Figure 3.2 Type of earnings of employed women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Figure 3.3 Type of employer for women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 x * Tables and Figures Page CHAPTER 4 FERTILITY Table 4.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Table 4.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 4.3 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.4 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 4.5 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 4.6 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 4.7 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . 49 Table 4.8 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Figure 4.1 Total fertility rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 44 Figure 4.2 Trends in age-specific fertility rates, 1988-89 UDHS, 1995 UDHS, and 2000-2001 UDHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Figure 4.3 Percentage of women age 15-49 who are mothers or pregnant with their first child, by level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 CHAPTER 5 FERTILITY REGULATION Table 5.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 5.2 Knowledge of contraceptive methods by background characteristics . . . . . . . . 53 Table 5.3 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 5.4 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 5.5 Current use of contraception by background characteristics . . . . . . . . . . . . . . . 60 Table 5.6 Current use of contraception by women's status . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 5.7 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 5.8 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 5.9 Source of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 5.10 Informed choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 5.11 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5.12 Reason for nonuse of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 5.13 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . 68 Table 5.14 Exposure to family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 5.15 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . . . 70 Table 5.16 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 5.17 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Figure 5.1 Contraceptive use among currently married women 15-49 . . . . . . . . . . . . . . . . 57 Figure 5.2 Contraceptive use (percent) in selected eastern and southern African countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Figure 5.3 Trends in the CPR among currently married women 15-49 years . . . . . . . . . . . 58 Figure 5.4 Contraceptive use among currently married women 15-49 by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Figure 5.5 Distribution of current users of modern contraceptive methods by source of supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Tables and Figures * xi Page CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table 6.2 Number of co-wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table 6.3 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 6.4 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 6.5 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 6.6 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 6.7 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 6.8 Postpartum amenorrhoea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . 82 Table 6.9 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 6.10 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Figure 6.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Figure 6.2 Median age at first marriage aong women 25-49 by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Figure 6.3 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . 86 Table 7.2 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . . 88 Table 7.3 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 7.4 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Table 7.5 Mean ideal number of children by background characteristics . . . . . . . . . . . . . 92 Table 7.6 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 7.7 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Figure 7.1 Fertility preferences of currently married women 15-49 . . . . . . . . . . . . . . . . . . 85 Figure 7.2 Fertility preferences among women by number of children . . . . . . . . . . . . . . . 87 Figure 7.3 Unmet need for family planning services among currently married women 15-49 by background chracteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Figure 7.4 Mean ideal number of children by background characteristics . . . . . . . . . . . . . 93 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 8.2 Early childhood mortality by socioeconomic characteristics . . . . . . . . . . . . . . 100 Table 8.3 Early childhood mortality by demographic characteristics . . . . . . . . . . . . . . . 102 Table 8.4 Early childhood mortality by woman’s status . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 8.5 Perinatal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table 8.6 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Figure 8.1 Trends in infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Figure 8.2 Under-five mortality by selected background characteristics . . . . . . . . . . . . . . 101 xii * Tables and Figures Page CHAPTER 9 REPRODUCTIVE HEALTH AND CHILD CARE Table 9.1 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table 9.2 Number of antenatal care visits and timing of first visit . . . . . . . . . . . . . . . . . 112 Table 9.3 Antenatal care content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 9.4 Place of antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table 9.5 Tetanus toxoid injections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table 9.6 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 9.7 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Table 9.8 Delivery characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Table 9.9 Postnatal care by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 121 Table 9.10 Women’s status and reproductive health care . . . . . . . . . . . . . . . . . . . . . . . . . 122 Table 9.11 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table 9.12 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Table 9.13 Vaccination trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Table 9.14 Prevalence and treatment of symptoms of acute respiratory infection and fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Table 9.15 Hand-washing materials in households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Table 9.16 Disposal of children's stools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Table 9.17 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Table 9.18 Knowledge of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Table 9.19 Diarrhoea treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Table 9.20 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 9.21 Child health care by women’s status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Table 9.22 Perceived problem in accessing women's health care by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table 9.23 Possession and use of mosquito nets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table 9.24 Mosquito net age and insecticide treatment for mosquito nets . . . . . . . . . . . . 138 Table 9.25 Malaria prevention during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Table 9.26 Birth registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Figure 9.1 Percentge of births for which women received medical assistance during delivery, by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 119 Figure 9.2 Percentage of children age 12-23 months who are fully vaccinated, by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Figure 9.3 Type of malaria tablets taken during pregnancy . . . . . . . . . . . . . . . . . . . . . . . 140 CHAPTER 10 WOMEN’S NUTRITIONAL STATUS Table 10.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Table 10.2 Breastfeeding status by child's age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Table 10.3 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . 146 Table 10.4 Foods consumed by children in the day or night preceding the interview . . . . 147 Table 10.5 Frequency of foods received by children in the day or night preceding the interview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Table 10.6 Frequency of foods received by children in preceding seven days . . . . . . . . . . 149 Table 10.7 Iodisation of household salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Tables and Figures * xiii Page Table 10.8 Micronutrient intake among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Table 10.9 Micronutrient intake among mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Table 10.10 Nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Table 10.11 Nutritional status of women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Table 10.12 Prevalence of anaemia in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Table 10.13 Prevalence of anaemia in women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Table 10.14 Prevalence of anaemia in men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Table 10.15 Prevalence of anaemia in children by anaemia status of mother . . . . . . . . . . . 162 Table 10.16 Prevalence of vitamin A deficiency in children . . . . . . . . . . . . . . . . . . . . . . . . 164 Table 10.17 Prevalence of vitamin A deficiency in women . . . . . . . . . . . . . . . . . . . . . . . . . 165 Figure 10.1 Percentge of children under five with low height-for-age, low weight- for-height, and low weight-for-age, by age of child . . . . . . . . . . . . . . . . . . . . 156 CHAPTER 11 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS Table 11.1 Knowledge of ways to avoid HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Table 11.2.1 Knowledge of programmatically important ways to avoid HIV/AIDS: women 169 Table 11.2.2 Knowledge of programmatically important ways to avoid HIV/AIDS: men . . . 170 Table 11.3.1 Knowledge of AIDS-related issues: women . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Table 11.3.2 Knowledge of AIDS-related issues: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Table 11.4 Discussion of HIV/AIDS with partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Table 11.5.1 Social aspects of HIV/AIDS prevention and mitigation: women . . . . . . . . . . . 175 Table 11.5.2 Social aspects of HIV/AIDS prevention and mitigation: men . . . . . . . . . . . . . 176 Table 11.6 Discussion of AIDS in the media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Table 11.7.1 Knowledge of symptoms of STIs: women . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Table 11.7.2 Knowledge of symptoms of STIs: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Table 11.8.1 Self-reporting of sexually transmitted infections and STI symptoms: women . 180 Table 11.8.2 Self-reporting of sexually transmitted infections and STI symptoms: men . . . 181 Table 11.9 Source of treatment of STIs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Table 11.10 Protection of partner by women with an STI . . . . . . . . . . . . . . . . . . . . . . . . . 183 Table 11.11 Number of sexual partners: married women and men . . . . . . . . . . . . . . . . . . 184 Table 11.12 Number of sexual partners: unmarried women and men . . . . . . . . . . . . . . . . 185 Table 11.13 Payment for sexual relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Table 11.14 Knowledge of source of male condoms and access to condoms . . . . . . . . . . . 187 Table 11.15.1 Use of condoms by type of partner: women . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Table 11.15.2 Use of condoms by type of partner: women . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Table 11.16.1 HIV/AIDS tests: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Table 11.16.2 HIV/AIDS tests: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Figure 11.1 Demand for HIV Testing Services by Background Characteristics: Women . . 192 Figure 11.2 Demand for HIV Testing Services by Background Characteristics: Men . . . . . 192 CHAPTER 12 ADULT MORTALITY Table 12.1 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 xiv * Tables and Figures Page Table 12.2 Adult mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Table 12.3 Maternal mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 APPENDIX A SAMPLE DESIGN Table A.1 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Table A.2 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . 212 Table B.2 Sampling errors for selected variables: total sample . . . . . . . . . . . . . . . . . . . . 213 Table B.3 Sampling errors for selected variables: urban sample . . . . . . . . . . . . . . . . . . . 214 Table B.4 Sampling errors for selected variables: rural sample . . . . . . . . . . . . . . . . . . . . 215 Table B.5 Sampling errors for selected variables: Central Region . . . . . . . . . . . . . . . . . . 216 Table B.6 Sampling errors for selected variables: Eastern Region . . . . . . . . . . . . . . . . . . 217 Table B.7 Sampling errors for selected variables: Northern Region . . . . . . . . . . . . . . . . 218 Table B.7 Sampling errors for selected variables: Western Region . . . . . . . . . . . . . . . . . 219 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Table C.2.1 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . 222 Table C.2.2 Age distribution of eligible and interviewed men . . . . . . . . . . . . . . . . . . . . . . 222 Table C.3 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Table C.4 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Table C.5 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Table C.6 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 APPENDIX F UNICEF WORLD SUMMIT FOR CHILDREN: END-DECADE INDICATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 Preface * xv PREFACE The 2000-2001 Uganda Demographic and Health Survey (UDHS) was the third national Demographic and Health Survey in a series that started in 1988, with the second conducted in 1995. The major objective of these surveys was to collect and analyse data on fertility, mortality, family planning, and health. Compared with the 1988-1989 UDHS and the 1995 UDHS, the present survey was significantly expanded in scope to include questions on gender issues, a malaria module, and blood testing for haemoglobin and vitamin A deficiency. Thus, the 2000-2001 UDHS will not only update the information from the 1995 UDHS but will also provide more detailed findings. In the past, Population and Housing Censuses were the only sources of demographic statistics in Uganda. The vital registration system in Uganda is still underdeveloped and has been revived in only a few pilot districts. The Uganda Demographic and Health Survey series is therefore an important alternative source of demographic and health statistics. The 2000-2001 UDHS was conducted in all of the districts of the country except four, namely, Bundibugyo, Gulu, Kasese, and Kitgum. This was a considerable improvement in coverage over the 1988-1989 UDHS, which excluded nine districts. However, this is less coverage than the 1995 UDHS, which excluded only Kitgum District. The staff of the Uganda Bureau of Statistics (UBOS) participated in the planning and implementation of this survey. In addition, many government departments contributed to the successful completion of the 2000-2001 UDHS and the timely publication of this report. The Ministry of Health provided experts who participated in the training of fieldworkers and drafted some of the chapters of the report. This contribution is very much appreciated. Special thanks go to the Population Secretariat for chairing and hosting all the meetings of the Steering Committee. The United States Agency for International Development (USAID) provided most of the funds for this survey. Additional funding was received from the United Nations Children’s Fund (UNICEF)/Uganda, the United Nations Population Fund (UNFPA)/Uganda and the British Department for International Development (DFID)/Uganda. ORC Macro provided technical support. We acknowledge and appreciate the generous support from these groups. We are grateful for the endeavours of government officials at all levels of administration that supported the survey. Finally, special gratitude goes to all the respondents for having spared their valuable time to attend to the interviews, which were sometimes lengthy, as well as for providing the blood samples. John B. Male-Mukasa Executive Director Uganda Bureau of Statistics Summary of Findings * xvii SUMMARY OF FINDINGS The 2000-2001 Uganda Demographic and Health Survey (UDHS) is a nationally represen- tative survey of 7,246 women age 15-49 and 1,962 men age 15-54. The main purpose of the 2000-2001 UDHS is to provide policy- makers and programme managers with de- tailed information on fertility; family planning; childhood and adult mortality; maternal and child health and nutrition; and knowledge of, attitudes about, and practices related to HIV/AIDS. The 2000-2001 UDHS is the third national sample survey of its kind to be under- taken in Uganda. The first survey was imple- mented in 1988-1989 and was followed by the 1995 UDHS. Caution needs to be exercised when analysing trends using the three UDHS data sets because of some differences in geo- graphic coverage. FERTILITY Constant Fertility. The UDHS results show that fertility in Uganda has remained station- ary in recent years. The total fertility rate (TFR) declined from 7.3 births per woman recorded in the 1988 survey to 6.9 births for the 1995 UDHS. Since then, the TFR has remained at the same level. The crude birth rate (CBR) from the 2000-2001 survey is 47 births per 1,000 population, essentially the same as that recorded in 1995 (48 births per 1,000 population). Large Fertility Differentials. Fertility varies enormously across subgroups of women. Fertility levels are much higher in rural areas (7.4 children per woman) than in urban areas (4.0 children per woman). The TFR is lowest in the Central Region (5.7 children per wom- an) and highest in the Northern Region (7.9 children per woman). Women who have attended secondary education have a much lower fertility (3.9 children per woman) than women with no education (7.8 children per woman), a difference of four children. Early Marriage. Although the minimum legal age for a woman to get married in Uganda is 18 years, the 2000-2001 UDHS results show that marriage is common among young girls. Among women age 20-49, 17 percent were married by age 15 and more than half were married by age 18. The median age at first marriage among women is just before 18 years and has been fairly stable for the past 30 years. Men generally marry about four years later than women. Women start having sexual relations earlier than men, with a difference of about two years. The median age at first intercourse for women 20-49 is 16.7 years. The median age for women shows no evidence of change over time, while that for men has increased slightly from 18.5 years among men currently age 50-54 to 19.4 years among men 25-29. Early Childbearing. Childbearing begins early in Uganda. Three in ten women age 15-19 are already mothers or pregnant with their first child. Teenage childbearing is closely related to a woman's education. Six in ten teenagers with no education have become mothers or are pregnant with their first child, compared to 33 percent of women with some primary educa- tion, and only 17 percent of those who attended secondary school. Polygyny. One in three married women in Uganda is in a polygynous relationship. The prevalence of polygynous unions increases with age; young women are less likely to be in a polygynous marriage than older women. Women who live in rural areas and in the Western Region are less likely than other women to be in a polygynous union. The pro- portion of women who are in a polygynous union in 2000-2001 is slightly higher than that recorded in 1995 (32 compared with 30 per- cent). xviii * Summary of Findings Birth Intervals. The median interval between births in Uganda is 29 months. Overall, 28 percent of births occur less than 24 months after a prior birth. The survival status of the previous birth has a strong impact on the birth interval. Median birth intervals for births that follow a child who died are five months short- er than those for births following a surviving child (25 months and 30 months, respectively). Desire for Smaller Families. The UDHS data indicate that the desire to stop childbearing among women has doubled since 1988. The percentage of married women who say that they want no more children or have been sterilised grew from 19 percent in 1988-1989 to 38 percent in 2000-2001. There has been a decline in the ideal family size among women in Uganda from 6.5 children in 1998-99 to 4.8 children in 2000-2001. Men want larger fami- lies than women, with an ideal number of 5.6 children. Respondents in rural areas, those who live in the Northern Region, and those with no education are more likely to want larger families than other respondents. Unplanned Fertility. Despite increasing use of contraception, the survey data show that unplanned pregnancies are still common in Uganda. One in four births in the five years prior to the survey were mistimed (wanted later), and 15 percent were not wanted at all. If unwanted births could be prevented, the total fertility rate in Uganda would be 5.3 births per woman instead of the actual level of 6.9. FERTILITY REGULATION Increasing Use of Contraception. Contracep- tive use among currently married women in Uganda has increased from 15 percent in 1995 to 23 percent in 2000-2001. Most of the increase is due to greater use of modern meth- ods (8 percent in 1995 compared with 18 percent in 2000-2001). The most widely used methods in 2000-2001 were injectables (6 percent), the lactational amenorrhoea method (4 percent), and the pill (3 percent). There has been a shift in method mix since 1995, when periodic abstinence, the pill, and inject- ables were the most widely used methods. Condom use has also increased from 1 percent in 1995 to 2 percent in 2000-2001. Large Differentials in Use of Contraception. There are large differences in the use of modern contraceptive methods across subgroups of married women. Use of modern family planning methods is much higher in urban areas than in rural areas (42 and 15 percent, respectively). Contraceptive use is highest in the Central Region (31 percent) and lowest in the Eastern Region (11 percent). Women with at least some secondary education are four times more likely than women with no education to use modern methods (42 percent and 9 percent, respec- tively). Contraceptive use in Uganda is posi- tively associated with the number of living children and women's socioeconomic status. In general, married women who live in DISH districts have higher than average contraceptive use rates, while those who live in CREHP dis- tricts have lower than average use rates. Among districts included in the DISH project, Kampala has the highest level of modern method use (50 perecnt), while districts classi- fied in Group I (Mbarara and Ntungamo) and in Group IV (Kamuli and Jinja) have the lowest modern contraceptive prevalence rate (10 to 15 percent). Source of Supply. Thirty-six percent of modern contraceptive users obtain their methods from a public source, while the private medical sector provides methods to 46 percent of users. Among sources in the public sector, hospitals and health centres are the most common sources (15 percent and 13 percent, respec- tively). There has been a significant shift in the source of family planning from that recorded in the 1995 UDHS. Public sources declined from 47 percent to 36 percent, while private medical sources increased from 42 percent to 46 per- cent. Family Planning Messages in Media. Radio is the most common source for receiving family Summary of Findings * xix planning messages (62 percent). One-third of women saw a family planning message on a billboard in the six months preceding the survey and about one-fifth were exposed to messages at community meetings. Three in ten women were not exposed to any family plan- ning message at all in the preceding six months. Urban women are much more likely than rural women to have heard or seen a family planning message in any of the mass media (89 versus 65 percent). Women in the Central Region and better educated women are the most likely to have been exposed to family planning messages. Unmet Need for Family Planning. Thirty-five percent of currently married women have an unmet need for family planning services—21 percent for spacing and 14 percent for limiting. If all the unmet need were satisfied, 57 percent of married women would be using contracep- tion. The level of unmet need for family plan- ning among currently married women in Uganda has increased from 29 percent in 1995. MATERNAL AND CHILD HEALTH Antenatal Care. Survey data show that antena- tal coverage is very high in Uganda. Women receive at least some antenatal care for more than nine in ten births. In most cases, antena- tal care is provided by a nurse or a midwife (83 percent). Doctors provide antenatal care to 9 percent of pregnant women, while the role of traditional birth attendants is insignificant. Only 42 percent of pregnant women make four or more antenatal care visits, while another 42 percent make only two or three visits. More- over, very few women receive antenatal care during the first trimester of pregnancy. The majority of women (70 percent) receive teta- nus toxoid vaccination during pregnancy, with 42 percent of the women receiving two or more doses of vaccine. Delivery Care. Only four in ten births in Ugan- da are assisted by a trained health worker, while 18 percent are assisted by a TBA (tradi- tional birth attendant) and 28 percent are assisted by a relative or friend. Fifteen percent of births are unassisted. Most births take place at home; only 37 percent of births occur in a health facility. Childhood Immunisation. Childhood vaccina- tion coverage has declined from 47 percent fully immunised in 1995 to 37 percent in 2000-2001. The decline in immunisation coverage has occurred for all types of vaccination. Some of the children who received vaccinationss did not receive them at the recommended time. Only 29 percent of children 12-23 months are fully vaccinated within the first 12 months. Childhood Illnesses. Acute respiratory infec- tions, diarrhoea, and malaria are common causes of child death. In the two weeks before the survey, 23 percent of children under five were ill with symptoms of acute respiratory infections. Two-thirds of these children were taken to a health facility. Twenty percent of children had diarrhoea in the two weeks pre- ceding the survey, 45 percent of whom were taken to a health care provider. A small major- ity of children with diarrhoea received oral rehydration therapy—oral rehydration salts, a recommended homemade fluid, or increased fluids in general. This means that many chil- dren are not receiving adequate fluids when they have diarrhoea. Malaria Control. Although use of insecticide- impregnated mosquito nets is a proven way of preventing malaria, only 13 percent of house- holds in Uganda have mosquito nets. Further- more, only 7 percent of children under five and 7 percent of pregnant women age 15-49 slept under a mosquito net the night before the survey. Breastfeeding. Breastfeeding is universally practiced in Uganda, with 98 percent of babies breastfed for at least some time. The median duration of breastfeeding is 22 months. How- ever, supplementation with other liquids and foods occurs too early in Uganda. Although the World Health Organisation recommends exclu- sive breastfeeding for the first six months, only 63 percent of Ugandan children under six months are exclusively breastfed. xx * Summary of Findings Perceived Problems in Accessing Health Care. In the 2000-2001 UDHS, women were asked whether they have problems seeking medical advice or treatment for themselves. The results show that 85 percent of women experience some kind of problem in accessing health care. The majority of women mentioned that getting money for treatment was a problem (63 per- cent). Other problems commonly cited include distance to a health facility (44 percent), having to take transport (43 percent), and the negative attitude of health care providers (42 percent). Birth Registration. Birth registration is one of the recognised rights of a child in Uganda today. Although registration became compul- sory in 1903, Uganda has never had a sound registration system for either statistical or legal purposes. Survey results indicate that coverage of birth registration in Uganda is poor, with only 4 percent of recent births reported by the mother to be registered. NUTRITIONAL STATUS Nutritional Status of Children. Survey data show that there has been little improvement since 1995 in children's nutritional status. Overall, 39 percent of Ugandan children under five years are classified as stunted (low height- for-age), 4 percent of children under five years are wasted (low weight-for-height), and 23 percent are underweight. Nutritional Status of Women. The mean height for Ugandan women is 158 centimetres (cm), which is similar to the mean height obtained in the 1995 UDHS. The cutoff point below which women are identified as short in stature is in the range of 140 to 150 cm. Two percent of women are less than 145 cm tall. Another measure of women's nutritional status is the body mass index (BMI), which is derived by dividing the weight in kilograms by the height in metres squared (kg/m2). A cutoff point of 18.5 has been recommended for defining chronic undernutrition. In the 2000-2001 UDHS, the mean BMI for women was 21.9, which falls within normal limits. Prevalence of Anaemia. Children and women are more likely to be affected by anaemia than men. A simple blood test performed as part of the survey found that 65 percent of children age 6-59 months are anaemic, while 30 percent of women age 15-49 and 18 percent of men age 15-54 are anaemic. Vitamin A. The 2000-2001 UDHS tested blood samples from women 15-49 and children under five years for level of vitamin A. Results of the analysis show that 28 percent of children 6-59 months in Uganda suffer from vitamin A defi- ciency (VAD). At this level, VAD in Uganda can be perceived as a severe public health problem. As expected, the prevalence of VAD is lower among children 6-11 months, when the children are still benefiting from the positive effect of breastfeeding. The highest prevalence of VAD is found among children 12-23 months (32 percent). VAD is also more common among children living in rural areas and in the North- ern Region. More than half of the women in Uganda suffer from VAD. The deficiency level in women varies according to the woman's characteristics, but not as much as in young children. As with children, rural women and women with no education are more likely than other women to have VAD. Pregnant and lactating women are not substantially different in VAD level from women who are neither pregnant nor breast- feeding. HIV/AIDS Knowledge of HIV/AIDS. In Uganda, HIV/AIDS has been termed a “household disease”, because nine in ten respondents of either sex knew personally of someone with HIV or who had died of AIDS. Although knowledge of AIDS in Uganda is universal, the level of awareness about the disease is not matched by the knowl- edge of ways to avoid contracting the virus. Summary of Findings * xxi The most commonly cited ways are using condoms (54 percent of women and 72 per- cent of men), abstaining from sexual relations (50 percent of women and 65 percent of men), and having only one sexual partner (49 per- cent of women and 43 percent of men). Knowledge of Mother-to-Child Transmission. Most men and women in Uganda know that HIV can be transmitted from mother to child. However, among the women who know about this mode of transmission, the quality of knowledge is uneven. Overall, 58 percent of women know that HIV can be transmitted during pregnancy, 69 percent know about transmission during delivery, and 46 percent know about transmission during breastfeeding. Levels of knowledge among men are similar. Knowledge of Symptoms of Sexually Transmit- ted Infections (STIs). STIs have been identified as cofactors in HIV/AIDS transmission. Almost half of women and one in four men either have no knowledge of STIs at all or are unable to recognise any symptoms of STIs in a man. Sixty-four percent of women know of some symptoms of STIs in women and 53 percent know of some symptoms in men. Knowledge of symptoms of STIs among men is generally higher than among women. Prevalence of STIs. Eight percent of women and 3 percent of men reported having had an STI in the 12 months preceding the survey. Given the low level of knowledge about symp- toms of STIs, many people may have STIs without knowing it. Therefore, the true level of prevalence of STIs could be higher than the reported one. The rate in 2000-2001 for women is higher than in 1995 (4 percent), but for men, it is lower than in 1995 (6 percent). HIV/AIDS testing. Eight percent of women and 12 percent of men report that they have been tested for HIV. Women in their twenties and men age 25-39 are the most likely to have had the test. This test is much more common among respondents living in urban areas, in the Central Region, and in Kampala district and among those who have secondary educa- tion. Desire to be tested and desire to know the outcome of the test is high among women and men in Uganda. Respondents living in rural areas and in the Northern Region, those who have primary education, and those who have never married but have had sex are more likely to want to be tested. Nine in ten women and men who were tested for HIV received the test results. MORTALITY Infant and Child Mortality. At current mortality levels, 152 out of every 1,000 children born in Uganda die before their fifth birthday, 88 of whom die during the first year of life. Results from the 2000-2001 UDHS show no evidence of improvement in infant and childhood mortality in recent years. There are considerable variations in mortality by residence and region. Childhood mortality rates in urban areas are substantially lower than in rural areas. Under-five mortality is lowest in the Central Region (135 per 1,000 live births) and is highest in the Northern Region (178 per 1,000 live births). Under-five mortality among children born to mothers with no education is highest (187 per 1,000 live births), while chil- dren born to mothers with secondary education have by far the lowest mortality (93 per 1,000 births). The household's wealth status is nega- tively associated with childhood mortality. For all measures, children in the highest quintile have the lowest mortality rates, while those in the lowest quintile have the highest mortality rates. Adult Mortality. The mortality rate for the ten- year period before the 2000-2001 UDHS is 9 deaths per 1,000 females and 10 deaths per 1,000 males. Comparison with the adult mortal- ity experience in the ten years before the 1995 UDHS reveals that the situation has not im- proved in the past five years. Similarly, the maternal mortality ratio has remained at the same level as that recorded in 1995 (504 in the 2000-2001 UDHS compared with 527 deaths per 100,000 live births in the 1995 UDHS). Introduction * 1 INTRODUCTION 1 1.1 GEOGRAPHY AND ECONOMY The Republic of Uganda is located in East Africa and lies astride the equator. It is a landlocked country bordering Kenya in the east, Tanzania in the south, Rwanda in the southwest, the Democratic Republic of Congo in the west, and Sudan in the north. The country has an area of 241,039 square kilometres and is administratively divided into 56 districts (45 at the time of the survey). Uganda has a decentralised system of governance and several functions have been ceded to the local governments. However, the central government retains the role of making policy, setting standards, and supervising. National security is also the role of the central government. Uganda has a favourable climate because of its relatively high altitude. The Central, Eastern, and Western regions of the country have two rainy seasons per year, with heavy rains from March to May and light rains between September and December. The level of rainfall decreases towards the north, turning into just one rainy season a year. The soil fertility 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 semidesert 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. The economy is predominantly agricultural with the majority of the population dependent on subsistence farming and light agro-based industries. The country is self-sufficient in food, although the distribution is uneven over all areas. Coffee, tea, and cotton are the major earners of Uganda’s foreign exchange. During the period immediately following independence, from 1962 to 1970, Uganda had a flourishing economy with a gross domestic product (GDP) growth rate of 5 percent per annum, compared with a population growth rate of 2.6 percent per annum. However, in the 1970s through the early 1980s, 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 government has introduced and implemented several reform programmes that have steadily reversed the setbacks and aimed the country towards economic prosperity. Consequently, between 1996 and 2000, the country’s real GDP grew at an average rate of 6.2 percent per annum. This is far higher than the population growth rate, which was estimated at 2.9 percent. The GDP per capita grew at a rate of 2.6 percent per annum. 1.2 POPULATION In the past, most demographic statistics in Uganda were derived from population censuses, which started in 1948. Subsequent censuses have been held in 1959, 1969, 1980, and 1991. In addition, Demographic and Health Surveys (DHS) have been conducted in 1988-1989, 1995, and 2000-2001, the subject of the present report. Additional demographic data have been obtained from small-scale surveys devoted to specific subjects. 2 * Introduction Table 1.1 Demographic characteristics Selected demographic indicators, Population Censuses 1948-1991___________________________________________________________________________ Census year____________________________________________ Indicator 1948 1959 1969 1980 1991___________________________________________________________________________ Population (thousands) Intercensal growth rate Sex ratio Crude birth rate Total fertility rate Crude death rate Infant mortality rate Percent urban Density (pop/sq km) 4,958.5 6,536.6 9,535.1 12,636.2 16,671.7 na 2.5 3.9 2.7 2.5 100.2 100.9 101.9 98.2 96.5 42.0 44.0 50.0 50.0 52.0 5.9 5.9 7.1 7.2 7.1 25.0 20.0 19.0 na 17.0 200.0 160.0 120.0 na 122.0 na 4.8 7.8 8.7 11.3 25.2 33.2 48.4 64.4 85.0 ___________________________________________________________________________ Source: Statistics Department, 1995:27, 56, 139 na = Not applicable Civil registration was made compulsory in Uganda in 1973. However, its coverage is incomplete and is therefore unsatisfactory as a source of demographic statistics. 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 mentioned above. Since 1995, an attempt has been made to revive the civil registration system in the country, but thus far, it has not reached a satisfactory level. Table 1.1 presents several demographic indices compiled from the population censuses of 1948 through 1991. The table shows that over that period, the population increased more than threefold. This represents an average annual growth rate of 2.9 percent. The high growth rate is brought about by high fertility and declining mortality levels. The level of urbanisation is still low but has been increasing over time. In 1991, a little more than 10 percent of the population lived in urban areas. Up to the late 1960s, there were more males than females in Uganda. This was mainly due to large numbers of male immigrants who came to the country to work at factories and plantations. In the mid-1970s these migrants left because of the deteriorating economic situation. Since then, the number of females exceeds that of males. 1.3 NATIONAL POPULATION AND HEALTH PROGRAMMES Uganda has instituted several policies to help improve the health status and life of its people. In 1995, Uganda adopted the National Population Policy for Sustainable Development. The policy document noted that indices of general health care are still unsatisfactory. Thus, the policy’s overall goal is to influence future demographic trends and patterns in desirable directions to improve the quality of life and standard of living of the people. In particular, the policy aims to reduce infant and child mortality, maternal mortality, and fertility and to increase the life expectancy of the population. The policy also aims to increase levels of full immunisation among children, increase levels of supervised deliveries, and increase the contraceptive prevalence rate. The National Reproductive Health Policy Guidelines for Reproductive Health Services state that the country’s priorities are “safe motherhood including post-abortion care, family planning, adolescent sexual and reproductive health, STIs including HIV/AIDS, reproductive organ cancer, and gender practices that perpetuate poor reproductive behaviour.” Introduction * 3 Other policies that indirectly impinge on population and health include the Adolescent Sexual and Reproductive Health Policy, the Nutrition Policy, the Framework for HIV/AIDS Activities in Uganda, Universal Primary Education, the Gender Policy, the Poverty Eradication Action Plan ,the Decentralisation Policy, the Liberalisation and Privatisation Policies, and the Plan for the Modernisation of Agriculture. To achieve the targets of these policies, the government, with the help of development partners, is implementing several population and reproductive health programmes in the country aimed at influencing the behaviour of the population. 1.4 OBJECTIVES OF THE SURVEY The 2000-2001 Uganda Demographic and Health Survey (UDHS) was designed to provide information on demographic, health, and family planning status and trends in the country. Specifically, the UDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, and breastfeeding practices. In addition, data were collected on the nutritional status of mothers and young children; infant, child, adult, and maternal mortality; maternal and child health; awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections; and levels of haemoglobin and vitamin A in the blood. The 2000-2001 UDHS is a follow-up to the 1988-1989 and 1995 UDHS surveys, which were also implemented by the Uganda Bureau of Statistics (UBOS, previously the Department of Statistics). The 2000-2001 UDHS is significantly expanded in scope but also provides updated estimates of basic demographic and health indicators covered in the earlier surveys. The specific objectives of the 2000-2001 UDHS are as follows: C To collect data at the national level that will allow the calculation of demographic rates, particularly the fertility and infant mortality rates C To analyse the direct and indirect factors that determine the level and trends in fertility and mortality C To measure the level of contraceptive knowledge and practice of women and men by method, by urban-rural residence, and by region C To collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS, and to evaluate patterns of recent behaviour regarding condom use C To assess the nutritional status of children under age five and women by means of anthropometric measurements (weight and height), and to assess child feeding practices C To collect data on family health, including immunisations, prevalence and treatment of diarrhoea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding C To measure levels of haemoglobin and vitamin A in the blood of women and children C To collect information on the extent of child labour. 1 The number of districts has since increased to 56. The newly formed districts are Kayunga and Wakiso in the Central Region; Kaberamaido, Mayuge, and Sironko in the Eastern Region; Pader, Nakapiripirit, and Yumbe in the Northern Region; and Kanungu, Kamwenge, and Kyenjojo in the Western Region. 4 * Introduction 1.5 ORGANISATION OF THE SURVEY Sample Design and Implementation The sample was drawn through a two-stage design. The first-stage sample frame for this survey is the list of enumeration areas (EAs) compiled from the 1991 Population Census. In this frame, the EAs are grouped by parish within a subcounty, by subcounty within a county, and by county within a district. A total of 298 EAs (102 in urban areas and 196 in rural areas) were selected. Urban areas and districts included in the Delivery of Improved Services for Health (DISH) project and the Community Reproductive Health Project (CREHP) were oversampled in order to produce estimates for these segments of the population. Within each selected EA, a complete household listing was done to provide the basis for the second-stage sampling. The number of households to be selected in each sampled EA was allocated proportionally to the number of households in the EA. It was not possible to cover all districts in the country because of security problems in a few areas. The survey was hence limited to 41 out of the then 45 districts in the country,1 excluding the districts of Kasese and Bundibugyo in the Western Region and Gulu and Kitgum in the Northern Region. These districts cover approximately 5 percent of the total population. The sample for the 2000-2001 UDHS was aimed at providing reliable estimates of important indicators for the population of Uganda at the national level (less the excluded districts), for urban and rural areas, and for each of the four regions in Uganda defined as— Central: Kalangala, Kampala, Kiboga, Luwero, Masaka, Mpigi, Mubende, Mukono, Sembabule, Nakasongola, and Rakai Eastern: Bugiri, Busia, Iganga, Jinja, Kamuli, Kapchorwa, Katakwi, Kumi, Mbale, Pallisa, Soroti, and Tororo Northern: Adjumani, Apac, Arua, Kotido, Lira, Moyo, Moroto, and Nebbi Western: Bushenyi, Hoima, Kabale, Kabarole, Kibaale, Kisoro, Masindi, Mbarara, Ntungamo, and Rukungiri. The sample was also designed to generate estimates of contraceptive prevalence rates for the districts in the DISH project funded by the United States Agency for International Development (USAID) and districts in the CREHP project. These districts are grouped in six subdomains, namely, the following: Introduction * 5 DISH districts: Group I: Mbarara and Ntungamo Group II: Masaka, Rakai, and Sembabule Group III: Luwero, Masindi, and Nakasongola Group IV: Jinja and Kamuli Group V: Kampala CREHP districts: Kabale, Kisoro, and Rukungiri. In each group, a minimum of 500 completed interviews with women was targeted to allow for separate estimates. Consequently, data for Kampala District can be presented separately because it has more than the specified minimum number of completed interviews. The 2000-2001 UDHS covered the same EAs as were covered by the 1995 UDHS. However, a new list of households within the EA was compiled and the sample households were not necessarily the same as those selected in 1995. In the case of the CREHP districts (Kabale, Kisoro and Rukungiri), five extra EAs were selected to generate a sample size sufficient to allow independent estimates. Because the 1995 and 2000-2001 UDHS did not cover the same geographical areas, the two surveys are not exactly comparable. Details of the UDHS sample design are provided in Appendix A and estimations of sampling errors are included in Appendix B. Questionnaires Three questionnaires were used for the 2000-2001 UDHS, namely, the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The contents of these questionnaires were based on the MEASURE DHS+ Model “B” Questionnaire, which was developed for use in countries with a low level of contraceptive use. In consultation with technical institutions and local organisations, UBOS modified these questionnaires to reflect relevant issues in population, family planning, and other health issues in Uganda. The revised questionnaires were translated from English into six major languages, namely, Ateso, Luganda, Lugbara, Luo, Runyankole/Rukiga, and Runyoro/Rutoro. The questionnaires were pretested prior to their finalisation. The pretest training took place from June 14 to July 8, 2000. For this exercise, seven women and seven men were trained to be interviewers, forming seven teams of one woman and one man each. Each team was assigned to test the questionnaires in one of the seven language groups (including English) into which the questionnaires had been translated. Three nurses were recruited to participate in the anemia testing exercise as health technicians. The pretest fieldwork was conducted during a one-week period (July 10-16, 2000). The Household Questionnaire was used to list all the usual members and visitors in selected households. Some basic information was collected on the characteristics of each person listed, including his or 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 6 * Introduction 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 durable goods. It also included questions that were designed to assess the extent of child labour and that were used to record the height and weight and the haemoglobin level of women 15-49 and children under the age of five. In households selected for the male survey, the haemoglobin level of men eligible for the individual interview was also recorded. The Women’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on topics related to their background, childbearing experience and preferences, marriage and sexual activity, employment, maternal and child care, and awareness and behaviour regarding AIDS and other sexually transmitted infections (STIs). Information necessary for the calculation of adult mortality including maternal mortality was also included in the Women’s Questionnaire. The Men’s Questionnaire was administered to all men age 15-54 living in every third household in the UDHS sample. 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, maternal and child health, nutrition, and maternal mortality. The questionnaires used in the UDHS are presented in Appendix E. The decision to include vitamin A testing was made rather late in the survey design process. As a result, ORC Macro and UBOS staff organized a special pretest of the vitamin A testing procedures shortly before the main training for the survey. Although there were some concerns about response rates, the pretest indicated that it was feasible to incorporate vitamin A testing into the UDHS. Therefore, ORC Macro staff and UBOS staff and consultants proceeded to develop a special set of training materials for the vitamin A testing. Training and Fieldwork A total of 70 interview staff (52 women and 18 men) was trained over a three-week period from August 23, 2000 to September 16, 2000. The trainers included the UBOS staff, guest lecturers, and consultants from ORC Macro. The training was conducted following the DHS training procedures, including class presentations, mock interviews, field practice, and tests. All of the participants were trained using the Household and Women’s Questionnaires. After training on the Women’s Questionnaire was completed, the male participants were trained separately in conducting an interview using the Men’s Questionnaire. The training included practice interviews using the questionnaire in English and the participant’s local language. A separate training was conducted for the 13 medical personnel who were designated as the team health technicians. This included training on parts of the Household Questionnaire that pertained to their tasks, taking blood samples from the subjects, using the HemoCue machine, and storing dry blood spots (DBS) samples. A one-day joint training session was conducted for all the field staff in taking the height and weight measurements of women and children. The interviewing team members were trained in anthropometric measurements so that in case the need arose, they could be called upon to assist the team’s health technician in performing these tasks. Eleven interviewing teams carried out data collection for the 2000-2001 UDHS. Each team consisted of one team supervisor, one field editor, one health technician, three or four female Introduction * 7 Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, accord- ing to urban-rural residence, Uganda 2000-2001_____________________________________________________________ Residence_________________ Result Urban Rural Total_____________________________________________________________ Household interviews Households sampled Households found Households interviewed Household response rate Individual interviews: women Number of eligible women Number of eligible women interviewed Eligible woman response rate Individual interviews: men Number of eligible men Number of eligible men interviewed Eligible man response rate 2,912 5,880 8,792 2,704 5,530 8,234 2,499 5,386 7,885 92.4 97.4 95.8 2,636 5,081 7,717 2,416 4,830 7,246 91.7 95.1 93.9 775 1,531 2,306 601 1,361 1,962 77.5 88.9 85.1 interviewers, one male interviewer, and one driver. The actual data collection took place over a five- month period, from September 28, 2000 to March 3, 2001. Seven staff members from UBOS coordinated and supervised fieldwork activities. ORC Macro participated in field supervision for interviews and measurements. Two additional persons were hired to supervise the collection of blood samples for vitamin A testing. Data Processing All questionnaires for the UDHS were returned to the UBOS offices in Entebbe for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing computer-identified errors. A team of eight data entry clerks, an office editor, and two data entry supervisors processed the data. Data entry and editing started on October 19, 2000. In January 2001, when it was noted that the data processing pace was lagging behind data collection, another shift was added to the data processing team. The evening shift was also composed of eight people (working four hours per day). In addition, both shifts worked for four hours each on Saturdays. 1.6 RESPONSE RATES Table 1.2 shows response rates for the 2000-2001 UDHS. A total of 8,792 households were selected in the sample, of which 8,234 were occupied. The short fall was largely due to structures that were found to be vacant. Of the existing households, 7,885 were successfully interviewed, yielding a household response rate of 96 percent. 8 * Introduction In the successfully interviewed households, 7,717 women were identified for the individual interview, and of these, 7,246 were successfully interviewed, yielding a response rate of 94 percent. In a subsample of households, 2,306 eligible men were identified for the individual interview, of which 1,962 were successfully interviewed, yielding a response rate of 85 percent. The overall response rates for women and men were 90 percent and 82 percent, respectively. Rural response rates were higher than urban rates. The principal reason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. The lower response rate for men was due to their more frequent and longer absence from the household. The refusal rate in the 2000-2001 UDHS was slightly more than 1 percent each for women and men. 1 A household was defined as a person or group of persons that usually lives and eats together. Characteristics of Households and Household Members * 9 Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age group, according to sex and urban-rural residence, Uganda 2000-2001____________________________________________________________________________________________________ Urban Rural Total_______________________ _______________________ __________________________ Age group Male Female Total Male Female Total Male Female Total____________________________________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Missing/DK Total Number 17.3 15.9 16.6 21.2 19.8 20.5 20.7 19.3 20.0 14.4 14.1 14.2 18.1 17.1 17.6 17.7 16.7 17.2 12.6 13.8 13.2 15.7 14.7 15.2 15.3 14.6 15.0 11.3 13.6 12.5 9.1 8.7 8.9 9.4 9.3 9.4 11.0 12.7 11.9 6.0 7.7 6.9 6.6 8.3 7.5 10.4 9.9 10.1 6.0 6.9 6.5 6.5 7.3 6.9 7.7 6.2 6.9 5.5 5.3 5.4 5.8 5.4 5.6 5.4 4.7 5.0 4.0 4.3 4.2 4.2 4.4 4.3 2.9 2.6 2.8 3.0 3.1 3.1 3.0 3.1 3.0 2.8 1.8 2.2 2.5 2.4 2.4 2.6 2.3 2.4 1.3 1.8 1.6 1.9 2.8 2.3 1.8 2.6 2.3 0.8 0.6 0.7 1.7 1.9 1.8 1.6 1.7 1.7 0.7 0.8 0.8 1.7 2.0 1.8 1.6 1.8 1.7 0.6 0.6 0.6 1.3 1.1 1.2 1.2 1.1 1.1 0.4 0.4 0.4 0.9 1.2 1.1 0.8 1.1 1.0 0.1 0.2 0.2 0.7 0.4 0.5 0.6 0.3 0.5 0.2 0.3 0.2 0.7 0.5 0.6 0.6 0.5 0.6 0.2 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2,221 2,453 4,674 15,436 16,418 31,855 17,657 18,871 36,528 __________________________________________________________________________________________________ Note: Table is based on the de facto population, i.e., persons who stayed in the household the night before the interview. 2CHARACTERISTICS OF HOUSEHOLDSAND HOUSEHOLD MEMBERS This chapter presents information on some of the socioeconomic characteristics of the household1 population and the individual survey respondents, such as age, sex, marital status, religion, urban-rural residence, and regional distribution. This chapter also considers the conditions of the households in which the survey population lives, including source of drinking water, availability of electricity, sanitation facilities, building materials, and possession of household durable goods. 2.1 POPULATION BY AGE AND SEX The 2000-2001 UDHS included a Household Questionnaire, which was used to elicit information on the socioeconomic characteristics of usual residents and visitors who had spent the previous night in the selected households. Table 2.1 shows the reported distribution of the household population in five-year age groups, by sex and urban-rural residence. The data show that there are slightly more women than men, with women constituting 52 percent of the population and men constituting 48 percent. The 10 * Characteristics of Households and Household Members sex composition of the population does not show significant variation by urban-rural residence. The table further depicts Uganda as a young population, with a large proportion of the population being in the younger age groups. The population under age 15 constitutes 52 percent of the total population. The older age groups are very small in comparison, as can be seen in the population pyramid (Figure 2.1). This type of age structure has a built-in momentum for the growth of the country’s population. When the young population eventually reaches reproductive age, the result will be a high population growth rate for some years to come. The data show an unexpected bulge in the proportion of women age 50-54. This is most likely due to women age 45-49 being deliberately pushed to the 50-54 age group to reduce the workload of the interviewer. There is also an unusually large number of girls age 14 relative to the number age 15 (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 given the levels observed in the UDHS 2000-2001, its effect on the overall results is considered negligible. Characteristics of Households and Household Members * 11 Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Uganda 2000-2001________________________________________ Residence_____________ Characteristic Urban Rural Total________________________________________ Sex of head of household Male Female Total Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size 69.2 73.0 72.5 30.8 27.0 27.5 100.0 100.0 100.0 16.4 10.1 11.0 16.1 11.0 11.8 15.0 12.6 12.9 15.5 14.6 14.8 11.2 14.2 13.8 8.8 11.8 11.4 5.6 8.9 8.4 3.5 6.2 5.8 7.8 10.4 10.0 100.0 100.0 100.0 4.2 4.9 4.8 2.2 HOUSEHOLD COMPOSITION The headship and composition of households is presented in Table 2.2. Nearly three in four households are headed by males, while one in four are headed by women. The proportion of female-headed households is slightly higher in urban areas than in rural areas (31 percent and 27 percent, respectively). One in every nine households has only one member. However, very large households (nine persons or more) still exist in Uganda. Even in urban areas, which tend to have smaller household sizes than rural areas, 8 percent of the households have nine or more persons. In urban areas, 33 percent of the households have one or two members, compared with 21 percent in rural areas. Rural areas have consistently higher percent- ages of larger households (five persons or more) than urban areas. Table 2.2 shows that the mean household size is 4.8 persons. This is similar to the figure obtained from the 1991 Population and Housing Census and the 1995 UDHS (Statistics Department and Macro International Inc., 1996). The mean household size is larger in rural areas (4.9 persons) than in urban areas (4.2 persons). 2.3 FOSTERHOOD AND ORPHANHOOD In Uganda, a child is defined as a person less than 18 years old, while some countries classify a child as a person under 15 years old. Information on fosterhood and orphanhood of children under both definitions is presented in Table 2.3. Overall, 58 percent of children under 18 years of age are living with both their parents, while 18 percent are living with neither their natural father nor natural mother. The bulk of children living with only one parent are living with the mother (17 percent), compared with only 6 percent living with only the father. Among children under 15 years of age, the percentage living with both parents is slightly higher (60 percent), while the percentage living with neither parent is 16 percent. In Uganda, an orphan is defined as a child under 18 years old who has lost at least one of his/her biological parents. Fourteen percent of children under 18 years of age are orphans. Among these, 3 percent are those who have lost both parents, 8 percent have lost their father only, and 3 percent have lost their mother only. The corresponding percentage of children under 15 years of age who have been orphaned is 12 percent. Although orphanhood levels increase with age, there are no significant differentials in orphanhood and fostering levels according to the child’s sex and residence. However, fewer urban children and children in the Central Region live with both their natural parents. 12 * Characteristics of Households and Household Members Table 2.3 Children’s living arrangements Percent distribution of de jure children under age 18 by survival status of parents and children's living arrangements, according to background characteristics, Uganda 2000-2001____________________________________________________________________________________________________________ Living Living with mother with father but not father but not mother Not living with either parent Missing Living ____________ _____________ ________________________ informa- with Only Only tion on Background both Father Father Mother Mother Both father mother Both father/ characteristic parents alive dead alive dead alive alive alive dead mother Total Number____________________________________________________________________________________________________________ Age 0-2 2-5 6-9 10-14 Sex Male Female Residence Urban Rural Region Central Eastern Northern Western Total Total 0-14 77.2 15.9 1.6 0.8 0.1 2.9 0.3 0.2 0.2 0.8 100.0 4,498 67.2 13.1 3.3 3.2 0.5 8.6 1.0 1.6 0.9 0.6 100.0 4,068 55.3 11.5 5.2 4.8 1.8 13.2 1.6 2.9 2.4 1.2 100.0 5,317 40.3 7.8 10.3 4.8 3.2 15.1 3.9 5.3 5.5 3.7 100.0 2,218 59.8 11.9 5.1 4.3 1.7 9.2 1.6 2.8 2.6 1.2 100.0 10,816 56.9 11.9 5.5 3.8 1.5 11.6 1.9 2.8 2.6 1.4 100.0 10,941 46.8 14.0 5.4 6.3 2.0 13.0 2.2 4.6 4.2 1.5 100.0 2,521 59.8 11.6 5.3 3.7 1.5 10.1 1.6 2.6 2.4 1.3 100.0 19,236 48.9 12.2 5.4 5.7 2.3 13.1 2.6 4.4 3.9 1.5 100.0 6,594 62.8 10.9 3.4 4.7 0.7 11.1 0.9 2.2 1.9 1.4 100.0 6,282 61.4 14.4 6.1 2.9 1.0 7.6 1.4 2.0 2.1 1.1 100.0 3,428 62.7 11.1 6.8 2.0 2.1 8.2 1.8 2.3 2.0 1.0 100.0 5,453 58.3 11.9 5.3 4.0 1.6 10.4 1.7 2.8 2.6 1.3 100.0 21,757 60.4 12.4 4.7 4.0 1.4 9.9 1.5 2.5 2.3 1.0 100.0 19,539 2.4 EDUCATIONAL LEVEL OF HOUSEHOLD POPULATION Education affects many aspects of life, including individual demographic and health behaviour. Studies have shown that educational level is strongly associated with contraceptive use; fertility; and the health, morbidity, and mortality of children. In each household, for all persons age four or older, data were collected on the highest level of education attended and the highest class completed at that level. For comparison with data from previous UDHS surveys, Table 2.4 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 background characteristics. One in four children age 4-5 has started school, with insignificant differences found between boys and girls. Overall, 15 percent are in preschool and 9 percent are in primary school (data not shown). More than one in four females (27 percent) age six and above in Uganda have never been to school, compared with only 15 percent of males. In all age groups except the youngest, males are less likely to have no education and more likely to have attained some secondary education than females. The proportion of boys and girls age 6-9 and 10-14 with no education is similar, which may be attributed to the Universal Primary Education programme introduced in 1997 for children under 15. Among older men and women, significant differentials in educational attainment between the sexes are observed. However, data in Table 2.4 show that sex differentials in education have been narrowing over time and the differences in educational attainment between school-age boys and girls have become insignificant. Characteristics of Households and Household Members * 13 Table 2.4 Educational attainment of household population Percent distribution of the de facto male and female household populations age six and over by highest level of education attended, according to background characteristics, Uganda 2000-2001________________________________________________________________________________________________________ Level of education _________________________________________________ More No Com- Some Completed than Don't Median Background educa- Some pleted second- second- second- know/ number characteristic tion primary primary ary ary ary missing Total Number of years__________________________________________________________________________________________________________ MALE__________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Central Eastern Northern Western Total 34.6 65.1 0.0 0.0 0.0 0.0 0.3 100.0 2,551 0.0 3.6 90.2 5.1 1.0 0.0 0.0 0.1 100.0 2,705 2.4 3.2 53.7 20.0 22.4 0.2 0.3 0.2 100.0 1,661 5.3 7.4 47.7 12.6 23.0 2.6 5.6 1.2 100.0 1,171 5.7 7.0 46.8 12.3 21.5 2.8 8.2 1.5 100.0 1,149 5.6 9.1 46.7 13.0 18.3 1.6 9.2 2.1 100.0 1,019 5.5 13.9 45.6 10.7 16.4 2.5 9.3 1.6 100.0 739 5.4 15.8 43.9 12.2 17.2 1.8 7.2 1.9 100.0 524 5.5 14.6 50.0 8.8 16.3 1.0 7.0 2.2 100.0 450 5.2 14.6 46.6 13.6 14.8 0.1 7.9 2.4 100.0 322 5.1 21.4 42.9 12.4 13.6 0.6 7.5 1.6 100.0 282 4.2 32.0 43.3 12.1 9.6 0.0 2.2 0.8 100.0 277 2.9 52.0 34.4 5.3 4.0 0.3 1.7 2.3 100.0 579 0.0 8.2 40.6 7.4 25.7 3.6 12.0 2.4 100.0 1,775 6.0 16.3 62.0 9.3 9.1 0.5 2.1 0.7 100.0 11,661 2.8 14.0 53.5 8.2 14.9 1.8 5.3 2.2 100.0 4,322 3.8 11.4 62.1 10.7 12.1 0.4 3.0 0.4 100.0 3,639 3.2 19.7 58.4 10.2 8.5 0.3 2.5 0.5 100.0 2,066 2.7 18.2 63.6 7.7 7.7 0.5 2.0 0.3 100.0 3,410 2.5 15.2 59.1 9.1 11.3 0.9 3.4 1.0 100.0 13,436 3.1 _________________________________________________________________________________________________________ FEMALE_________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Central Eastern Northern Western Total 32.6 67.3 0.0 0.0 0.0 0.0 0.0 100.0 2,611 0.0 4.6 88.0 6.4 0.9 0.0 0.0 0.1 100.0 2,756 2.5 9.9 49.9 16.1 22.9 0.4 0.6 0.2 100.0 1,755 5.0 15.9 50.3 11.7 15.7 1.2 4.7 0.4 100.0 1,574 4.4 22.6 47.7 9.7 14.4 0.4 5.0 0.2 100.0 1,380 4.0 25.9 49.0 10.8 9.5 0.4 3.6 0.8 100.0 1,028 3.0 32.1 46.7 8.5 7.4 0.3 4.5 0.6 100.0 824 2.5 33.8 47.1 7.7 8.4 0.0 2.3 0.8 100.0 579 2.4 46.1 38.5 6.2 6.1 0.0 2.0 1.1 100.0 430 0.7 59.7 28.2 4.2 6.0 0.0 0.8 1.2 100.0 500 0.0 69.0 23.9 3.3 1.2 0.0 2.0 0.7 100.0 328 0.0 77.1 18.6 1.7 0.0 0.0 1.1 1.6 100.0 342 0.0 79.8 16.6 1.7 0.5 0.0 0.5 0.9 100.0 565 0.0 11.7 46.1 9.6 22.1 1.4 8.2 0.8 100.0 1,993 5.2 28.8 57.5 7.0 5.5 0.1 0.8 0.3 100.0 12,687 1.6 19.4 53.2 9.0 13.5 0.6 3.5 0.8 100.0 4,628 3.3 23.3 60.3 8.3 6.6 0.1 1.3 0.2 100.0 4,053 2.0 39.4 50.7 5.3 3.4 0.1 0.8 0.3 100.0 2,272 0.5 30.9 57.7 5.5 4.6 0.2 0.9 0.2 100.0 3,727 1.4 26.5 55.9 7.3 7.8 0.3 1.8 0.4 100.0 14,680 1.9 __________________________________________________________________________________________________________ Note: Totals include eight men and six women for whom age is missing. An asterisk indicates that a figure has been suppressed because it is based on fewer than 25 respondents. 14 * Characteristics of Households and Household Members The percentage of both males and females who have never attended school increases steadily with age. Among females, this proportion decreases from 80 percent in the oldest age group (65 years or more) to 5 percent among those age 10-14. The decline is slightly less drastic among males, from 52 percent to 4 percent, respectively. It is worth noting that despite the existence of the UPE programme, about one-third of girls and boys age 6-9 years have never been to school. This could be attributed to hindrances like long distances to the nearest school and parents who consider these children to be too young to start schooling. Another possible factor is that the UDHS mostly occurred in the last few months of 2000, and children who turned age six may have been waiting to enter the school year that began in January 2001. Levels of educational attainment are higher in urban areas than in rural areas. The percentage with no education is lower and the percentage with secondary education is higher in urban areas than in rural areas. Similarly, the median number of years of schooling is higher in urban areas than in rural areas. Whereas women show wide variations across regions, educational levels of men are less varied. Both men and women in the Central Region have the highest levels of secondary education. On the other hand, in the Northern Region, while almost 40 percent of women have had no education, the educational levels of men are only slightly different from those in the Western Region. This pattern was also observed in the 1995 UDHS. 2.5 CHILD LABOUR Uganda is a signatory to the International Labour Organisation International Programme for the Elimination of Child Labour (ILO-IPEC). Despite all policies and laws put in place, child labour still exists in Uganda. In addition to exploiting children and subjecting them to a hazardous working environment, child labour has the effect of denying children a chance to get an education, thus affecting their future. The 2000-2001 UDHS collected information in the Household Questionnaire on the engagement of children age 5-17 in domestic and commercial employment. The objective was to establish the magnitude of child labour in the country and the circumstances under which these children work. The survey established whether in the week preceding the survey, a child was working outside the household or for a member of the household, the type of work done, the tenure of the job, the location/environment of the work, and number of hours worked. The survey also collected information on participation in domestic chores. The results are presented in Table 2.5. Overall, less than 5 percent of children age 5-17 worked for someone who was not a member of the household. Children’s employment does not vary much according to urban-rural residence, the sex of the household head or whether the child is in school or not. However, older boys and children in the Eastern Region are more likely to work than other children. It is worth noting that the chance for a child to be employed by someone outside the household is inversely related to the household’s wealth status. Children in the lowest quintile are the most likely to be working, and those in the highest quintile are the least likely to work. Most children (83 percent of boys and 88 percent of girls) helped around the house with chores such as cooking, shopping, cleaning, washing dishes, fetching water, and caring for animals. Although there is no difference by the sex of the household head, in general, children age 10-14, rural children, children in the Central Region, and those who are attending school are more likely Characteristics of Households and Household Members * 15 Table 2.5 Children’s economic activity Among children age 5-17, the percentage who worked for someone who was not a member of the household in the week preceding the survey, the percentage who regularly helped with household chores in the week preceding the survey, and the percentage who worked for the family in the week preceding the survey, by sex and background characteristics, Uganda 2000-2001 ________________________________________________________________________________________________ Boys Girls ___________________________________ ____________________________________ Worked for Worked for someone someone who is not Regularly who is not Regularly a member helps with Worked Number a member helps with Worked Number Background of the household for the of of the household for the of characteristic household chores family boys household chores family girls _________________________________________________________________________________________________ Age 5-9 10-14 15-17 Residence Urban Rural Region Central Eastern Northern Western Sex of household head Male Female Schooling status Attending school Not attending school Wealth index quintile Lowest Lower middle Middle Upper middle Highest Total 2.5 73.8 23.3 3,264 3.2 81.6 22.3 3,331 5.4 92.3 54.6 2,864 4.9 94.3 50.8 2,938 8.6 87.2 56.7 1,156 4.6 87.9 53.4 1,163 4.6 78.2 18.7 835 2.4 83.6 15.8 976 4.6 83.8 43.8 6,449 4.3 88.2 41.9 6,457 3.5 89.6 47.9 2,320 1.7 90.7 45.1 2,351 7.2 80.7 46.7 1,934 6.8 85.5 42.3 2,115 3.3 69.9 28.7 1,159 4.7 84.7 26.7 1,146 4.1 85.9 33.9 1,871 3.7 88.0 32.8 1,821 4.4 83.1 40.3 5,381 3.5 87.1 37.2 5,303 5.1 83.4 42.7 1,903 5.6 88.8 41.5 2,129 4.6 87.9 45.8 5,839 4.3 90.6 42.4 5,856 4.6 64.2 21.1 1,445 3.1 76.6 23.9 1,576 6.4 78.4 39.3 1,322 5.8 86.2 35.5 1,320 5.2 81.0 40.7 1,443 5.5 86.4 41.0 1,381 4.0 85.3 44.5 1,515 4.4 90.0 43.7 1,485 4.1 87.3 47.4 1,549 3.3 90.8 44.9 1,619 3.3 83.1 32.1 1,455 1.9 84.5 27.5 1,627 4.6 83.2 40.9 7,284 4.1 87.6 38.5 7,433 than other children to help with chores around the house. The household’s wealth status does not have a strong influence on the participation of children in household chores. Questions were also asked of all children age 5-17 about whether they worked for the family farm or business in the week prior to the survey. Data in Table 2.5 show that four in ten children worked for their family. This figure is higher for older children, children in the rural areas, and those attending school. There is no clear pattern of the involvement of children in the family business or farm by the household’s wealth status. Whereas children in the middle three quintiles seem to have gradually higher rates as their wealth status increases, children in the lowest and highest quintiles are the least likely to work for the family farm or business. 16 * Characteristics of Households and Household Members 2.6 HOUSING CHARACTERISTICS Information was collected about certain characteristics of the households, including access to electricity, source of drinking water, time to water source, type of sanitation facility, and construction materials of the dwelling. This information is used to assess the status of public health. The information on housing characteristics is presented by urban-rural residence in Table 2.6. Nine percent of households in Uganda have access to electricity. Although still low, this proportion shows a slight improvement from the 7 percent observed in the 1995 UDHS. Access to electricity is much higher in urban areas (44 percent) than in rural areas (2 percent). Table 2.6 shows that open wells are still a major source of drinking water, while boreholes are the second most important source. These two sources combined are used by one half of the households with another 16 percent of households getting water from protected wells. Only one in nine households has access to piped water, mainly from a public tap. The percentage of households with access to piped water is much higher in the urban areas (63 percent) compared to the rural areas (2 percent). The urban-rural difference is also reflected in the time taken to draw water. In urban areas, nearly two-thirds of the households are within 15 minutes of a water source, compared with only 15 percent of rural households. Although half of urban households take nine minutes to collect water, in the rural areas the median duration is 30 minutes, more than three times longer. Households without proper toilet facilities are more exposed to the risk of diseases like dysentery, diarrhoea, and typhoid fever. Most households (79 percent) in Uganda use traditional pit latrines; this is true in both urban and rural areas. Flush toilets, as well as ventilated improved pit (VIP) latrines, are less common in the rural areas than in the urban areas. Overall, one in six households in Uganda has no toilet facilities of any kind. This problem is more common in rural areas, where about one-fifth of the households have no toilet facilities, compared with only 3 percent of households in urban areas. The type of material used for the floor may be viewed as an indicator of the quality of housing (an income dimension) as well as an indicator of health risk. Some floor materials like earth, sand, and cow dung pose a health problem since they can act as breeding grounds for pests and may be a source of dust. They are also more difficult to keep clean. Overall, four out of every five households have floors made of earth, sand, or cow dung. In general, rural households have poorer quality floors than urban households. Ninety percent of rural households have earth or dung floors, while 73 percent of the urban households have cement or vinyl floors. Very few households (less than 1 percent) in both rural and urban areas have floors made from tiles or polished wood. When compared with the 1995 UDHS, the overall status of housing conditions shows an improving trend. The same trend was shown by the 1999-2000 Uganda National Household Survey (UNHS). Characteristics of Households and Household Members * 17 Table 2.6 Housing characteristics Percent distribution of households by housing characteristics, according to residence, Uganda 2000-2001_____________________________________________________ Residence Housing ______________ characteristic Urban Rural Total_____________________________________________________ Electricity Yes No Missing Total Source of drinking water Piped into dwelling Piped into yard/plot Public tap Open well in yard/plot Open public well Protected well in yard/plot Protected public well Borehole in yard/plot Public borehole Spring River, stream Pond, lake Dam Rainwater Tanker truck Bottled water Gravity flow scheme Other Missing Total Time to water source Percentage <15 minutes Median time to water source Sanitation facility Flush toilet Traditional pit toilet Ventilated improved pit latrine No facility, bush, field Other Missing Total Flooring material Earth, sand Dung Parquet or polished wood Vinyl, asphalt strips Ceramic tiles Cement Other Total Number 43.9 2.4 8.6 56.0 97.3 91.2 0.1 0.3 0.3 100.0 100.0 100.0 5.1 0.1 0.9 7.0 0.1 1.1 51.2 1.5 8.9 0.1 0.0 0.0 6.8 28.3 25.1 0.2 0.1 0.1 10.9 17.0 16.1 0.2 0.2 0.2 13.6 26.4 24.5 1.3 9.4 8.2 0.3 8.8 7.5 0.6 5.3 4.6 0.2 1.6 1.4 0.4 0.4 0.4 0.1 0.0 0.0 0.7 0.0 0.1 0.0 0.6 0.5 1.4 0.2 0.4 0.1 0.2 0.2 100.0 100.0 100.0 62.7 15.4 22.5 9.2 29.9 29.6 9.1 0.5 1.7 79.9 78.3 78.5 7.9 1.1 2.1 2.7 19.1 16.7 0.2 0.8 0.7 0.1 0.2 0.2 100.0 100.0 100.0 19.3 59.9 53.8 7.1 30.0 26.6 0.6 0.1 0.2 24.7 3.5 6.6 0.4 0.0 0.1 47.8 6.4 12.5 0.1 0.1 0.1 100.0 100.0 100.0 1,174 6,711 7,885 2 The wealth index is created by using factor analysis to identify the most important variables to divide households into quintiles by socioeconomic status. 18 * Characteristics of Households and Household Members Table 2.7 Household durable goods Percentage of households possessing various durable consumer goods and means of transport, by residence, Uganda 2000- 2001 ___________________________________________________ Residence Durable ________________ consumer goods Urban Rural Total ___________________________________________________ Household possessions Radio Television Telephone Refrigerator Lantern Cupboard Means of transport Bicycle Motorcycle/scooter Car/truck Boat/canoe None of the above Number of households 77.5 47.0 51.5 26.6 1.9 5.6 14.5 0.6 2.7 12.2 0.3 2.1 64.9 26.8 32.5 53.2 22.0 26.7 19.8 42.1 38.8 5.4 1.9 2.4 6.1 0.6 1.4 0.4 0.4 0.4 10.4 32.4 29.2 1,174 6,711 7,885 2.7 HOUSEHOLD DURABLE GOODS The 2000-2001 UDHS also collected information on the household’s ownership of selected durable goods. Combined with other indicators, information on ownership of durable goods can be used to generate a wealth index that acts as a proxy measure of the socioeconomic status of a household.2 Further, ownership of a radio or television is a measure of access to mass media; telephone ownership measures access to an efficient means of communication; cupboard and refrigerator ownership indicates the capacity for hygienic storage of foods and utensils; lantern ownership indicates a source of lighting; and ownership of a bicycle, motorcycle, boat/canoe, or private car shows the means of transport privately available to the household. Ownership of these items, in turn, has a bearing on the household’s access to information and health care. Table 2.7 shows that more than half of the households in Uganda own a radio; urban households are more likely than rural households to have a radio (78 percent compared with 47 percent). Only 6 percent of households own a television, and only 3 percent have a telephone. Refrigerators are also uncommon. One-third of Ugandan households own lanterns, while more than one-fourth have cupboards. Two-fifths of households own bicycles. Bicycles are more common in rural areas than in urban areas, while cars and motorcycles are almost exclusively owned by urban households. About one-third of rural households and 10 percent of urban households do not own any of the above durable goods. 1 In this table, "married" refers to those in a form al or offic ial marriage, while "living together" refers to those in informal or consensual unions. In the remainder of the report, marriage refers to both categories, i.e., formal and informal unions. Characteristics of Respondents and Women’s Status * 19 3CHARACTERISTICS OF RESPONDENTSAND WOMEN’S STATUS This chapter provides a description of the situation of men and women of reproductive age in Uganda. The description is presented in terms of the following variables: age at the time of the survey, marital status, residence, education, literacy, and media access. In addition, factors that enhance women’s empowerment are explored, including employment, occupation, earnings, and continuity of employment. Women’s decisionmaking autonomy at the household level is also explored. An analysis of these variables provides the socioeconomic context within which demographic and reproductive health issues are examined in the subsequent chapters. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Background characteristics of the 7,246 women age 15-49 and 1,962 men age 15-54 interviewed in the 2000-2001 UDHS are presented in Table 3.1. The distribution of the respondents according to age shows a similar pattern for males and females. For both sexes, the proportion of respondents in each age group declines with increasing age. Forty-three percent of women and 39 percent of men are in the 15-24 age group, 32 percent of women and 31 percent of men are age 25-34, and the remaining respondents are age 35-49 and age 35-54 for women and men, respectively. Forty-five percent of women compared with 55 percent of men are formally married1. Male respondents were much more likely than female respondents to have never married (34 percent for males and 20 percent for females). It is interesting to note that 22 percent of females declared themselves to be living together with a man or in consensual unions, while the corresponding percentage for males is only 5 percent. Whereas 9 percent of women are divorced and 3 percent are widowed, the corresponding proportions for men are 5 percent and less than 1 percent, respectively. The distribution of male and female respondents by residence is the same. Less than 17 percent of respondents are found in the urban areas. The largest proportion of both male and female respondents (34 percent and 32 percent, respectively) is in the Central Region. The Northern Region is the least populated area with 16 percent of women and 15 percent of men. Data in Table 3.1 show that men are much more likely to have gone to school and attained higher levels of education than women. Whereas 22 percent of women have never attended school, the corresponding proportion for men is only 6 percent. Furthermore, whereas 29 percent of men have gone to secondary or higher education, only 18 percent of women have. According to 1991 census data, the DISH project serves 29 percent of the women of reproductive age in Uganda, and the CREHP project covers 7 percent. The projects cover similar proportions of men and women (30 percent and 6 percent, respectively). 20 * Characteristics of Respondents and Women’s Status Table 3.1 Background characteristics of respondents Percent distribution of women and men by background characteristics, Uganda 2000-2001__________________________________________________________________________________ Number of women Number of men_________________ _________________ Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted__________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Marital status Never married Married Living together Divorced, separated Widowed Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Missing DISH/CREHP districts DISH I Mbarara and Ntungamo II Masaka, Rakai, and Sembabule III Luwero, Masindi, and Nakasongola IV Kamuli and Jinja V Kampala CREHP (Kisoro, Kabale, and Rukungiri) Neither Total 22.3 1,615 1,687 22.5 441 440 20.8 1,504 1,542 16.4 321 337 18.5 1,341 1,326 15.8 310 315 13.6 983 955 14.8 291 283 11.2 810 783 11.8 231 225 7.9 570 547 8.4 165 166 5.8 423 406 6.1 120 117 na na na 4.2 83 79 20.1 1,456 1,603 34.4 675 700 45.1 3,267 3,075 55.3 1,085 1,056 22.3 1,614 1,600 4.8 95 111 9.2 665 708 4.8 94 83 3.4 245 260 0.7 13 12 16.7 1,207 2,416 16.6 325 601 83.3 6,039 4,830 83.4 1,637 1,361 32.3 2,341 2,445 34.2 671 677 27.0 1,956 1,767 26.7 523 466 16.0 1,158 1,041 14.5 284 273 24.7 1,792 1,993 24.7 484 546 21.9 1,584 1,459 6.2 122 118 59.8 4,330 4,098 64.8 1,272 1,201 18.4 1,331 1,688 28.9 568 643 0.0 1 1 0.0 0 0 28.7 2,077 2,317 29.7 582 622 5.4 392 446 5.8 115 132 6.7 486 541 7.5 147 162 3.3 240 206 3.4 66 53 4.9 356 554 4.3 84 124 8.3 604 570 8.7 171 151 6.5 472 755 5.8 114 188 64.8 4,696 4,174 64.5 1,265 1,152 100.0 7,246 7,246 100.0 1,962 1,962 ___________________________________________________________________________________ Note: Education refers to the highest level ever attended whether or not that level was completed. na = Not applicable 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS 2 These sentences include the following: 1) Breast m ilk is good for babies. 2) Most Ugandans live in villages. 3) Immunization can prevent children from getting diseases. 4) Family planning teaches people to be responsible to their family. Characteristics of Respondents and Women’s Status * 21 Table 3.2 shows the distribution of respondents according to the highest level of schooling attended. As mentioned before, the data show that men are better educated than women. Whereas 6 percent of men have never gone to school, the corresponding proportion for women is 22 percent. The reverse situation is observed for those who attended secondary or higher education. Younger people are more likely to be educated and to reach higher levels of education than older people. For women, the percentage without formal education is 9 percent for age 15-19, 15 percent for age 20-24, and 45 percent for age 45-49. For men, the increase is gradual, from 2 percent for age 15-19 to 5 percent for age 25-29 to 14 percent in the 50-54 age category. Rural people are less educated than their urban counterparts. One in four rural women do not have an education, compared with 7 percent of urban women. The corresponding figures for men are 7 percent and 2 percent for rural men and urban men, respectively. The pattern, however, changes for secondary or higher education. Whereas only 12 percent of rural women have attended secondary or higher education, 48 percent of urban women have at least some secondary education. School attainment among female respondents varies by region. Women in the Central Region are the least likely to have no education (12 percent). On the other hand, 39 percent of women in the Northern Region have not attended school. In the Eastern and Western regions, the percentage of women who have not attended school is 19 percent and 27 percent, respectively. Data for the male respondents, however, are less varied, with the percentage who have never attended school ranging between 4 and 9 percent. The last column in Table 3.2 shows the median number of years of schooling. The figures confirmed the previous findings: younger persons and those living in the urban areas and in the Central Region have had more years of schooling. The results also confirm the marginalisation of women regarding education and the evolution of women’s education in Uganda over the years. Women are still less likely to have formal education than men. 3.3 LITERACY A person’s ability to read is important in taking advantage of day-to-day opportunities. In the 2000-2001 UDHS, level of literacy is determined by the respondent’s ability to read none, part, or all of a simple sentence. Interviewers were given cards on which sentences2 were printed in all the major languages spoken in Uganda. Respondents who had attended secondary school were assumed to be literate and were not asked to read a sentence. Data in Table 3.3 reveal that 40 percent of women in the survey could not read at all, compared with 16 percent of the men. Literacy levels decrease with increasing age among women, from 57 percent among women 15-19 to 34 percent in the 45-49 age group. However, six out of ten men in all age groups are literate, showing their greater access to education over the years. 22 * Characteristics of Respondents and Women’s Status Table 3.2 Educational attainment by background characteristics Percent distribution of women and men by highest level of schooling attended, and median number of years of schooling completed, by background characteristics, Uganda 2000-2001 ______________________________________________________________________________________________________________ Highest level of schooling attained ___________________________________________________________________________ More Number Median Background No edu- Some Completed Some Completed than of years of characteristic cation primary primary1 secondary secondary2 secondary Total women schooling _____________________________________________________________________________________________________________ WOMEN _____________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Central Eastern Northern Western Total 9.1 50.5 15.6 23.7 0.4 0.6 100.0 1,615 5.0 15.1 51.3 11.4 16.8 1.4 3.9 100.0 1,504 4.4 22.0 48.2 9.9 14.8 0.5 4.7 100.0 1,341 4.0 26.4 48.8 11.1 9.9 0.4 3.3 100.0 983 3.1 32.5 47.2 8.5 7.5 0.1 4.2 100.0 810 2.5 35.5 45.6 7.3 9.3 0.0 2.2 100.0 570 2.3 44.8 41.1 6.1 6.0 0.0 2.0 100.0 423 1.1 7.4 33.8 10.9 35.2 2.2 10.5 100.0 1,207 6.5 24.7 51.7 11.1 10.7 0.2 1.5 100.0 6,039 3.2 11.5 45.4 11.9 24.7 1.2 5.3 100.0 2,341 5.6 19.4 51.6 13.1 13.3 0.3 2.4 100.0 1,956 3.7 38.8 44.7 8.9 6.1 0.1 1.4 100.0 1,158 1.5 27.1 52.5 9.2 9.1 0.3 1.8 100.0 1,792 3.0 21.9 48.7 11.0 14.8 0.6 3.0 100.0 7,246 3.9 ____________________________________________________________________________________________________________ MEN ____________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Region Central Eastern Northern Western Total 1.6 59.0 12.7 26.7 0.1 0.0 100.0 441 5.5 2.1 47.8 18.0 23.5 3.2 5.4 100.0 321 6.0 5.0 49.6 12.2 18.7 4.0 10.5 100.0 310 5.5 5.7 50.2 14.3 18.9 1.1 9.7 100.0 291 5.6 12.9 46.8 14.9 15.6 1.9 7.9 100.0 231 5.1 12.9 41.1 17.0 16.8 3.5 8.7 100.0 165 5.5 11.9 47.4 17.8 15.8 1.9 5.2 100.0 120 5.3 13.6 46.0 12.1 19.8 0.0 8.5 100.0 83 4.8 2.2 24.7 12.0 38.3 4.7 18.2 100.0 325 8.4 7.0 55.3 15.2 17.2 1.4 3.9 100.0 1,637 5.2 5.1 43.7 13.6 23.1 3.7 10.8 100.0 671 6.1 4.3 55.1 10.3 25.4 1.0 3.9 100.0 523 5.4 8.6 50.9 19.5 16.4 0.5 4.0 100.0 284 5.4 8.4 53.5 17.8 14.6 1.5 4.1 100.0 484 5.1 6.2 50.2 14.6 20.7 2.0 6.3 100.0 1,962 5.5 _____________________________________________________________________________________________________________ 1Completed 7th grade at the primary level. 2Completed 6th grade at the secondary level. For both sexes, literacy levels are higher in urban areas than in rural areas. The gap between men and women is wide, particularly in the rural areas where 60 percent of the men are literate, compared with 42 percent of the women. The gap is also significant across regions. In the Northern Region, for example, the literacy level of men is 69 percent, compared with 24 percent for women. In other regions, the gap is less pronounced; in the Central and Western regions, it is 7 percentage points, and in the Eastern Region, the gap between the male and female literacy level is 21 percentage points. Characteristics of Respondents and Women’s Status * 23 Table 3.3 Literacy Percent distribution of women and men by level of schooling attended, level of literacy, and percentage who are literate, according to background characteristics, Uganda 2000-2001________________________________________________________________________________________________________________ No schooling or primary school ________________________________________ No card Secondary Can read Can read Cannot with Background school or a whole part of a read at required Percent characteristic higher sentence sentence all language Missing Total Number literate________________________________________________________________________________________________________________ WOMEN________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Central Eastern Northern Western Total 24.8 32.1 12.9 28.3 1.4 0.5 100.0 1,615 56.9 22.1 26.4 10.4 39.2 1.5 0.4 100.0 1,504 48.6 20.0 27.9 10.3 38.7 2.7 0.5 100.0 1,341 47.9 13.7 29.0 10.9 43.1 2.5 0.8 100.0 983 42.7 11.8 30.2 8.0 47.3 1.8 0.9 100.0 810 42.0 11.6 31.7 6.0 47.8 2.1 0.9 100.0 570 43.3 8.0 25.5 9.1 55.2 2.0 0.2 100.0 423 33.5 47.8 28.2 8.2 14.0 1.3 0.5 100.0 1,207 76.0 12.5 29.3 10.7 44.9 2.0 0.6 100.0 6,039 41.8 31.2 38.6 7.6 18.6 2.9 1.0 100.0 2,341 69.8 15.9 19.5 11.2 51.5 1.4 0.5 100.0 1,956 35.4 7.6 16.4 9.9 65.5 0.5 0.2 100.0 1,158 24.0 11.2 35.4 13.1 37.8 2.2 0.3 100.0 1,792 46.6 18.4 29.1 10.3 39.7 1.9 0.6 100.0 7,246 47.5 _______________________________________________________________________________________________________________ MEN_______________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Region Central Eastern Northern Western Total 26.7 36.9 19.5 12.7 4.1 0.1 100.0 441 63.6 32.1 34.6 16.1 14.2 3.1 0.0 100.0 321 66.7 33.2 33.0 15.3 14.7 3.4 0.5 100.0 310 66.1 29.7 33.1 17.7 16.5 2.5 0.4 100.0 291 62.8 25.4 35.6 15.3 19.5 4.2 0.0 100.0 231 61.0 29.0 35.0 13.3 18.4 4.3 0.0 100.0 165 64.0 23.0 42.1 14.2 16.9 3.7 0.0 100.0 120 65.1 28.3 36.8 3.4 25.8 3.3 2.4 100.0 83 65.1 61.2 24.3 6.1 5.2 3.1 0.1 100.0 325 85.5 22.5 37.5 17.9 18.1 3.6 0.3 100.0 1,637 60.0 37.6 38.8 7.4 9.6 6.6 0.0 100.0 671 76.4 30.3 26.2 19.5 19.6 4.1 0.4 100.0 523 56.4 21.0 47.8 15.8 14.2 1.3 0.0 100.0 284 68.8 20.2 33.1 24.3 21.8 0.0 0.6 100.0 484 53.3 28.9 35.3 16.0 15.9 3.6 0.3 100.0 1,962 64.3 ________________________________________________________________________________________________________________ Note: Percent literate includes those who have attended secondary school and those who can read a whole sentence. 3.4 ACCESS TO MASS MEDIA Information access is essential in increasing people’s knowledge and awareness of what is taking place around them, which may eventually affect their perceptions and behaviour. In the survey, exposure to the media was assessed by asking how often a respondent reads a newspaper, watches television, or listens to a radio. Most of the population is exposed to some form of media. In general, men are more likely than women to have access to mass media; this is true for all types of media. Table 3.4 shows that radio is the most popular medium. Three in four men and more than half of the women listen to a radio broadcast at least once a week. Twenty-four percent of men read a newspaper at least once a week, compared with 15 percent of the women. 24 * Characteristics of Respondents and Women’s Status Table 3.4 Exposure to mass media Percentage of women and men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Uganda 2000-2001 ________________________________________________________________________________________________ Reads a Watches Listens to newspaper television the radio at least at least at least All Background once a once a once a three No mass characteristic week week week media media Number _______________________________________________________________________________________________ WOMEN ________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Total 20.1 13.8 54.9 7.6 35.2 1,615 14.9 9.2 56.5 5.2 36.9 1,504 13.5 10.7 53.4 5.6 39.2 1,341 13.3 8.5 50.3 4.9 41.6 983 12.6 6.3 50.7 3.9 41.7 810 12.2 6.8 48.3 3.5 40.7 570 8.3 6.1 42.2 3.3 48.0 423 43.7 36.5 81.5 23.2 10.7 1,207 9.0 4.4 46.8 1.8 44.7 6,039 30.6 24.1 73.1 14.2 18.8 2,341 8.9 3.8 48.1 1.4 42.0 1,956 4.9 1.4 24.9 0.6 69.3 1,158 6.8 2.7 48.6 1.2 42.8 1,792 0.2 2.0 30.5 0.0 62.6 1,584 9.0 6.1 51.5 1.9 39.4 4,330 50.6 30.8 82.5 23.0 9.7 1,331 14.7 9.7 52.6 5.4 39.1 7,246 ________________________________________________________________________________________________ MEN ________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Total 19.7 14.5 76.8 8.0 15.4 441 24.8 15.4 78.0 9.2 13.5 321 32.8 20.5 75.0 15.2 14.6 310 22.2 12.5 78.0 9.0 14.0 291 24.5 12.4 69.3 7.8 16.3 231 28.3 15.5 70.4 11.6 19.7 165 19.8 6.7 71.7 3.3 18.4 120 21.8 6.2 63.9 3.7 23.6 83 59.9 49.3 92.4 38.8 2.4 325 17.3 7.4 71.1 3.4 18.4 1,637 38.3 27.5 87.4 20.8 7.4 671 17.6 10.6 67.5 4.2 22.9 523 17.7 5.1 57.7 2.4 27.3 284 16.3 5.5 74.5 2.9 12.9 484 0.1 2.3 43.3 0.0 45.0 122 13.4 7.9 70.9 2.9 18.6 1,272 54.1 31.3 89.7 25.7 3.0 568 24.4 14.3 74.6 9.3 15.8 1,962 ____________________________________________________________________________________________ Note: Total includes one woman with missing information on education Characteristics of Respondents and Women’s Status * 25 Given the low television broadcast coverage in the country, the percentage of women and men who watch television is low (10 percent of women and 14 percent of men). The proportion that has access to all three media at least once a week is generally low for both men and women (5 percent for women and 9 percent for men). Four in ten women and one in six men have no exposure to any mass media, which poses a challenge in the provision of information to the population. Table 3.4 further provides an analysis of the responses by background characteristics of respondents. The results by age show that the proportion of women and men who are exposed to any media at least once a week generally declines slowly with age. The proportion who have no access to any media increases with age for both sexes. The data show that urban residents are more likely to have access to mass media than rural residents. Among women, although less than 10 percent of the women in rural areas read a newspaper or watch television at least once a week, the percentages for urban women are 44 percent and 37 percent, respectively. A similar pattern is found for listening to the radio, with only 47 percent of rural women listening to a radio as opposed to 82 percent of their urban counterparts. For men, although 60 percent of men in the urban areas read a newspaper at least once a week, the corresponding proportion for rural men is only 17 percent. The findings depict the urban-rural gap in socioeconomic development as reflected in higher standards of living in the urban areas than in the rural areas. For both women and men, media access is highest in the Central Region. For example, 73 percent of women in the Central Region listen to a radio at least once a week, compared with less than 50 percent of women in the Eastern and Western regions and only one-quarter of women in Northern Region. The data on media access by educational attainment of respondents reveal that exposure to media is positively associated with educational attainment. For example, 83 percent of women who had reached secondary or higher education listen to a radio at least once a week, compared with 31 percent of women with no education. The same pattern is shown for men. 3.5 EMPLOYMENT Respondents were asked whether they were employed at the time of the survey and if not, whether they were employed in the 12 months that preceded the survey. Table 3.5 and Figure 3.1 show that 73 percent of women and 63 percent of men were currently employed. The proportion currently employed increases with age and number of living children among women. The data for men show a less distinct pattern. Women who were divorced, separated, or widowed are the most likely to be employed (83 percent), followed by those who were married (78 percent). Never- married women and men are the least likely to be employed (51 percent and 38 percent, respectively). Married men and men who are divorced, separated, or widowed show equal levels of current employment (76 percent). The current employment level for women is higher in rural areas than in urban areas, while the reverse is true for men. Women in the Western Region are the most likely to be employed (84 percent), followed by the Eastern and Northern regions (77 to 78 percent), while the level in the Central Region is 60 percent. For men, employment levels vary between 41 and 42 percent in the Eastern and Northern regions to 82 percent in the Western Region. It is worth noting that for both women and men, current employment levels are inversely associated with educational attainment. 26 * Characteristics of Respondents and Women’s Status Ta bl e 3. 5 E m pl oy m en t s ta tu s Pe rc en t d ist rib ut io n of w om en a nd m en b y em pl oy m en t s ta tu s an d co nt in ui ty o f e m pl oy m en t, ac co rd in g to b ac kg ro un d ch ar ac te ris tic s, U ga nd a 20 00 -2 00 1 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ W O M EN M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ E m pl oy ed in th e E m pl oy ed in th e 12 m on th s pr ec ed in g N ot 1 2 m on th s pr ec ed in g N ot th e su rv ey em pl oy ed t he s ur ve y em pl oy ed __ __ __ __ __ __ __ __ __ __ _ in th e __ __ __ __ __ __ __ __ __ __ _ in th e N ot 12 m on th s N ot 12 m on th s Ba ck gr ou nd C ur re nt ly cu rr en tly pr ec ed in g C ur re nt ly cu rr en tly pr ec ed in g M iss in g/ ch ar ac te ris tic em pl oy ed em pl oy ed th e su rv ey To ta l1 N um be r2 em pl oy ed em pl oy ed th e su rv ey do n’ t k no w To ta l N um be r __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Ag e 1 5- 19 2 0- 24 2 5- 29 3 0- 34 3 5- 39 4 0- 44 4 5- 49 M ar ita l s ta tu s N ev er m ar rie d M ar rie d or in u ni on D iv or ce d, s ep ar at ed , w id ow ed N um be r of li vi ng c hi ld re n 0 1 -2 3 -4 5 + Re si de nc e U rb an R ur al Re gi on C en tra l E as te rn N or th er n W es te rn Ed uc at io n N o ed uc at io n P rim ar y S ec on da ry + To ta l 54 .4 6 .3 39 .2 10 0. 0 1, 61 5 27 .2 7. 5 64 .9 0. 4 10 0. 0 44 1 69 .5 7 .7 22 .8 10 0. 0 1, 50 4 64 .2 19 .4 16 .3 0. 0 10 0. 0 32 1 78 .3 5 .8 15 .9 10 0. 0 1, 34 1 73 .3 19 .5 7. 1 0. 0 10 0. 0 31 0 83 .0 5 .2 11 .8 10 0. 0 9 83 81 .5 18 .1 0. 4 0. 0 10 0. 0 29 1 83 .4 5 .2 11 .4 10 0. 0 8 10 78 .4 20 .3 1. 3 0. 0 10 0. 0 23 1 87 .4 4 .4 8 .2 10 0. 0 5 70 76 .0 22 .8 1. 1 0. 0 10 0. 0 16 5 83 .3 6 .4 10 .4 10 0. 0 4 23 67 .6 29 .2 3. 1 0. 1 10 0. 0 12 0 69 .0 23 .8 7. 2 0. 0 10 0. 0 83 51 .0 6 .9 41 .9 10 0. 0 1, 45 6 37 .8 10 .7 51 .3 0. 2 10 0. 0 67 5 78 .2 5 .8 15 .9 10 0. 0 4, 88 1 76 .3 22 .0 1. 8 0. 0 10 0. 0 1, 18 0 8 2. 9 6 .1 11 .0 10 0. 0 9 10 75 .6 15 .4 8. 9 0. 1 10 0. 0 10 7 56 .8 6 .4 36 .7 10 0. 0 1, 73 0 40 .0 12 .3 47 .5 0. 2 10 0. 0 72 7 72 .5 6 .6 21 .0 10 0. 0 2, 02 1 78 .7 17 .1 4. 2 0. 0 10 0. 0 39 2 80 .9 5 .5 13 .6 10 0. 0 1, 66 5 75 .3 23 .8 0. 9 0. 0 10 0. 0 30 7 83 .1 5 .8 11 .1 10 0. 0 1, 83 0 75 .7 22 .1 2. 2 0. 0 10 0. 0 53 5 56 .7 6 .7 36 .6 10 0. 0 1, 20 7 67 .1 7. 1 25 .6 0. 2 10 0. 0 32 5 76 .7 6 .0 17 .3 10 0. 0 6, 03 9 62 .2 19 .9 17 .9 0. 1 10 0. 0 1, 63 7 60 .3 6 .8 32 .9 10 0. 0 2, 34 1 75 .0 3. 7 21 .3 0. 0 10 0. 0 67 1 76 .6 5 .4 18 .0 10 0. 0 1, 95 6 42 .4 35 .4 22 .2 0. 0 10 0. 0 52 3 77 .8 10 .7 11 .4 10 0. 0 1, 15 8 40 .6 40 .8 18 .2 0. 4 10 0. 0 28 4 84 .0 2 .9 13 .1 10 0. 0 1, 79 2 81 .7 4. 6 13 .6 0. 1 10 0. 0 48 4 79 .1 8 .1 12 .8 10 0. 0 1, 58 4 78 .2 17 .0 4. 7 0. 1 10 0. 0 12 2 74 .9 5 .5 19 .6 10 0. 0 4, 33 0 63 .6 19 .1 17 .2 0. 1 10 0. 0 1, 27 2 61 .4 5 .8 32 .8 10 0. 0 1, 33 1 58 .3 14 .8 26 .8 0. 1 10 0. 0 56 8 73 .4 6 .1 20 .5 10 0. 0 7, 24 6 63 .0 17 .7 19 .2 0. 1 10 0. 0 1, 96 2 1 M ay n ot a dd u p to 1 00 .0 d ue to m iss in g ca se s 2 In cl ud es o ne w om an w ith m iss in g in fo rm at io n on e du ca tio n. Characteristics of Respondents and Women’s Status * 27 3.6 OCCUPATION Respondents who were currently employed were asked to state their occupation, and the results are presented in Tables 3.6.1 and 3.6.2. Among women who are currently employed, 77 percent are engaged in agriculture and 23 percent are involved in nonagricultural activities. The percentages for men are 54 percent and 46 percent, respectively. The strong involvement of the population in agriculture reflects the predominance of the agricultural sector in the Ugandan economy. Data in Table 3.6.1 and 3.6.2 also reveal that among women who are engaged in agriculture, most work on family land, while most men work on their own land. Tables 3.6.1 and 3.6.2 further show that most women and men who are engaged in nonagricultural activities work in sales and services occupations or unskilled manual labour. The professional, technical, and managerial occupations, which require more skill but have higher income-earning potential, employ only 3 percent of working women and 6 percent of working men. Data in Tables 3.6.1 and 3.6.2 show the expected patterns. Except for women in urban areas and those with secondary or higher education, the majority work in agriculture, whereas among men, only a majority of older men, married men, rural men, those in the Northern and Western regions, and those with less than secondary education work in agriculture. 28 * Characteristics of Respondents and Women’s Status Table 3.6.1 Occupation: women Percent distribution of currently employed women by occupation, according to background characteristics, Uganda 2000-2001 ______________________________________________________________________________________________________________________ Agricultural Nonagricultural ____________________________ _______________________________________________ Other/ Prof./ Sales Skilled Unskilled don’t Background Own Family Rented Other’s tech./ and manual manual know/ characteristic land land land land manag. Clerical services labour labour missing Total Number1 ______________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Never married Married/living together Divorced, separated Widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Total 12.3 61.1 5.4 3.2 0.5 0.0 6.5 2.3 8.4 0.3 100.0 878 21.1 39.1 8.3 5.0 3.4 0.8 11.4 2.6 7.9 0.4 100.0 1,045 25.5 33.6 7.8 5.8 4.0 0.2 13.0 2.3 6.9 0.8 100.0 1,050 29.3 31.7 8.0 4.3 3.3 0.4 10.2 3.3 8.0 1.5 100.0 816 31.3 34.5 6.1 4.8 2.9 0.5 11.1 2.1 6.4 0.2 100.0 675 32.8 37.4 7.7 6.8 1.7 0.0 6.4 2.7 3.7 0.9 100.0 498 41.3 27.9 7.5 6.6 2.1 0.0 6.8 1.8 5.8 0.3 100.0 352 4.2 54.7 2.6 3.2 5.0 1.1 11.2 4.8 12.5 0.8 100.0 743 30.7 37.2 8.4 4.9 2.3 0.2 8.5 1.9 5.4 0.6 100.0 3,819 14.6 37.1 5.6 7.5 2.9 0.3 18.6 3.3 9.5 0.5 100.0 545 35.1 21.3 7.5 6.5 2.2 0.1 9.7 3.2 12.6 1.9 100.0 209 10.6 52.3 4.6 3.2 4.2 0.8 10.0 3.5 10.2 0.6 100.0 982 20.9 37.6 8.1 5.7 4.4 0.6 12.6 2.4 7.2 0.3 100.0 1,465 27.9 35.5 9.0 5.1 1.6 0.0 11.0 2.3 6.8 0.7 100.0 1,347 37.3 34.9 6.6 5.3 1.2 0.1 6.4 2.1 5.2 0.9 100.0 1,522 3.6 5.6 1.9 2.7 10.1 1.3 40.9 6.7 26.0 1.3 100.0 684 28.7 44.0 8.1 5.3 1.6 0.2 5.4 1.8 4.3 0.6 100.0 4,632 19.6 18.6 3.3 7.7 5.6 0.8 20.0 6.0 17.0 1.4 100.0 1,411 21.7 47.4 12.3 2.9 2.1 0.1 7.9 1.5 3.6 0.4 100.0 1,499 37.9 38.6 4.2 5.3 0.8 0.3 6.4 0.5 5.6 0.5 100.0 901 27.4 50.0 7.9 4.4 1.8 0.2 4.6 1.4 2.2 0.3 100.0 1,505 34.5 39.1 9.1 6.9 0.0 0.0 4.6 0.9 4.3 0.6 100.0 1,253 25.9 42.8 7.8 4.9 0.2 0.1 8.4 2.4 7.1 0.6 100.0 3,244 10.0 24.1 2.5 2.6 16.8 1.9 24.4 5.3 11.5 0.9 100.0 818 25.5 39.0 7.3 5.0 2.7 0.3 9.9 2.5 7.1 0.7 100.0 5,316 ______________________________________________________________________________________________________________________ 1Includes one woman with missing information on education. 3.7 EARNINGS, EMPLOYER, AND CONTINUITY OF EMPLOYMENT Table 3.7 shows the distribution of women and men by their employment status. The data indicate that 27 percent of employed women receive payment in cash only, 35 percent receive both cash and kind, 9 percent receive only payment in kind, and 29 percent receive no payment for their work (Figure 3.2). Men are more likely than women to be paid in cash for their work. Table 3.7 further shows that women and men who work in agriculture are much more likely to receive no payment than those who work in nonagricultural jobs. Data on type of employer in Table 3.7 indicate that 63 percent of working women are self- employed, while 28 percent are employed by a relative and 9 percent are employed by a nonrelative. These results are also displayed graphically in Figure 3.3. Table 3.7 further shows that Characteristics of Respondents and Women’s Status * 29 Table 3.6.2 Occupation: men Percent distribution of currently employed men by occupation, according to background characteristics, Uganda 2000-2001 ________________________________________________________________________________________________________________________ Agricultural Nonagricultural ___________________________ _______________________________________________ Other/ Prof./ Sales Skilled Unskilled don’t Background Own Family Rented Other’s tech./ and manual manual know/ characteristic land land land land manag. Clerical services labour labour missing Total Number ______________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Marital status Never married Married/living together Divorced, separated Widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Total 9.2 35.0 3.2 11.1 1.3 0.2 13.0 4.1 16.9 6.0 100.0 120 13.8 21.9 5.5 7.4 4.6 0.0 16.4 9.5 15.7 5.3 100.0 206 24.0 8.7 6.4 6.0 7.5 1.5 18.0 9.5 14.8 3.5 100.0 227 30.7 5.7 7.1 4.4 8.0 0.5 17.5 8.0 14.8 3.2 100.0 237 36.6 6.1 9.3 6.7 6.8 0.0 13.6 7.0 11.1 2.9 100.0 181 47.8 2.9 4.3 3.9 9.3 0.0 16.7 4.6 7.2 3.4 100.0 125 57.5 6.0 6.7 2.6 5.4 1.7 9.5 6.1 2.4 2.1 100.0 81 54.5 3.3 9.3 1.4 3.7 1.9 3.2 5.1 17.6 0.0 100.0 57 6.9 28.6 3.2 7.9 7.0 0.0 15.6 8.3 17.0 5.7 100.0 255 36.8 7.0 7.8 4.8 6.4 0.8 15.7 6.9 10.7 3.2 100.0 900 24.3 7.7 2.4 11.0 3.3 0.0 7.3 10.1 31.7 2.1 100.0 73 * * * * * * * * * * 100.0 7 10.3 27.3 2.4 9.4 7.2 0.1 16.2 6.7 15.0 5.5 100.0 291 27.2 9.8 7.9 5.5 5.8 0.6 14.6 9.4 16.0 3.2 100.0 309 35.4 6.3 8.0 4.7 6.8 1.2 13.2 10.3 11.3 2.8 100.0 231 43.3 4.3 7.4 4.2 5.7 0.6 15.9 4.7 10.8 3.1 100.0 405 1.9 1.2 0.7 0.8 14.5 0.3 33.6 19.7 26.2 1.1 100.0 218 36.1 13.7 7.7 7.0 4.5 0.7 11.1 4.7 10.4 4.2 100.0 1,017 22.0 13.0 7.3 5.1 6.3 0.3 17.8 10.5 15.0 2.6 100.0 503 16.1 8.7 12.2 1.1 7.9 1.1 23.8 3.7 22.1 3.4 100.0 222 54.9 7.5 1.1 2.1 8.0 0.9 6.6 4.2 8.1 6.6 100.0 115 40.8 12.2 3.7 10.6 4.8 0.6 9.4 6.5 7.2 4.2 100.0 395 46.6 4.7 12.3 10.6 1.3 0.0 3.0 0.4 14.7 6.3 100.0 96 33.2 14.1 7.1 6.8 0.7 0.3 13.9 5.7 14.4 3.7 100.0 809 17.3 7.0 3.2 2.1 21.3 1.6 21.6 13.5 9.7 2.8 100.0 331 30.0 11.5 6.5 5.9 6.3 0.6 15.1 7.4 13.2 3.6 100.0 1,236 ________________________________________________________________________________________________ * Estimate based on fewer than 25 unweighted cases, and has been suppressed. 64 percent of women who work in agriculture are self-employed, compared with 58 percent of women who are self-employed in the nonagricultural sector. Table 3.7 presents the distribution of women by the continuity of their employment. Sixty- five percent of working women work all year, 29 percent work seasonally, and 6 percent work occasionally. The percentage of women who work all year is higher among women who work in nonagricultural occupations than among those working in agriculture (75 percent and 62 percent, respectively), while seasonal employment is high among agricultural workers (34 percent). 30 * Characteristics of Respondents and Women’s Status Table 3.7 Type of employment Percent distribution of currently employed women and men by type of employment (agricultural or nonagricultural), according to type of earnings, and for women according to type of employer and continuity of employment, Uganda 2000-2001 ___________________________________________________________________ Employment Non- characteristic Agricultural agricultural Total ___________________________________________________________________ WOMEN ___________________________________________________________________ Type of earnings Cash only Cash and in-kind In-kind only Not paid Total Type of employer Self-employed Employed by a nonrelative Employed by a relative Total Continuity of employment All year Seasonally Occasionally Total Number1 13.9 68.8 26.6 39.5 20.9 35.3 10.8 1.7 8.7 35.7 8.6 29.4 100.0 100.0 100.0 64.2 58.4 62.8 2.3 31.8 9.2 33.5 9.7 28.0 100.0 100.0 100.0 61.7 74.9 64.8 34.4 12.3 29.2 3.9 12.8 6.0 100.0 100.0 100.0 4,082 1,227 5,316 ___________________________________________________________________ MEN ___________________________________________________________________ Type of earnings Cash only Cash and in-kind In-kind only Not paid Total Number 8.8 79.3 41.3 48.0 13.8 32.2 5.6 0.6 3.3 37.6 6.3 23.2 100.0 100.0 100.0 665 569 1,236 ___________________________________________________________________ 1 Total includes ten women with missing information on occupation. 3.8 CONTROL OVER EARNINGS AND WOMEN’S CONTRIBUTION TO HOUSEHOLD EXPENDITURE Women who were working and receiving cash earnings were asked to state who decides how their earnings are used. In addition, they were asked what proportion of household expenditures were met by their earnings. Data in Table 3.8 show that six out of every ten women decide by themselves how their earnings are to be spent. One in every four working women reported that they make the decision jointly with someone else, while one in six reported that the decision on how to use their earnings is made by someone else entirely. Table 3.8 also shows how respondents’ degree of control over the use of their earnings varies by background characteristics. Regardless of age, the majority of respondents make their own decisions on how their cash earnings are spent. However, older women are more likely to make these decisions than younger women. Unmarried women tend to make their own decisions about Characteristics of Respondents and Women’s Status * 31 32 * Characteristics of Respondents and Women’s Status Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of currently employed women receiving cash earnings by person who decides how earnings are to be used, and by proportion of household expenditures met by earnings, according to background characteristics, Uganda 2000-2001 _______________________________________________________________________________________________________________ Person who decides Proportion of household how earnings are used expenditures met by earnings ______________________________ ____________________________________ Some- Almost Less Half Background Self one none/ than or characteristic only Jointly1 else2 Missing Total none half more All Missing Total Number ________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Never married Married/living together Divorced, separated, widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Total 52.2 20.7 27.1 0.0 100.0 24.6 33.2 29.7 12.4 0.0 100.0 339 53.9 26.9 19.2 0.0 100.0 8.4 32.3 38.9 20.4 0.0 100.0 683 57.0 28.7 14.3 0.0 100.0 7.0 29.7 40.1 23.0 0.2 100.0 710 65.3 22.6 12.1 0.0 100.0 3.7 28.8 40.9 26.3 0.2 100.0 560 62.0 23.8 13.9 0.3 100.0 4.9 31.1 34.4 29.2 0.3 100.0 445 66.8 22.6 10.7 0.0 100.0 3.8 30.0 37.7 28.4 0.0 100.0 338 66.3 25.1 7.8 0.7 100.0 4.3 23.5 40.7 30.8 0.6 100.0 213 75.3 9.0 15.7 0.0 100.0 26.5 28.7 31.6 13.2 0.0 100.0 341 49.6 31.9 18.4 0.1 100.0 5.2 30.5 40.3 23.9 0.2 100.0 2,415 94.5 3.7 1.8 0.0 100.0 7.5 30.4 31.6 30.3 0.3 100.0 533 62.4 20.1 17.6 0.0 100.0 20.5 30.1 32.9 16.5 0.0 100.0 478 59.9 24.1 16.0 0.0 100.0 6.9 30.2 41.7 21.0 0.2 100.0 924 57.5 27.3 15.2 0.0 100.0 4.5 30.8 35.6 29.0 0.1 100.0 918 59.8 26.0 14.0 0.3 100.0 5.4 30.0 39.1 25.2 0.3 100.0 969 86.5 9.4 4.0 0.0 100.0 13.9 29.5 39.2 17.4 0.0 100.0 594 53.6 28.4 17.9 0.1 100.0 6.4 30.4 37.7 25.3 0.2 100.0 2,695 83.1 11.4 5.4 0.1 100.0 15.6 35.3 36.7 12.2 0.1 100.0 1,087 48.8 25.8 25.5 0.0 100.0 3.1 30.2 36.7 30.0 0.0 100.0 974 57.7 33.5 8.8 0.0 100.0 8.1 28.6 27.3 36.0 0.0 100.0 140 46.0 36.7 17.2 0.1 100.0 4.1 25.5 41.7 28.3 0.4 100.0 1,088 54.7 28.0 17.1 0.2 100.0 4.8 28.8 37.3 28.9 0.2 100.0 692 55.8 26.4 17.8 0.1 100.0 8.2 30.2 37.3 24.2 0.1 100.0 1,985 77.4 16.9 5.7 0.0 100.0 9.7 32.1 40.9 17.0 0.3 100.0 611 59.6 24.9 15.4 0.1 100.0 7.8 30.3 38.0 23.8 0.2 100.0 3,289 _______________________________________________________________________________________________________________ 1 With husband or someone else 2 Includes husband the use of their earnings, while married women are more likely to involve another person in making the decision. Urban women are more independent in making their own decisions than rural women (87 percent and 54 percent, respectively). In the rural areas, decisions on the use of women’s earnings are made either jointly (28 percent) or by someone else (18 percent). There are notable regional variations in the way decisions are made on how women’s earnings are used. The percentage of women who make decisions on their earnings by themselves ranges from 83 percent in the Central Region to 46 percent in the Western Region. The proportion of women who independently decide how to use their earnings increases with education: 55 to 56 percent for women with primary or less education, compared with 77 percent for women with secondary or higher education. Characteristics of Respondents and Women’s Status * 33 Table 3.9 Control over earnings according to contribution to household expenditures Percent distribution of currently employed women who received cash earnings by person who decides how earnings are used and current marital status, according to proportion of household expenditures met by earnings, Uganda 2000-2001 ___________________________________________________________________________________________________________________________ Currently married or living with a man Not currently married or living with a man_________________________________________________________________ __________________________________ Jointly Jointly Contribution Jointly with Someone with Someone to household Self with someone Husband else Self someone else expenditures only husband else only only Missing Total Number1 only else only Total Number1 ___________________________________________________________________________________________________________________________ Almost none/none Less than half Half or more All Total 77.6 12.3 4.0 6.2 0.0 0.0 100.0 126 81.2 9.8 9.0 100.0 130 59.7 25.3 0.0 14.5 0.3 0.2 100.0 736 83.7 5.2 11.1 100.0 260 45.9 35.3 0.7 17.8 0.2 0.1 100.0 972 89.3 5.2 5.6 100.0 276 36.8 36.5 0.1 26.2 0.3 0.0 100.0 577 91.9 4.7 3.4 100.0 207 49.6 31.4 0.5 18.2 0.2 0.1 100.0 2,415 87.0 5.7 7.2 100.0 874 1 Includes three married women and one unmarried woman with missing information on contribution to household expenditures. When asked the proportion of household expenditures met by their earnings, one in four working women reported that their earnings support the entire household expenditures and 38 percent reported that their earnings constitute half or more of household expenditures. Older women; women who are widowed, divorced, or separated; rural women; and less educated women are more likely to support their households financially. 3.9 CONTROL OVER EARNINGS ACCORDING TO CONTRIBUTION OF HOUSEHOLD EXPENDITURE Table 3.9 shows how decisions on use of women’s earnings are made and the contribution of these earnings to the household expenditure by the respondent’s marital status. Independence in decision-making is inversely related to the proportion of women’s contribution to the household expenses among currently married women, while those who decide with their husband show the reverse pattern. For example, 78 percent of women whose contribution is minimal decide for themselves how the earnings are used. On the other hand, only 37 percent of women who support all household expenses decide by themselves how their earnings are used. Of women who meet the entire household expenditure, 37 percent share the decision with their husband and 26 percent say their husband alone makes decisions. Most women who are not currently married (between 81 percent and 92 percent) make their own decisions, regardless of their contribution to the household expenditures. 3.10 WOMEN’S PARTICIPATION IN HOUSEHOLD DECISIONMAKING In addition to information on women’s education, employment status, and control over earnings, information was obtained on some direct measures of women’s autonomy and status. Specifically, questions were asked on women’s participation in household decisionmaking, on their acceptance of wife beating, and on their opinions about when a wife should be able to deny sex to her husband. Such information provides insight into women’s control over their environment and their attitudes toward gender roles, both of which are relevant to understanding women’s demographic and health behaviour. 34 * Characteristics of Respondents and Women’s Status Table 3.10 Women’s participation in decisionmaking Percent distribution of women by person who has the final say in making specific decisions, according to marital status and type of decision, Uganda 2000-2001 _____________________________________________________________________________________________________ Jointly with Some- Decision Jointly some- one not made/ Household Self with one Husband else not decisions only husband else only only applicable Total Number __________________________________________________________________________________________________ CURRENTLY MARRIED OR LIVING WITH A MAN____________________________________________________________________________________________________ Own health care 43.5 17.7 0.1 37.6 0.9 0.1 100.0 4,881 Large household purchases 11.3 26.5 0.2 60.0 1.6 0.4 100.0 4,881 Daily household purchases 18.9 26.6 0.3 52.5 1.4 0.2 100.0 4,881 Visits to family or relatives 24.8 31.2 0.6 41.7 1.1 0.5 100.0 4,881 What food to cook each day 83.1 6.0 1.3 8.0 1.3 0.2 100.0 4,881 Children’s health care 20.5 37.9 0.5 32.3 1.4 7.4 100.0 4,881 ____________________________________________________________________________________________________ NOT CURRENTLY MARRIED OR LIVING WITH A MAN_____________________________________________________________________________________________________ Own health care 45.6 na 3.9 na 41.9 8.6 100.0 2,365 Large household purchases 30.7 na 4.1 na 53.2 12.0 100.0 2,365 Daily household purchases 31.3 na 4.4 na 52.6 11.7 100.0 2,365 Visits to family or relatives 37.2 na 5.1 na 46.5 11.3 100.0 2,365 What food to cook each day 34.3 na 6.2 na 48.4 11.1 100.0 2,365 Children’s health care 32.8 na 3.7 na 22.0 41.5 100.0 2,365 ________________________________________________________________________________________________ Note: Not currently married refers to never-married, divorced, separated, or widowed women. na=Not applicable To assess women’s decisionmaking autonomy, information was sought on women’s participation in five different types of household decisions: on the respondents’ own health care; on making large household purchases; on making household purchases for daily needs; on visits to family, friends, or relatives; and on what food should be cooked each day. Having a final say in decisionmaking processes is the highest degree of autonomy. Table 3.10 shows the percent distribution of women according to who in the household usually has the final say on each aspect. The autonomy of women in this case would be measured by either their independently making such decisions or jointly deciding on such issues. Results in Table 3.10 indicate that among currently married women, independence in making household decisions ranges from 83 percent on what food to cook daily to a low of 11 percent on large household purchases. Although 44 percent of married women decide on their health care by themselves, husbands make such decisions for 38 percent of women. Husbands are more likely to decide on making large household purchases (60 percent), daily household purchases (53 percent), and visits to family or relatives (42 percent). Decisions on children’s health care are most likely to be made jointly by the respondents and their husbands (38 percent) or by the husbands only (32 percent). Only 20 percent of married women would make independent decisions on their children’s health care. Among nonmarried women, decisions on their own health care are made by the respondents (46 percent) or someone else (42 percent). The remaining decisions are made mostly by either the respondents themselves or by someone else, possibly because the majority are younger women who still live with their parents. Characteristics of Respondents and Women’s Status * 35 Table 3.11 Women’s participation in decisionmaking by background characteristics Percentage of women who say that they alone or jointly have the final say in specific household decisions, by background characteristics, Uganda 2000-2001 ________________________________________________________________________________________________________________________ Alone or jointly has final say in: _______________________________________________________________________________ Visits to What None Own Making Making family/ food All of the Background health large daily relatives/ to cook specified specified characteristic care purchases purchases friends daily decisions decisions Number1 ________________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Never married Married/living together Divorced, separated, widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Employment Not currently employed Employed for cash Employed not for cash Total 24.9 8.4 10.7 20.3 30.4 5.8 57.2 1,615 56.6 27.5 33.9 48.2 76.8 18.9 11.9 1,504 66.4 42.5 51.0 59.1 86.3 33.4 5.2 1,341 71.0 53.5 58.4 65.7 91.3 41.0 2.8 983 71.4 53.4 59.2 66.4 91.6 39.3 2.6 810 74.1 57.9 64.1 71.5 94.5 47.7 2.3 570 76.5 63.5 69.6 77.4 91.9 55.2 1.5 423 27.0 11.6 12.4 19.0 18.0 10.3 66.9 1,456 61.4 38.0 45.8 56.6 90.4 26.1 3.4 4,881 85.5 71.9 73.0 79.4 76.5 69.3 10.8 910 30.0 13.6 16.4 24.5 32.0 11.3 56.3 1,730 61.6 35.3 41.2 54.9 79.9 26.6 8.5 2,021 66.5 45.3 53.4 61.1 90.8 35.1 3.3 1,665 70.8 53.3 58.8 66.1 92.4 40.3 2.0 1,830 65.7 39.6 46.1 58.2 71.0 32.6 19.0 1,207 55.9 36.4 41.8 50.7 74.7 27.5 16.7 6,039 64.7 39.5 45.0 58.4 75.6 31.6 16.6 2,341 50.6 27.7 34.0 34.8 80.3 18.0 15.0 1,956 59.7 41.7 48.0 68.7 55.7 31.8 19.2 1,158 54.2 40.5 45.1 51.3 77.3 33.1 18.7 1,792 63.7 46.8 50.5 59.8 84.5 35.5 6.9 1,584 55.0 33.3 39.4 49.1 72.9 25.1 18.5 4,330 58.3 36.9 43.1 51.6 65.6 30.3 24.8 1,331 44.7 20.7 24.8 39.2 59.5 14.4 31.0 1,917 70.4 50.6 57.9 61.8 88.8 40.4 6.2 3,289 48.7 30.0 34.2 48.0 64.1 21.9 21.6 2,027 57.5 36.9 42.5 51.9 74.1 28.4 17.1 7,246 _______________________________________________________________________________________________________________________ 1 Includes one woman with missing information on education and 11 women with missing information on employment. Table 3.11 shows that although more than one in four women have a say in all five areas of decisionmaking, 17 percent have no say in any of the specified areas. Women’s autonomy increases with age, from 6 percent among women age 15-19 to 55 percent among those 45-49. Women who have never married, have had no children, only have primary education, and who are not employed are the least likely to participate in decisionmaking in the household. Four in ten women who were employed for cash participate in making all decisions at the household level, compared with 22 percent of women who are not employed for cash and 14 percent of unemployed women. This implies that cash employment increases women’s decisionmaking power. 36 * Characteristics of Respondents and Women’s Status 3.11 WOMEN’S AGREEMENT WITH REASONS FOR WIFE BEATING Violence against women is one of the areas that are increasingly being recognised as affecting health-seeking behaviour. Violence against women has serious consequences for their mental and physical well-being, including their reproductive and sexual health (WHO, 1999). In most instances, the abuser is a member of the woman’s own family and the violent incidents take place at home (Centre for Health and Gender Equity, 1999). Wife beating is one of the most common forms of domestic violence worldwide. The 2000-2001 UDHS sought information on what women perceive to be the justifiable circumstances under which husbands can beat their wives. The reasons for wife beating that were asked about in the UDHS were burning the food, arguing with the husband, going out without informing the husband, neglecting the children, and refusing to have sexual relations with the husband. Table 3.12 shows that many women find wife beating justified in certain circumstances. More than three-quarters of Ugandan women agree that at least one of these factors is sufficient justification for wife beating. This is not surprising because traditional norms teach women to accept, tolerate, and even rationalise battery. This norm is a great barrier to women’s empowerment with consequences for their health. The most widely accepted reasons for wife beating are neglecting the children (67 percent) and going out without informing the husband (56 percent). Four in ten women think that arguing with a spouse is justifiable grounds for battery. Only 24 percent and 22 percent of women, respectively, feel that denying sex to the husband and burning food are justifications for wife beating. Table 3.12 also shows women’s perceptions of the justifications for wife beating by background characteristics. Except for urban women and women in the Central Region, two-thirds of women agree with some reason to justify wife beating. In general, younger women, women in rural areas, women in the Northern and Western regions, less educated women, and women who are employed but do not receive cash payment are more likely to agree with at least one of the reasons for wife beating. 3.12 WOMEN’S AGREEMENT WITH REASONS FOR REFUSING SEXUAL RELATIONS Female respondents were asked whether it is justifiable for a wife to withhold sex in the following circumstances: when she knows her husband has a sexually transmitted infection, when her husband has sex with other women, when she has recently given birth, and when she is tired or not in the mood. Overall, women agree that husbands can be denied sex. Two in three women in Uganda agree that all the above reasons are rational justifications for women refusing to have sexual relations with their husband, and only 4 percent agree with none of the reasons. Considering the specific reasons presented above, nine in ten women think that a woman is justified in not having sex with her husband if he has a sexually transmitted infection or if the woman has recently given birth. Younger women, women who have never married, women who have no children, women who live in rural areas and in the Northern Region, women with no education, women who are employed but do not receive cash payment, and women who have no say in household decisions are the least likely to agree with all of the reasons for refusing sex. Characteristics of Respondents and Women’s Status * 37 Table 3.12 Women's attitude toward wife beating Percentage of women who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Uganda 2000-2001 ______________________________________________________________________________________________ Husband is justified in hitting or beating his wife if she: Percentage ________________________________________________ who agree Goes out with at Burns Argues without Neglects Refuses least one Background the with telling the sexual specified characteristic food him him children relations reason Number1 ______________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Never married Married/living together Divorced, separated, widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Employment Not employed For cash Not for cash Number of decisions in which woman has final say2 0 1-2 3-4 5+ Total 27.1 37.9 58.1 66.9 22.2 78.0 1,615 21.7 36.6 58.8 69.7 23.1 78.6 1,504 19.4 32.7 55.1 67.3 24.3 76.8 1,341 20.7 41.0 54.8 65.8 27.3 74.7 983 19.5 35.4 54.1 66.5 23.1 75.2 810 18.5 37.9 51.8 66.6 24.4 73.1 570 27.9 39.7 57.7 67.2 30.7 73.1 423 22.5 31.3 52.9 64.1 17.6 75.4 1,456 22.6 39.2 57.5 69.2 26.4 77.3 4,881 19.5 33.8 55.3 62.4 23.4 73.5 910 23.7 34.2 54.5 65.3 19.8 75.9 1,730 22.0 37.9 58.1 69.4 23.3 78.4 2,021 20.6 36.5 57.4 68.1 25.8 77.2 1,665 22.4 38.8 54.9 66.3 28.2 74.2 1,830 10.9 20.6 45.0 57.7 12.7 65.6 1,207 24.5 40.2 58.5 69.3 26.5 78.6 6,039 11.2 16.9 45.2 52.5 13.1 63.5 2,341 25.4 45.7 58.9 72.2 24.6 78.5 1,956 42.9 66.8 61.8 80.2 44.3 88.7 1,158 19.7 34.2 64.3 73.0 25.4 83.2 1,792 27.5 44.2 60.2 71.2 32.2 79.7 1,584 22.9 38.7 58.3 68.5 24.7 78.1 4,330 13.5 22.6 45.0 58.9 13.3 67.3 1,331 20.3 33.9 56.4 66.0 19.9 76.1 1,917 16.1 30.9 52.2 63.0 19.8 71.9 3,289 33.9 49.6 63.1 75.8 35.6 84.3 2,027 26.9 35.9 55.9 68.4 23.0 78.1 1,210 27.4 44.0 63.6 71.3 28.3 80.6 1,966 20.8 36.4 56.5 65.8 20.9 76.4 1,427 16.9 32.4 50.9 64.7 23.6 72.7 2,643 22.2 36.9 56.3 67.3 24.2 76.5 7,246 ______________________________________________________________________________________________ 1Includes one woman with missing information on education and 11 women with missing information on employment. 2Either by herself or jointly 38 * Characteristics of Respondents and Women’s Status Table 3.13 Women's attitude toward refusing sex with husband Percentage of women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, according to background characteristics, Uganda 2000-2001 ____________________________________________________________________________________________________ Wife is justified in refusing sex with husband if she: ___________________________________________ Knows Percentage Percentage Knows husband who agree who agree Has husband has with all with none Is tired recently has sex sexually of the of the Background or not given with other transmitted specified specified characteristic in mood birth women disease reasons reasons Number1 ____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Never married Married/living together Divorced, separated, widowed Number of living children 0 1-2 3-4 5+ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Employment Not employed For cash Not for cash Number of decisions in which woman has final say2 0 1-2 3-4 5+ Number of reasons wife beating justified 0 1-2 3-4 5 Total 74.4 83.4 75.5 87.1 61.8 7.6 1,615 80.4 90.7 77.2 91.6 65.4 2.8 1,504 80.6 90.7 75.1 93.3 64.8 3.1 1,341 83.8 91.6 77.8 93.2 68.8 2.7 983 82.4 91.0 76.5 91.2 65.8 3.1 810 79.6 90.5 77.2 93.4 67.0 2.7 570 76.6 88.3 76.4 91.4 65.4 5.2 423 73.9 83.3 76.5 88.6 62.4 7.5 1,456 80.6 90.5 75.8 91.7 65.0 3.2 4,881 82.5 90.4 79.5 92.7 70.3 3.4 910 74.0 83.2 75.0 87.5 60.6 7.2 1,730 80.3 90.4 76.3 91.7 65.6 3.6 2,021 82.5 91.6 76.6 93.1 66.4 2.7 1,665 81.0 90.7 77.7 92.5 67.6 3.1 1,830 84.3 93.4 80.1 93.9 71.0 2.6 1,207 78.5 88.2 75.6 90.7 63.9 4.4 6,039 87.3 95.4 78.4 93.1 70.0 1.9 2,341 84.7 92.3 81.1 92.9 71.4 2.8 1,956 64.7 79.8 64.7 82.6 51.1 11.5 1,158 73.1 83.3 76.2 92.5 60.9 3.5 1,792 73.4 86.9 70.6 89.9 57.7 3.9 1,584 80.0 88.2 77.1 90.7 65.8 4.7 4,330 85.0 94.4 80.9 94.4 71.6 2.5 1,331 77.0 88.4 77.3 87.8 63.2 6.1 1,917 84.0 92.2 77.3 95.0 68.2 1.2 3,289 74.4 84.6 74.0 88.4 61.8 6.9 2,027 70.9 80.7 75.3 85.9 59.7 9.3 1,210 78.3 89.4 76.4 89.1 64.9 5.4 1,966 84.3 93.4 78.7 94.5 68.6 1.7 1,427 81.7 90.3 75.6 93.5 65.8 2.0 2,643 84.1 90.2 76.1 90.2 69.8 5.6 1,705 78.3 88.3 75.3 93.3 63.2 2.8 2,735 76.4 88.0 76.8 89.3 62.1 4.8 2,133 82.4 92.4 80.2 91.3 70.4 3.4 672 79.5 89.1 76.4 91.2 65.1 4.1 7,246 ___________________________________________________________________________________________________ 1Includes one woman with missing information on education and 11 women with missing information on employment. 2Either by herself or jointly Characteristics of Respondents and Women’s Status * 39 Table 3.14 Smoking and alcohol consumption Percentage of women and men who currently smoke, who have consumed alcohol in the past 30 days, who have been drunk in the past 30 days, and who currently smoke and have consumed alcohol in the past 30 days, by background characteristics, Uganda 2000-2001 ________________________________________________________________________________________________________________________________ WOMEN MEN _______________________________________________ ___________________________________________________ Currently Currently smokes smokes and has and has Consumed Been consumed Consumed Been consumed Currently alcohol drunk alcohol Currently alcohol drunk alcohol Background smokes in past in past in past smokes in past in past in past characteristic tobacco 30 days 30 days 30 days Number tobacco 30 days 30 days 30 days Number ________________________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Residence Urban Rural Region Central Eastern Northern Western Marital status Never married Married/living together Divorced, separated, widowed Occupation Prof., tech., manag., & clerical Sales Agriculture/self-employed Skilled manual Unskilled manual Not worked in past 12 months Total 0.7 12.8 2.5 0.2 1,615 2.9 17.1 6.4 1.4 441 2.1 20.1 3.9 0.7 1,504 15.0 39.7 12.0 6.3 321 2.7 28.2 6.2 1.1 1,341 33.2 49.8 25.7 20.8 310 3.9 28.2 7.9 1.6 983 35.0 56.5 29.8 25.9 291 5.6 31.0 8.4 2.8 810 31.7 58.5 30.9 24.9 231 7.2 32.9 11.0 3.3 570 44.2 65.2 39.6 35.1 165 8.0 32.1 9.6 5.4 423 41.1 57.4 44.9 27.8 120 na na na na na 39.4 59.0 32.9 33.5 83 0.8 23.6 6.4 0.5 1,207 19.6 41.0 17.7 10.4 325 3.8 24.1 5.9 1.7 6,039 26.3 45.7 24.0 18.9 1,637 1.2 21.3 5.8 0.5 2,341 24.2 39.2 17.2 13.6 671 0.8 27.1 6.2 0.5 1,956 15.3 46.8 28.6 11.6 523 2.9 34.7 9.5 2.2 1,158 39.8 54.0 30.2 33.0 284 9.0 17.2 3.7 3.5 1,792 28.6 45.6 20.5 20.1 484 0.7 12.4 2.3 0.1 1,456 9.0 25.6 7.6 4.6 675 3.8 26.7 6.5 1.8 4,881 31.9 54.9 30.6 22.8 1,180 4.5 27.8 9.1 2.1 910 53.2 57.6 35.7 39.8 107 0.1 29.4 4.4 0.1 177 14.2 54.5 17.6 11.2 89 0.9 28.4 7.0 0.6 581 20.6 49.4 23.3 13.8 212 4.4 25.7 6.6 2.1 4,428 33.6 52.8 29.1 24.0 996 2.1 26.1 4.7 0.9 145 29.4 46.6 22.2 14.1 102 2.6 27.1 8.3 0.9 420 32.9 46.7 23.8 22.6 181 1.6 15.5 3.3 0.6 1,489 3.4 18.4 7.4 2.4 378 3.3 24.0 6.0 1.5 7,246 25.2 45.0 23.0 17.5 1,962 ___________________________________________________________________________________________________ na = Not applicable 3.12 USE OF TOBACCO AND ALCOHOL The use of tobacco negatively affects the health of the persons consuming it as well as those with whom they share the environment. In particular, use of tobacco has a strong negative health impact on pregnant women. The 2000-2001 UDHS asked men and women whether they smoke, what type of tobacco they smoke, and how many cigarettes they had smoked in the past 24 hours. Alcohol consumption can lead to drunkenness and oftentimes uncontrolled sexual behaviour. The survey asked respondents whether they had ever drunk alcohol, whether they currently drink, and how often they had become drunk in the last 30 days. Table 3.14 gives the results for tobacco and alcohol consumption. The table shows that only 3 percent of women are active tobacco smokers, compared with 25 percent of men. Men smoke an average of four cigarettes per day (data not shown). Overall, one in four women and almost one in two men consumed alcohol at least once in the past 30 days. Among those who drank, one in four women and one in two men got drunk at least once. Eighteen percent of men and less than 2 percent of women both smoke and drink. 40 * Characteristics of Respondents and Women’s Status The percentage of smokers is very low among teenage men (3 percent) but increases rapidly initially and later slowly to a level of 44 percent among men age 40-44 years and declines gradually thereafter. The likelihood of women smoking increases with age. The age pattern for alcohol consumption in the last 30 days is the same as that for smoking. Urban women and men are less likely to engage in smoking and drinking than their rural counterparts. Although women in the Western Region are much more likely to smoke than other women, they are less likely to drink. Unmarried men and women (usually young and with no cash income) are less likely to engage in smoking and drinking than those who are currently married. However, those who are no longer in union show higher levels of indulgence. Women and men who did not work in the 12 months preceding the survey are less likely to drink alcohol than those who worked. However, consumption of alcohol among those who work does not vary much according to the type of occupation. Fertility * 41 Table 4.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by residence, Uganda 2000-2001____________________________________________ Residence________________ Age group Urban Rural Total____________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 TFR 15-44 GFR CBR 119 192 178 238 354 332 193 319 298 137 278 259 84 203 187 27 83 76 5 44 40 4.0 7.4 6.9 4.0 7.1 6.7 158 258 241 41.3 48.0 47.3 ____________________________________________ Note: Rates are for the period 1 to 36 months preceding the survey, expressed per 1,000 women. Rates for the age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for age 15-49, expressed per woman. GFR: General fertility rate (births divided by the number of women 15-44), expressed per 1,000 women. CBR: Crude birth rate, expressed per 1,000 population. FERTILITY 4 This chapter discusses current, cumulative, and past fertility in terms of levels, patterns, and trends that were observed on the basis of the 2000-2001 UDHS and past surveys. Data on fertility were obtained through the birth histories of women age 15-49 interviewed in the 2000-2001 UDHS. Each woman was asked about all of the births she had had in her lifetime. To ensure completeness of the responses, questions were asked separately about sons and daughters who live with the mother, who live elsewhere, and who have died. Subsequently, a list of all births was recorded along with name, age if still alive, and age at death if dead. 4.1 CURRENT FERTILITY LEVELS The current level of fertility is important as it presents the prevailing situation and relates to population policies and programmes. Current fertility can be measured using the age-specific fertility rate (ASFR), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR). The ASFR provides the age pattern of fertility, while the TFR refers to the number of live births that a woman would have had if she were subject to the current ASFRs throughout her reproductive ages (15–49 years). More generalised indicators of fertility include the number of live births per 1,000 women of reproductive age, which is the GFR, and the number of live births per 1,000 population, which is the CBR. The measures of fertility presented in this chapter refer to the period three years prior to the survey. This generates a sufficient number of births to provide robust and current estimates. The most commonly used measure of current fertility is the TFR. The 2000-2001 UDHS indicated a TFR of 6.9 children per woman, similar to that obtained from the 1995 UDHS. Table 4.1 shows that on average, a Ugandan woman would have 6.9 children by the end of her reproductive years if the current fertility pattern were to prevail. Table 4.1 also presents the GFR (241 live births per 1,000 women) and the CBR (47 live births per 1,000 women). Fertility levels in the urban areas are lower than in the rural areas, irrespective of the woman’s age. This phenomenon has been observed in earlier studies. Consequently, the TFR in the urban areas is much lower than in the rural areas (4.0 and 7.4 children, respectively). However, because of the small proportion of the urban population, this low urban fertility has a small impact on the level of fertility for the country as a whole, which remains high. 42 * Fertility Table 4.1 shows the age pattern of fertility in Uganda. It is evident that fertility starts early in the teen ages, rises rapidly to reach its peak in the 20–24 age group, and declines to only 40 live births per 1,000 women in the oldest age group (45-49 years). The relatively high level of fertility in the youngest age group, which constitutes a large proportion of the women, leads to a large number of births. As shown below, Uganda has the highest TFR of countries in eastern and southern Africa that have recently participated in the DHS programme: Country Year TFR Uganda 2000-2001 6.9 Malawi 2000 6.3 Zambia 1996 6.1 Eritrea 1995 6.1 Ethiopia 2000 5.9 Rwanda 2000 5.8 Tanzania 1999 5.6 Kenya 1998 4.7 Zimbabwe 1999 4.0 4.2 FERTILITY DIFFERENTIALS Fertility is known to vary by residence, educational background, and other background, characteristics of a woman. In this report, the study of fertility differentials is done using the TFR and completed fertility in terms of the mean number of births to women age 40–49 by these characteristics. Table 4.2 and Figure 4.1 show that there is a substantial regional variation in TFRs, ranging from 5.7 births per woman in the Central Region to 7.9 births per woman in the Northern Region. On the other hand, the mean number of births in all regions does not vary significantly (7.1 to 7.2 births per woman 40-49). The difference between the TFR and completed fertility is an indicator of the magnitude and direction of fertility change. For Uganda as a whole, the difference is 0.2 children, which reflects no significant change in the fertility level in the past 20 to 25 years. This is true in the Eastern and Western regions. In the Central Region, the difference is notable (TFR of 5.7 births per woman compared with mean number of children ever born to women 40-49 of 7.2 births). This implies that there has been a decline in fertility in this region. In the Northern Region it appears that fertility may have increased over the past decade or two. The spatial variation is further reflected in the panel, which shows the TFR by whether the districts are covered in the DISH and CREHP (CARE) projects. As a group, all districts in the DISH project and all districts in the CARE project show lower TFRs than those of the districts not covered by either project. Within the five groups of districts included in the DISH project, the TFR varies from 3.4 births per woman in Kampala to 7.4 births per woman in Group I (Mbarara and Ntungamo). Two variables are used as socioeconomic indicators: the woman’s education and the wealth status of her household. These indicators show a strong relationship with fertility levels. The TFR among women with no education (7.8) is twice as high as the TFR among women with secondary education (3.9). Even sharper variations in TFRs are shown by the woman’s wealth. Whereas the Fertility * 43 Table 4.2 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 background characteristics, Uganda 2000-2001___________________________________________________________ Mean number of children ever Total Percentage born to Background fertility currently women age characteristic rate1 pregnant 40-49___________________________________________________________ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ DISH/CREHP districts DISH I Mbarara and Ntungamo II Masaka, Rakai, and Sembabule III Luwero, Masindi, and Nakasongola IV Kamuli and Jinja V Kampala CREHP (Kisoro, Kabale, and Rukungiri Neither Wealth index quintile Lowest Lower middle Middle Upper middle Highest Total 4.0 8.0 6.1 7.4 13.5 7.3 5.7 10.0 7.2 7.4 14.7 7.1 7.9 11.6 7.1 6.9 14.1 7.1 7.8 13.0 7.0 7.3 13.7 7.3 3.9 8.2 6.7 6.0 11.4 7.0 7.4 12.4 6.6 7.2 11.2 7.9 7.1 16.0 6.7 6.2 14.0 6.9 3.4 7.4 6.2 5.9 12.0 6.7 7.3 13.1 7.2 8.5 13.8 7.4 8.2 16.4 7.2 7.5 12.8 7.5 6.3 11.5 6.8 4.1 9.2 6.6 6.9 12.6 7.1 __________________________________________________________ 1 Rate for women age 15-49 TFR for women in the poorest 20 percent of the population is 8.5 births per woman, the TFR for the richest 20 percent is only 4.1 births per woman. At the time of the survey, 13 percent of women reported that they were pregnant. This is a slight decline from the 14 percent observed in the 1995 UDHS. 44 * Fertility 4.3 TRENDS IN AGE-SPECIFIC FERTILITY RATES One way of analysing trends is by comparing current data with those from previous studies. Unfortunately, the three Uganda DHS surveys did not share exactly the same geographic coverage. In the 1988-1989 survey, nine districts in the Northern Region were excluded. In the 1995 UDHS, eight enumeration areas (six in Kitgum District, one in Apac District, and one in Moyo District) were not covered, while in the 2000-2001 UDHS, Kasese and Bundibugyo districts in the Western Region and Gulu and Kitgum districts in the Northern Region were not surveyed. Although the estimates may be influenced by the exclusion of some districts, they provide a useful indicator for examining the changes in fertility that have taken place in Uganda over time. As shown in Figure 4.2, little change is observed. The TFR has barely changed from 7.3 recorded in the 1988-1989 UDHS (referring to mid-1987) to 6.9 recorded in both the 1995 and 2000-2001 UDHS surveys. Another way to examine trends in fertility is to compare age-specific fertility rates from the 2000-2001 UDHS for successive five-year periods preceding the survey, as presented in Table 4.3. Since 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. Generally, only small changes are observed, implying that fertility has remained at the same level over time. Fertility * 45 Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey by mother’s age at the time of the birth, Uganda 2000-2001 ________________________________________________________ Number of years preceding survey _______________________________________ Age group 0-4 5-9 10-14 15-19 ________________________________________________________ 15-19 190 201 199 188 20-24 334 336 349 308 25-29 299 317 323 307 30-34 261 265 282 [282] 35-39 187 221 [249] - 40-44 84 [107] - - 45-49 [39] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in 4.4 CHILDREN EVER BORN Table 4.4 gives the percent distribution of women by number of children ever born (CEB) for all women as well as for currently married women. The table also shows the mean number of children ever born according to five-year age groups. Childbearing starts early in Uganda. Although the mean number of children ever born among women age 15-19 is 0.3 live births per woman, the figure increases rapidly, and by her late twenties, a woman would have given birth to more than three children and to more than six children by her late thirties. 46 * Fertility Table 4.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, mean number of children ever born, and mean number of living children, according to age, Uganda 2000-2001 ___________________________________________________________________________________________________________________________ Mean Mean number number Number of children ever born Number of of ___________________________________________________________________________ of children living Age 0 1 2 3 4 5 6 7 8 9 10+ Total women ever born children ______________________________________________________________________________________________________________________________ ALL WOMEN _____________________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 74.4 19.3 5.1 1.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,615 0.3 0.3 15.6 22.0 30.0 21.4 8.6 2.1 0.3 0.1 0.0 0.0 0.0 100.0 1,504 1.9 1.7 4.4 10.1 14.3 20.7 25.4 15.8 6.2 2.9 0.2 0.1 0.0 100.0 1,341 3.4 2.9 3.5 3.5 6.3 9.0 15.2 18.1 19.7 14.6 6.2 2.4 1.4 100.0 983 5.0 4.2 3.6 4.6 5.4 4.7 8.5 9.2 13.1 17.0 16.1 11.5 6.4 100.0 810 6.1 5.0 4.7 4.1 4.7 3.4 6.3 7.2 8.2 12.3 12.9 14.2 22.0 100.0 570 6.9 5.6 3.7 2.4 2.7 3.8 3.6 9.3 10.1 11.9 12.4 15.1 25.0 100.0 423 7.4 5.8 22.1 12.2 12.0 10.7 10.20 8.00 6.60 6.10 4.4 3.6 4.1 100.0 7,246 3.4 2.9 ___________________________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ___________________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 32.0 48.8 15.5 3.1 0.5 0.0 0.0 0.0 0.0 0.0 0.0 100.0 466 0.9 0.8 6.0 20.5 34.7 24.8 10.6 2.4 0.3 0.1 0.0 0.0 0.0 100.0 1,150 2.2 1.9 2.3 8.3 12.4 20.5 27.6 18.6 6.9 2.9 0.2 0.2 0.0 100.0 1,078 3.6 3.1 2.5 2.3 5.3 8.5 14.0 18.2 21.3 16.4 7.4 2.5 1.7 100.0 807 5.3 4.4 3.2 4.0 4.1 4.7 7.6 9.2 11.8 17.9 17.5 12.3 7.7 100.0 652 6.3 5.2 3.6 2.3 4.4 2.6 6.2 6.7 8.1 11.1 13.3 16.4 25.3 100.0 431 7.4 5.9 3.3 2.0 1.9 2.7 3.4 8.0 9.7 11.9 12.3 15.7 29.1 100.0 297 7.7 6.1 6.5 12.6 14.3 13.1 12.7 10.0 8.0 7.5 5.5 4.5 5.3 100.0 4,881 4.2 3.5 There is no significant difference in the mean number of children ever born between women in the general population and currently married women, except in the youngest age groups. Among women age 15-19, those in the general population have given birth to 0.3 children, while those who are currently married have had on average almost one child. Differences at older ages reflect the impact of marital dissolution through divorce and widowhood. The last column in Table 4.4 shows the mean number of children who survived. The difference between the mean number of CEB and living children is an indicator of the level of mortality in the population. Since voluntary childlessness is rare in Uganda, it is assumed that most married women with no births are unable to physiologically bear children. The percentage of women who are childless at the end of the reproductive period is an indirect measure of primary infertility (the proportion of women who are unable to bear children at all). Table 4.4 shows that primary infertility is low (about 3 percent). 4.5 BIRTH INTERVALS The study of birth intervals is important in understanding the health status of young children. Previous research has shown that short birth intervals are closely associated with poor health of children, especially during infancy. This is particularly true for children born at intervals of less than 24 months. The study of birth intervals is done using two measures, namely, median birth interval and proportion of non-first births that occur with an interval of 24 months or more after the previous birth. Table 4.5 presents the distribution of second and higher order births in the five years preceding the survey by the number of months since the previous birth, according to background characteristics. The table also presents the median number of months since last birth. Fertility * 47 Table 4.5 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, according to background characteristics, Uganda 2000-2001____________________________________________________________________________________________________ Median number of months Number Months since preceding birth since of Background ________________________________________________ preceding non-first characteristic 7-17 18-23 24-35 36-47 48+ Total birth births____________________________________________________________________________________________________ Age 15-19 20-29 30-39 40+ Birth order 2-3 4-6 7+ Sex of preceding birth Male Female Survival of preceding birth Living Dead Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Total1 26.3 21.2 40.8 9.6 2.1 100.0 24.3 118 10.8 21.1 45.0 15.5 7.6 100.0 27.8 3,385 7.7 14.4 40.5 19.0 18.4 100.0 31.5 2,270 6.1 12.4 34.4 18.6 28.5 100.0 35.2 512 9.9 20.6 42.2 15.9 11.4 100.0 28.6 2,509 9.5 15.8 44.2 17.4 13.1 100.0 29.4 2,362 9.1 16.8 39.9 17.8 16.3 100.0 30.4 1,414 9.2 17.5 42.7 17.3 13.4 100.0 29.4 3,174 10.0 18.4 42.2 16.5 12.9 100.0 29.0 3,110 6.9 17.3 44.8 17.4 13.5 100.0 29.9 5,313 24.4 21.4 29.4 14.0 10.9 100.0 24.7 972 9.4 19.5 32.4 16.6 22.0 100.0 31.0 564 9.6 17.8 43.4 16.9 12.2 100.0 29.1 5,720 10.4 19.4 40.3 15.5 14.5 100.0 28.7 1,664 9.1 20.5 43.5 16.5 10.4 100.0 28.3 1,965 9.5 13.5 41.6 19.8 15.6 100.0 31.8 1,100 9.5 16.4 44.0 16.8 13.3 100.0 29.4 1,555 8.4 16.0 41.0 18.6 16.0 100.0 31.1 1,669 10.1 18.8 43.6 16.2 11.3 100.0 28.5 4,063 9.6 17.8 37.9 16.9 17.7 100.0 30.0 551 9.6 18.0 42.4 16.9 13.1 100.0 29.2 6,285 __________________________________________________________________________________________________ Note: First births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 1Total includes one birth with missing information on mother’s education. Table 4.5 shows that the majority of Ugandan children (72 percent) are born at least 24 months after their previous sibling. Ten percent of births occur less than 18 months after the previous birth. The overall median birth interval is 29 months, which is similar to what was observed in the 1995 UDHS. Children born to younger women tend to have shorter birth intervals than those born to older women. The proportion of births with intervals less than 24 months declines steeply from 48 percent among women age 15-19 to 19 percent among women age 40 and above. The median birth interval increases with age from 24 months among women 15-19 to 35 months among women age 40 or older. There are no strong differentials in median birth interval by residence, region, birth order, or sex of the previous child. However, the survival status of the previous birth has a strong impact on the birth interval. Median birth intervals for births that follow a child who died are five months 48 * Fertility Table 4.6 Age at first birth Percentage of women who have given birth by specified exact ages and median age at first birth, by current age, Uganda 2000-2001 ___________________________________________________________________________________ Percentage who have Median Age at first birth: never age at ____________________________________ given first Current age 15 18 20 22 25 birth Number birth ___________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 2.4 na na na na 74.4 1,615 a 4.9 41.9 70.1 na na 15.6 1,504 18.5 6.2 36.7 65.4 82.0 91.6 4.4 1,341 18.9 9.6 43.0 68.8 85.1 93.3 3.5 983 18.6 0.1 40.8 64.1 79.4 89.8 3.6 810 18.8 8.4 42.2 65.9 79.8 89.3 4.7 570 18.7 2.9 45.3 63.2 76.7 89.2 3.7 423 18.5 __________________________________________________________________________________ na = Not applicable a Omitted because less than 50 percent of the women in the age group 15-19 have had a birth by age 15. shorter than those for births following a surviving child (25 months and 30 months, respectively). The percentage of births occurring after a very short interval (less than 18 months) is more than three times higher 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. 4.6 AGE AT FIRST BIRTH The age at which childbearing commences is an important determinant of the overall level of fertility as well as the health and welfare of the mother and the child. In some societies, postponement of first births due to an increase in age at marriage has contributed to overall fertility decline. However, in Uganda, it is not uncommon for women to have children before getting married. Table 4.6 shows the percentage of women who have given birth by specific ages, according to age at the time of the survey. Data in the last column of Table 4.6 show that the initiation of childbearing has not changed much over time. Data from the previous UDHS surveys show the same pattern. This suggests that there has been no significant change in age at first birth in Uganda for the past 30 years. Births to women under age 20 are considered unsafe to both mother and child. The proportion of women who had their first birth before age 15 has shown a decline over time from 10 percent among women age 30-34 to only 2 percent among women age 15-19. However, Table 4.6 also shows that the postponement is for a short time, since two-thirds of women have had a child before they reach age 20. Fertility * 49 Table 4.7 Median age at first birth by background characteristics Median age at first birth among women age 20-49, by current age and background characteristics, Uganda 2000-2001__________________________________________________________________________________________________ Current age Background _____________________________________________________ Age Age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49__________________________________________________________________________________________________ Residence Urban Rural Region Central Eastern Northern Western Education No education Primary Secondary+ Total 19.9 19.7 18.7 19.2 19.2 18.1 19.4 19.2 18.3 18.8 18.5 18.8 18.6 18.6 18.6 18.7 18.7 18.9 17.8 18.2 18.9 17.5 18.5 18.4 18.1 18.8 18.5 18.8 17.6 17.6 18.4 18.5 17.9 18.5 18.1 19.1 19.2 19.5 18.5 18.8 19.1 19.4 19.3 19.4 19.4 19.7 19.3 19.4 17.8 18.2 17.8 18.6 18.7 18.8 18.3 18.4 18.0 18.6 18.6 18.6 18.5 18.1 18.4 18.5 a 21.1 19.8 21.1 19.3 19.5 a 20.4 18.5 18.9 18.6 18.8 18.7 18.5 18.7 18.8 __________________________________________________________________________________________________ a Omitted because less than 50 percent of the women had a birth before entering the age group. To study differentials in age at first birth, Table 4.7 presents the median age at first birth for different subgroups of the population. Overall, the median age at first birth among women 20- 49 is 18.7 years. The age group 15-19 is excluded because only a small fraction of these women had a birth before age 15. Urban women, women who reside in the Western Region, and better educated women tend to have their first child at a later age than other women. The relationship between education and initiation of childbearing is clear: women with secondary education starte

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