Uzbekistan - Demographic and Health Survey - 1997

Publication date: 1997

Uzbekistan Demographic and Health Survey 1996 Institute of Obstetrics and Gynecology Ministry of Health of the Republic of Uzbekistan ~DHS Demographic and Health Surveys Macro International Inc. World Summit for Children Indicators: Uzbekistan 1996 Value BASIC INDICATORS Childhood mortality Maternal mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Basic education Children in especially difficult situations Infant mortality rate Under-five mortality rate Maternal mortality ratio Percent stunted (of children under 3 years) Percent wasted (of children under 3 years) Percent underweight (of children under 3 years) Percent of households within 15 minutes of a safe water supply 2 Percent of households with flush toilets or V1P latrines Percent of women 15-49 with completed primary education Percent of men 15-49 with completed primary education Percent of girls 6-12 attending school Percent of boys 6-12 attending school Percent of women 15-49 who are literate Percent of children who are orphans (both parents dead) Percent of children who do not live with their natural mother Percent of children who live in single adult households 49 per 1,000 59 per 1,000 39 per 100,000 l 31.3 11.6 18.8 84.8 22.6 99.2 99.5 78.6 75.6 99.8 0.1 1.7 1.9 SUPPORTING INDICATORS Women's Health Birth spacing Safe motherhood Family planning Nutrition Maternal nutrition Low birth weight Breastfeeding Iodine Child Health Diarrhea control Percent of births within 24 months of a previous birth s Percent of births with medical prenatal care Percent of births with prenatal care in first trimester Percent of births with medical assistance at delivery Percent of births in a medical facility Percent of births at high risk Contraceptive prevalence rate (any method, married women) Percent of currently married women with an unmet demand for family planning Percent of currently married women with an unmet need for family planning to avoid a high-risk birth Percent of mothers with low BMI Percent of births at low birth weight (of those reporting numeric weight) Percent of children under 4 months who are exclusively breastfed Percent of households with iodised salt Percent of children with diarrhea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) Acute respiratory infection Percent of children with acute respiratory infection in preceding 2 weeks who were seen by medical personnel I Data from the Ministry of Health ~ Piped, well, and bottled water First births are excluded. 29.5 95.0 72.7 97.5 94.1 42.7 55.6 13.7 10.7 7.7 4.3 4.0 16.7 37.1 87.1 Uzbekistan Demographic and Health Survey 1996 Institute of Obstetrics and Gynecology Ministry of Health of the Republic of Uzbekistan Tashkent City, Uzbekistan Macro International Inc. Calverton, Maryland USA September 1997 This report summarizes the findings of the 1996 Uzbekistan Demographic and Health Survey (UDHS) conducted by the Institute of Obstetrics and Gynecology, Ministry of Health of the Republic of Uzbekistan. Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Development. The UDHS is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the Uzbekistan survey may be obtained from the Institute of Obstetrics and Gynecology, 132 A H. Abdullaev Ave., Tashkent City, Uzbekistan 700124 (Telephone: (7312) 637830; Fax: (7312) 638483). Additional information about the DHS program may be obtained by writing to: DHS, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (Telephone: 301-572-0200; Fax: 301-572-0999). Recommended citation: Institute of Obstetrics and Gynecology [Uzbekistan] and Macro International Inc. 1997. Uzbekistan Demographic and Health Survey, 1996. Calverton, Maryland: Institute of Obstetrics and Gynecology and Macro International Inc. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi i Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Map of Uzbekistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiv CHAPTER I INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Shavkat I. Karimov 1.1 Geography and Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 History of Uzbekistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.4 Health Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.5 Family Planning Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.6 Demographic and Health Data Collection System in Uzbekistan . . . . . . . . . . . . . . . . . . 6 1.7 Objectives and Organization of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.7. l Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.7.2 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.7.3 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.7.4 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.7.5 Response Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 CHAPTER 2 2.1 2.2 2.3 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . . . 13 Damin A. Asadov and Mila A. Li Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.1.1 Sex and Age Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.1.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.1.3 Educational Level of Household Members . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.2.1 Household Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 2.3.1 Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 2.3.2 Educational Level of the Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2.3.3 School Attendance and Reasons for Leaving School . . . . . . . . . . . . . . . . . . . . 22 2.3.4 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 iii 2.4 Page 2.3.5 Women's Employment Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.3.6 Employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.3.7 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.3.8 Decisions on Use of Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.3.9 Child Care While Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Pensioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ! 2.4.1 Composition of Households Containing Pensioners . . . . . . . . . . . . . . . . . . . . 31 2.4.2 Housing Characteristics of Households Containing Pensioners . . . . . . . . . . . 32 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 3.6 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Shavkat L Karimov, Akhror B. Yarkulov, and Damin A. Asadov Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Pregnancy and Motherhood Among Women Age 15-19 . . . . . . . . . . . . . . . . . . . . . . . 44 CHAPTER 4 CONTRACEPTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Damin A. Asadov, Farida I¢£ Xyupova, Feruza Z Faizieva and Mila A. Li 4.1 Knowledge of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.2 Ever Use o f Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.3 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.4 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 4.5 Knowledge of the Fertile Period and of the Contraceptive Effect of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.6 Source of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.7 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.8 Reasons for Nonuse of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.9 Preferred Method of Contraception for Future Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.10 Exposure to Family Planning Messages in the Electronic Media . . . . . . . . . . . . . . . . . 61 4.11 Acceptability of Use of Electronic Media to Disseminate Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.12 Exposure to Family Planning Messages in Print Media . . . . . . . . . . . . . . . . . . . . . . . . 62 4.13 Attitudes of Couples toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.14 Social Marketing of Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 CHAPTER 5 5.1 INDUCED ABORTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Feruza T Faizieva, Jeremiah M. Sullivan, and Alisa D. Podporenko Pregnancy Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 iv 5.2 5.3 5A 5.5 5.6 5.7 5.8 Lifetime Experience with Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Rates of Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Time Trends in Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Abortion Rates from the Ministry of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Use &Contraception before Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Service Providers and Medical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Complications of Abortion and Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 CHAPTER 6 6.1 6.2 6.3 6.4 6.5 6.6 OTHER PROXIMATE DETERMINANTS OF FERTIL ITY . . . . . . . . . . . . . . . . . . 79 Akhror B. Yarkulov, Kia £ Weinstein, Rano M. Usmanova, and GuHstan N. Bekbaulieva Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Age at Filst Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Age at First Sexual Inlercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Postpartum Amenorrhea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . 85 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 CHAPTER 7 7.1 7.2 7.3 7.4 FERTIL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Saidazym A( Soultanov, Kia l. Weinstein, Mila A. Li and Rano M. Usmanova Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Wanted and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 8.6 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Akhror B. Yarlculov and Jeremiah M. Sullivan Background and Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Levels and Trends in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Infant Mortality Rates from the Ministry of Health . . . . . . . . . . . . . . . . . . . . . . . . 101 Socioeconomic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . 102 Demographic Differentials in Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . 103 High-Risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 CHAPTER 9 9.1 9.2 9.3 9A 9.5 MATERNAL AND CHILD HEALTH Akhror B. Yarkulov, Damin A. Asadov and Saidazym N. Soultanov . . . . . . . . . . . . 107 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Assistance and Medical Ca~e at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Acule Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 9.6 9.7 Page Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Dia~hea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 CHAPTER 10 10.1 10.2 10.3 NUTRITION OF WOMEN AND CHILDREN . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Akhror B. Yarkulo~; Farida M Ayupova and Parakhad R. Menlik~dov Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 10.1.1 Initiation of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12l 10.1.2 Age Pattern of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 10. 1.3 Types of Supplemental Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Nutritional Status of Children under Age Three . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 10.2.1 Measures of Nutritional Status in Childhood . . . . . . . . . . . . . . . . . . . . . . 126 10.2.2 Levels of Child Undernutrition in Uzbekistan . . . . . . . . . . . . . . . . . . . . . 127 Women's Anthropometric Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 CHAPTER 11 11.1 11.2 11.3 11.4 11.5 ANEMIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Saidazym N. Soultanov, Almaz 1~ Sharmanov, and Nazima M. Abrarova Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Anemia Measurement Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Anemia Prevalence Among Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Anemia Prevalence Among Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Thanh LO A.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 A.2 Characteristics of the UDHS Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 A.3 Sample Allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I45 A.4 Stratification and Systematic Selection of Clusters . . . . . . . . . . . . . . . . . . . . . . . . . . 147 A.4.1 Urban areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 A.4.2 Rural areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 A.5 Sampling Probabilities of Selected Health Blocks and Villages . . . . . . . . . . . . . . . . . 148 A.5.1 Urban areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 A.5.2 Rural areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 vi Page APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Thanh L~ APPENDIX C DATA QUAL ITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 APPENDIX D SAMPLE IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 APPENDIX E PERSONS INVOLVED IN THE 1996 UZBEKISTAN DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 APPENDIX F QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 vii Table 1.1 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 Table 2.12 Table 2,13 Table 2.14 Table 2.15 Table 2.16 Table 2.17 Table 2.18 Table 2.19 Table 2.20 Table 2.21 Table 2.22 Table 2.23 Table 3.1 Table 3.2 Table 3.3 Table 3A Table 3.5 Table 3.6 Table 3,7 TABLES Page Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Population by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Ethnicity, religion and residence by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 School attendance and reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Decision on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Pensioners by age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Composition of households with pensioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Housing characteristics of households with pensioners . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Possession of durable goods for households with pensioners . . . . . . . . . . . . . . . . . . . . . . 33 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Age-specific fertility rates from other sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Trends in fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Trends in birth and fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 ix Table 3.8 Table 3.9 Table 3.10 Table 3.11 Table 3.12 Table 4. I Table 4.2 Table 43 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 Table 5.1 Table 5.2 Table 53 Table 5A Table 5.5 Page Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Pregnancy and motherhood among women age 15-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Children born to women age 15-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Knowledge of contraceptive methods by background characteristics . . . . . . . . . . . . . . . . 49 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 52 Use of pill brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Number of children at the time of first use of contraception . . . . . . . . . . . . . . . . . . . . . . . 54 Knowledge of the fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Satisfaction with current sources of supply for contraceptive methods . . . . . . . . . . . . . . . 59 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Heard about family planning on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Acceptabi l i ty of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Wives' perceptions of their husbands' attitude toward family planning . . . . . . . . . . . . . . . 66 Knowledge of the Red Apple social marketing logo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Exposure to family plannitlg messages and knowlege of the Red Apple social marketing logo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Pregnancy outcomes by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Lifetime experience with induced abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Induced abortion rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Induced abortion rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Trends in age-specific induced abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 X Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 6.10 Table 7.1 Table 7.2 Table 7.3 Table 7A Table 7.5 Table 7.6 Table 7.7 Table 7.8 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Page Comparison of abortion rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Use of contraception prior to pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Source of services, type of provider, and procedure used for abortion . . . . . . . . . . . . . . . 77 Health problems following abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Current marital .,tatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Sexual relationships of nonmarried women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8l Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Postpartum amenorrhea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Median duration of postparlum amencrrhea, abstinence, and insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Termitxation of exposure to the risk of pregnatxcy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . . . 96 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Trends in infant mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 102 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . 103 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 110 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Delivery characteri~t'cs: caesarean section, birth weight and size . . . . . . . . . . . . . . . . . 113 xi Table 9,6 Table 9.7 Table 9.8 Table 9.9 Table 9.10 Table 9.11 Table 9,12 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Table I 1.1 Table 11.2 Table 11.3 Table A. 1 Table A.2 Table A.3 Table A.4 Table A.5 Table A.6 Table B.1 Table B.2 Table B.3 Table 13.4 Table 13.5 Table B.6 Table 13.7 Table B.8 Page Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Vaccinations by background characteri~t?cs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Prevalence o f acute respiratory infection and fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Knowledge of diarrhea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Prevalence o f diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Types of food received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . . . . . 125 Nutritional status of children by demographic characteristics . . . . . . . . . . . . . . . . . . . . . 127 Nutritional status of children by background characterist'cs . . . . . . . . . . . . . . . . . . . . . . 129 Anthropometric indicators of female nutritional .,tatus . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Nutritional status of women by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 132 Anemia among women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Anemia among children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Anemia among children born to anemic mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Population distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Percent distribution of population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Proportional sample allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Proposed sample allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Number of sample points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Proposed number of sample points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Sampling errors - National sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Sampling errors - Urban sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Sampling errors- Rural sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Sampling errors - Region 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Sampling erroTs - Region 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Sampling errors - Region 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Sampling errors - Region 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 xii Table B,9 Table C. 1 Table C.2 Table C.3 Table CA Table C.5 Table C.6 Table D. 1 Page Sampling errors - Tashkent City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 xiii Figure 1.1 Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 4.1 Figure 4.2 Figure 4.3 Figure 5.1 Figure 5.2 Figure 6.1 Figure 6.2 Figure 7.1 Figure 7.2 Figure 7.3 Figure 8.1 Figure 9.1 Figure 9.2 Figure 9.3 Figure 10,1 Figure 10.2 Figure 11.1 Figure 11.2 Figure 11.3 FIGURES Page Oblast Composition of Regions in Uzbekistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Population Pyramid of Uzbekistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 School Enrollment by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Housing Characteristics by Residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Age-specific Fertility Rates by Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Total Fertility Rate by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Trends in Age-Specific Fertility Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Percent of Non-first Births Born Within 24 Months of Previous Birth . . . . . . . . . . . . . 43 Use of Specific Contraceptive Methods among Currently Married Women . . . . . . . . . 51 Current Use of Family Planning by Background Characteristics . . . . . . . . . . . . . . . . . . 53 Distribution of Current Contraceptive Users by Source of Supply . . . . . . . . . . . . . . . . . 59 Age-specific Rates of Fertility and Induced Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Total Induced Abortion Rate by Background Characteristics . . . . . . . . . . . . . . . . . . . . 75 Marital Status of Women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Percentage of Women Married by Specific Exact Ages . . . . . . . . . . . . . . . . . . . . . . . . . 82 Fertility Preferences among Currently Married Women 15-49 . . . . . . . . . . . . . . . . . . . 90 Fertility Preferences among Currently Married Women by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Percentage of Currently Married Women with Unmet Need and Met Need for Family Planning Services by Background Characteristics . . . . . . . . . . . . . . . 94 Under-five Mortality by Selected Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Percent Distribution of Births by Antenatal Care and Delivery Characteristics . . . . . 109 Vaccination Coverage Among Children Age 12-23 Months . . . . . . . . . . . . . . . . . . . . 115 Prevalence of Respiratory Illness and Diarrhea in the Last Two Weeks by Age of the Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Prevalence of Stunting by Age of Child and Length of Birth Interval . . . . . . . . . . . . . 128 Prevalence of Stunting by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . 130 Prevalence of Moderate Anemia among Women Age 15-49 by Pregnancy Status and Breastfeeding Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Distribution of Women 15-49 by Hemoglobin Levels . . . . . . . . . . . . . . . . . . . . . . . . . 137 Percentage of Women with Moderate or Severe Anemia among Those Who are Currently Using or Not Using the IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 XV LIST OF CONTRIBUTORS Shavkat I. Karimov, M.D., Ph.D. Academician, Academy of Sciences of Republic of Uzbekistan Minister of Health, Republic of Uzbekistan Ministry of Health 12 Navoy Street Tashkent City, Uzbekistan 700011 Jeremiah M. Sullivan, Ph.D. Deputy Director, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Akhror B. Yarkulov, M.D. Deputy Minister of Health, Republic of Uzbekistan Ministry of Health 12 Navoy Street Tashkent City, Uzbekistan 70001 l Damin A. Asadov, M.D., Ph.D. Rektor, Central Asian Medical Pediatric Institute Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistan 700124 Saidazim. N. Soultanov, M.D., Ph.D. Director, Research Institute of Obstetrics and Gynecology Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistan 700124 Almaz T. Sharmannv, M.D., Ph.D. Health Specialist, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Kia I. Weinstein, Ph.D. Consultant, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Farlda M. Ayupova, M.D. Ph. D Chief, Children and Adolescents' Gynecology Division Research Institute of Obstetrics and Gynecology Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistau 700124 ×vii Feruza T. Faizieva, M.D., Ph.D. Consultant, Family Planning Center Research Institute of Obstetrics and Gynecology Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistan 700124 Mila A. Li, M.D., Ph.D. Chief, Division of Health and Demographic Surveys Research Institute of Obstetrics and Gynecology Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistan 700124 Rano M. Usmanova, M.D., Ph.D. Research Institute of Obstetrics and Gynecology Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistau 700124 Thanh L~ Sampling Statistician, Demographic and Health Surveys Macro International Inc. 11785 Beltsville Drive Calverton, MD 20705, USA Alisa D. Podporenko, M.D., Ph.D. Chief Physician, Research Institute of Obstetrics and Gynecology Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistan 700124 Gulistan N. Bekbaulieva Staff member, Institute of Advanced Education of Physicians Ministry of Health, Republic of Uzbekistan 51 Parkentskaya Street Tashkent City, Uzbekistan 700007 Parakhat R. Menlikulov Chief, Health Care Management Ministry of Health, Republic of Uzbekistan 132 A H. Abdullaev Ave. Tashkent City, Uzbekistan 700124 Nazym Abrarova Staff Member Research Associate, Institute of Obstetrics and Gynecology Ministry of Health, Republic of Uzbekistan 132 A H. Abdul/aev Ave. Tashkent City, Uzbekistan 700124 xviii SUMMARY OF FINDINGS Shavkat I. Karimov The 1996 Uzbekistan Demographic and Health Survey (UDHS) is a nationally representative survey of 4,415 women age 15-49. Fieldwork was conducted from June to October 1996. The UDHS was sponsored by the Ministry of Health (MOH), and was funded by the United States Agency for International Development. The Institute of Obstetrics and Gynecology implemented the survey with technical assistance from the Demographic and Health Surveys (DHS) program. PURPOSE The purpose of the UDHS was to provide data to the MOH on factors which determine the health status of women and children such as fertility, contraception, induced abortion, maternal care, infant mortality, and nutritional status. Some statistics presented in this report are currently available to the MOH from other sources. For example, the MOH collects and regularly publishes information on fertility, contraception, induced abortion and infant mortality. However, the survey presents information on these indices in a manner which is not currently available, i.e., by population subgroups such as those defined by age, marital duration, education, ethnicity. Additionally, the survey provides statistics on some issues not previously available in Uzbekistan: for example, breastfeeding practices and anemia status of women and children. Thus, existing MOH data and the UDHS data are complementary. When considered together, they provide a more complete picture of the health conditions in Uzbekistan than was previously available. FERTILITY Fertility Rates. Survey results indicate a total fertility rate (TFR) for all of Uzbekistan of 3.3 children per woman. Fertility levels differ for different population groups. The TFR for women living in urbml areas (2.7 children per woman) is substantially lower than for women living in rural areas (3.7). The TFR for Uzbeki women (3.5 children per woman) is higher than for women of other ethnicities (2.5). Among the regions of Uzbekistan, the TFR is lowest in Tashkent City (2.3 children per woman). Time Trends. The UDHS data show that fertility has declined in Uzbekistan in recent years. For example, fertility among 25-29 year-olds has fallen by one-third over the past 20 years. The declining trend in fertility can be seen by comparing the completed family size of women near the end of their childbearing years with the current TFR. Completed family size among women 45-49 is 4.6 children which is one child more than the current TFR (3.3), Birth Intervals. Overall, one-third of nonfirst births (30 percent) in Uzbekistan take place within 24 months of the previous birth. The median birth interval is 2.5 years. Age at Onset of Childbearing. The median age at which women in Uzbekistan begin childbearing has been holding steady at about 21.5. Most women have their first birth while in their early twenties, although about one-quarter of women give birth before age 20. One-half of married women in Uzbekistan (51 percent) do not want to have more children, and a large majority of women (75 percent) want either to delay their next birth by at least two years (24 percent) or to stop childbearing altogether. These are the women who are potentially in need of some method of family planning. xix FAMILY PLANNING Knowledge. Knowledge of contraceptive methods is high among women in Uzbekistan. Knowledge of at least one method is 89 percent. High levels of knowledge are the norm for women of all ages, all regions of the country, all educational levels, and all ethnicities. However, knowledge of sterilization was low; only 27 percent of women reported knowing of this method. Ever Use. Among currently married women, 68 percent report having used a method of contraception at some time. The women most likely to have ever used a method of contraception are those age 30 and above, Current Use. Overall, among currently married women, 56 percent report that they are currently using a contraceptive method. More than half(51 percent) are using a modem method of contraception and another 4 percent are using a traditional method. The IUD is by far the most commonly used method; almost half of currently married women (46 percent) are using the IUD. Other modern methods of contraception account for only a small amount of use among currently married women: pills and condoms (2 percent each), and injectables and female sterilization ( I percent each). Thus, the practice of family planning in Uzbekistan places high reliance on a single mcthod, the IUD, although the pill, condom and injectables are widely known. Source of Methods. The vast majority of women obtain their contraceptives through the public sector (98 percent): 55 percent from a government hospital, and 18 percent from a women's consulting center. The source of supply of the method depends on the method being used. For example, most women using IUDs obtain them at hospitals (58 percent) or women's consulting centers (19 percent). Government pharmacies supply 26 percent of pill users and 90 percent of condom users. Pill users also obtain supplies from women's consulting centers or polyclinics (24 percent). Private sector provision of contraceptives is a relatively new phenomenon in Uzbekistan. The survey found that private pharmacies accounted for only 3 percent of pill supplies. However, the private sector is expected to become increasingly important. Fertility Preferences. A majority of women in Uzbekistan (51 percent) indicated that they desire no more children. Among women age 30 and above, the proportion that want no more children increases to 75 percent. Thus, many women come to the preference to stop childbearing at relatively young ages when they have 20 or more potential years of childbearing ahead of them. For some of these women, the most appropriate method of contraception may be a long-acting method such as female sterilization, However, there is a deficiency of both knowledge and use of this method in Uzbekistan. In the interest of providing couples with a broad choice of safe and effective methods, information about this method and access to it should be made available so that informed choices about its suitability can be made by individual women and couples. INDUCED ABORTION Abortion Rates. From the UDHS data, the total abortion rate (TAR)--the number of abortions a woman will have in her lifetime based on the currently prevailing abortion rates--was calculated. For Uzbekistan, the TAR for the period from mid-1993 to mid-1996 is 0.7 abortions per woman. As expected, the TAR for Uzbekistan is substantially lower than recent estimates of the TAR for other areas of the former Soviet Union such as Kazakstan (1.8), Romania (3.4 abortions per woman), and Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively). The TAR is higher in urban areas (1.0 abortions per woman) than in rural areas (0.5). The TAR in Tashkent City is 1.3 which is two to three times higher than in other regions of Uzbekistan. Additionally the TAR is substantially lower among ethnic Uzbek women (0.5) than among women of other ethnicities (1.0). XX Time Treads, During the recent five-year period, the abortion rate in Uzbekistan has declined by 31 percent according to the UDHS data and by 43 percent according to the Ministry of Health data. Thus, the recourse to the practice of abortion is declining in Uzbekistan. INFANT MORTALITY In the UDHS, infant mortality data were collected based on the international definition of a live birth which, irrespective of the duration of pregnancy, is a birth that breathes or shows any sign of life (United Nations, 1992). Mortality Rates. For the five-year period before the survey (i.e., approximately mid- 1992 to mid- 1996), infant mortality in Uzbekistan is estimated at 49 infant deaths per 1,000 births. The estimates of neonatal and postneonatal mortality are 23 and 26 per 1,000. The MOH publishes infant mortality rates annually but the definition of a live birth used by the MOH differs from that used in the survey. As is the case in most of the republics of the former Soviet Union, a pregnancy that terminates at less than 28 weeks of gestation is considered premature and is classified as a late miscarriage even if signs of life are present at the time of delivery. Thus, some events classified as late miscarriages in the MOH system would be classified as live births and infant deaths according to the definitions used in the UDHS. Time Trends. Over the period from 1986 to 1995, the MOH has reported a steady declining trend in the annual infant mortality rate from 46.3 to 26.0 per 1,000. The average of the annual rates for the 10- year period is 37 per 1,000. This corresponds to the UDHS rate for the same time period of 44 per 1,000. Thus, the rates of infant mortality based on MOH data are lower than the estimates derived from the survey by 16 percent, no doubt due in some part to definitional differences, MATERNAL AND CHILD HEALTH Uzbekistan has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. This system includes special delivery hospitals, the obstetrics and gynecology departments of general hospitals, women's consulting centers, and doctor's assistant/midwife posts (FAPs). There is an extensive network of FAPs throughout rural areas. Delivery. Virtually all births in Uzbekistan (94 percent) are delivered at health facilities: 94 percent in delivery hospitals and less than 1 percent in either general hospitals or FAPs. Only 6 percent of births are delivered at home. Almost all births (98 percent) are delivered under the supervision of medically trained persons: 94 percent by a doctor and 4 percent by a nurse or midwife. Antenatal Care. As expected, the survey data indicate that a high proportion of respondents (95 percent) receive antenatal care from professional health providers: the majority from a doctor (85 percent) and a significant proportion from a nurse or midwife (10 percent). The general pattern in Uzbekistan is that women seek antenatal care early and continue to receive care throughout their pregnancies. The median number of antenatal care visits reported by respondents is 8. Immunization. Information on vaccination coverage was collected in the UDHS for all children under three years of age. In Uzbekistan, child health cards are maintained in the local health care facilities or day care centers rather than in the homes of respondents. The vaccination data were obtained from the health cards in the health facilities or day care centers. In Uzbekistan, the percentage of children 12-23 months of age who have received all World Health Organization (WHO) recommended vaccinations is high (85 percent). BCG vaccination is usually given in delivery hospitals and was nearly universal (98 percent). Almost all children (100 percent) have received xxi the first doses of polio and DPT/DT. Coverage for the second doses of polio and DPT/DT is also nearly universal (98 percent). The third doses of polio and DPT/DT have been received by more than 94 percent of children. This represents a dropout rate of only 3 and 5 percent for the polio and DPT/DT vaccinations, respectively. A high proportion of children (92 percent) have received the measles vaccine. NUTRITION Breastfeeding. Breastfeeding is almost universal in Uzbekistan; 96 percent of children born in the three years preceding the survey are breastfed. Overall, 19 percent of children are breastfed within an hour of delivery and 40 percent within 24 hours of delivery. The median duration of breastfeeding is lengthy (17 months). However, durations of exclusive breastfeeding, as recommended by WHO, are short (0.4 months). Supplementary feeding. Supplementary feeding starts early in Uzbekistan. At age 0-3 months, a significant proportion of breastfeeding children are given infant formula (12 percent) and powdered or evaporated milk (23 percent). By 4-7 months of age, 19 percent of breastfeeding children are given foods high in protein (meat, poultry, fish, and eggs) and 35 percent are given fruits or vegetables, Nutritional Status. In the UDHS, the height and weight of children under three years of age were measured. These data are used to determine the proportion of children who are stunted (short for their age, a condition which may reflect chronic undernutrition) and the proportion who are wasted (underweight according to their height, a condition which may reflect an acute episode of undernntrition resulting from a recent illness). In a well-nourished population of children, it is expected that about 2.3 percent of children will be measured as moderately or severely stunted or wasted. For all of Uzbekistan, the survey found that 3 l percent of children are severely or moderately stunted and 12 percent are severely or moderately wasted. PREVALENCE OF ANEMIA Testing of women and children for anemia was one of the major efforts of the 1996 UDHS. Anemia has been considered a major public health problem in Uzbekistan for decades. Nevertheless, this was the first anemia study in Uzbekistan done on a national basis. The study involved hemoglobin (Hb) testing for anemia using the Hemocue system. Women. Sixty percent of the women in Uzbekistan suffer from some degree of anemia. The great majority of these women have either mild (45 percent) or moderate anemia (14 percent). One percent have severe anemia. Children. Sixty-one percent of children under the age of three suffer from some degree of anemia. Twenty-six percent have moderate anemia. One percent of children are severely anemic. More than half of the children (53 percent) living in region, which includes Karakalpakstan, are diagnosed as having moderate or severe anemia. In Tashkent City, the prevalence of moderate anemia among children is relatively low (7 percent), while no cases of severe anemia are diagnosed. A certain relationship was observed between the prevalence of anemia among mothers and their children. Among children of mothers with moderate anemia, 3 percent have severe anemia and 38 percent have moderate anemia. The prevalence of moderate anemia among these children is more than twice as high as among children of non-anemic mothers. xxii Republic of Karakalpakstan Aral Sea / Khorezmskaya Oblast / Bukharskaya ~I'~ Oblast Navoiiskaya Oblast J j/ Kashkadaryinskaya Oblast Aidarkul / J UZBEKISTAN Tashkentskaya Oblast \\ \\ TASHKENT ~ cITY \ Namanganskaya Oblast Z Andizhanskaya ~ yrdaryinskaya ~) Oblast akskaya Oblast Samarkandskayaoblast N~.~'¢~'~ Ferganskaya Oblast \\ Surkhandaryinskaya Oblast AFGHANISTAN CHAPTER 1 INTRODUCTION Shavkat L Karimov 1.1 Geography and Population Located in the middle of Central Asia between the two major rivers of Amudarya and Syrdarya, the Republic of Uzbekistan is a region with favorable climatic and geographical conditions. The territory of Uzbekistan is 447,400 square kilometers. The country borders Kazakstan to the north, Kyrgyzstan and Tajikistan to the south and east, Afghanistan to the south, and Turkmenistan to the west. Uzbekistan's landscape is a unique combination of plains and mountains. The western part of Uzbekistan consists of plains, Kizilkum deserts and lowland areas, such as Fergana Valley, Tashkent and the Hunger Steppe, and the Sanzaro-Nuratin, Samarkand, Kashkadarya and Surkhandarya lowlands. The mountains in Uzbekistan, which are branches of the West Tien-Shan and Gissaro-Alay ranges, cover about one-third of the country's territory and are located mainly in the south and southeast of Uzbekistan. Uzbekistan consists of 12 administrative regions (oblasts) and the Autonomous Republic of Karakalpakstan. Each region is further broken down into administrative areas called raions. There are 157 raions in Uzbekistan. With a population of 22.5 million, Uzbekistan is the third most populous country in the former Soviet Union after Russia and the Ukraine. Approximately 61 percent of the population resides in rural areas. The country is characterized by a high rate of population growth which is mainly due to the high birth rate (29.4 per 1,000 population) and relatively low death rate (6.6 per 1,000 population) (Goskomprognozstat, 1995). With an average annual population growth rate in excess of 2.5 percent, the population in Uzbekistan has increased by 12 million during the last three decades (Akhmedov, 1993). As a result of high fertility and population growth rates, Uzbekistan has a young population: 41 percent of the population are children under 15 years of age, while the population over 65 years of age is relatively small at less than 5 percent (Ministry of Health, 1995). The population density of Uzbekistan is 47 persons per square kilometer. However, the population is unevenly distributed among the different regions. The population is mainly concentrated in the grasslands and in the industrialized urban areas. Five oblasts of Uzbekistan have population densities of more than 150 per square kilometer, while in areas such as Karakalpakstan and Navoi oblast, which consist mainly of deserts, the population density is very low at 8 and 6 per square kilometer, respectively (Akhmedov, 1993). The most industrially developed region of Uzbekistan, Tashkent oblast, has a population density of 278 per square kilometer. The capital of Uzbekistan, Tashkent City, with a population of more than 2 million, is the largest city in Central Asia. Uzbekistan is a multinational country. According to the 1989 Population Census, people of more than 130 nationalities live in Uzbekistan. The majority of the population are Uzbeks, constituting more than 71 percent of the population. Other significant ethnic groups are Russians, Tajik, Kazaks and Tatars (Akhmedov, 1993). The Uzbek culture is influenced by the religion of Islam, and the language belongs to the Turkik group of languages. Family ties are strong, especially among Uzbeks living in rural areas, and this plays an important role in the formation of their values, attitudes, behavior, and goals. 1.2 History of Uzbekistan People who lived in the territory of Uzbekistan in ancient times were mainly nomadic and involved in primitive agriculture and cattle breeding. Nevertheless, as early as the fifth and sixth centuries B.C., centralized states were established throughout the territory of Uzbekistan: Baktria (Southern Uzbekistan), Khorezm (Aral Sea Region), and Sogd (Zaravshan Valley and Kashkadarya Region). During that time, the large cities of Samarkand, Kyuzelgir and Kalagyr were built. During the sixth century, the territory of Uzbekistan was conquered by Turkik tribes who introduced their language and culture. Arab invasions in the seventh and eighth centuries brought Islam, which unified many settled and seminomadic Turkik speaking tribes of Fergana Valley, Tashkent and Khorezm Regions and completed the formation of the Uzbek nation. The period between the ninth and 13th centuries is characterized as the epoch of renaissance in Uzbekistan. Trade, craftsmanship, construction, science and poetry became well developed. In the beginning of the 13th century, Central Asia was invaded by Genghis Khan who initially destroyed the cities and then established his ruling dynasty which dominated Central Asia for several centuries. In 1370, Talnerlan (Timur), one of the Genghis Khan's descendants (Genghizid), came to power. He created an empire which became one of the most powerful forces in Asia. It extended from tbe Middle East to India and from Caucasus to Russia. Despite being brutal, Tamerlan promoted fine art and architecture. Such masterpieces of Uzbek architecture as Gur-Emir, Shaki-Zinda, and Biby-Khanym in the capital city of Samarkand were built during Tamerlau's reign. Tamerlan established Timurids dynasty which successfully ruled in many regions of Central Asia even after the collapse of his empire. One of tbe Timurids, Emir Ulugbek, became famous as a scientist-astronomist. He shaped the borders of his state, which eventually became the borders of Uzbekistan. After the collapse of the Timurids dynasty in the 18th century, three states were established in the territory of Uzbekistan: Bukhara Emirate, Kokand Khanate and Khiva Khanate. In the second half of the 19th century, the Russian Empire established a protectorate over Khiva Khanate and Bukhara Emirate and incorporated Kokand Khanate as part of its Turkestan regional administrative unit. The Russian conquest played a positive role in cultural and economic development by breaking the region's economic isolation and introducing industries, technology and advanced culture. Tile First Russian Revolution in 1905-1907 had a tremendous political impact in the Turkestan Region initiating a nationalistic movement which later became a major force against Russian Tzarism in the area. After the 1917 Bolshevik Revolution, several autonomous states were established in Central Asia. In 1924, the Soviet Government granted Uzbekistan the status of Soviet Socialist Republic incorporating the Republic to the Soviet Union. This event became a landmark in the economic and social reconstruction of Uzbekistan and led to industrial development, eradication of illiteracy, the granting of women's rights, and the introduction of a Western health care system. The system of compulsory secondary education was introduced during the Soviet era and this created a skilled labor force wbich became the keystone of the Republic's development. During World War II, many industries were evacuated from Russia and other European parts of the former Soviet Union and brought to Uzbekistan. These industries became the principal basis for the postwar economic development of Uzbekistan. As a Soviet republic, Uzbekistan for many years relied on a planned economic system, which was tiglttly controlled, but on the other hand, generously supported by the central Soviet Government. With the collapse of the former Soviet Union in 1991, Uzbekistan was granted independence and became a sovereign republic. The country opened its doors to the world community and became a member of the United Nations as well as other international organizations. Under transition from a centrally planned economy to a market economy, Uzbekistan is now experiencing rapid social and economic changes. The process to date has produced disruption in most sectors of the economy, causing economic decline, inflation, and instability of the new national currency. In order to stabilize the economy, the Government of Uzbekistan has taken a number of steps to restructure the economy by attracting foreign investments and rebuilding economic relations with the other former Soviet republics. 1.3 Economy Uzbekistan is self-sufficient in terms of agricultural production. However, during the Soviet era, cotton production became the number one priority in order to meet the strategic objectives of the former Soviet Government. In some areas of Uzbekistan, this policy required that 85-90 percent of the arable land be devoted to cotton production (Akhmedov, 1993). This has had a tremendously negative impact on the other sectors of agriculture. Currently, the Government of Uzbekistan is reconsidering this policy and is promoting the development of livestock farming, production of crops, grapes, melons, silkworm breeding, etc. Uzbekistan is rich in mineral resources, such as copper, gold, lead, zinc, and bauxite. The country also has substantial energy resources, such as oil and gas. During the last two decades, Uzbekistan developed national industries in copper, machinery, chemical fertilizers, and construction ofoil, gas and hydroelectric plants. Under the new economic policy of attracting foreign investments, several joint enterprises with Korean, Italian, Turkish, American and other firms have been established during the last few years. 1.4 Health Care System The health care system in Uzbekistan was developed as part of the Soviet-planned system and was intended to provide adequate access to health services to all citizens and to maintain a focus on prevention. With these goals, a nationwide network of over 6,000 primary, secondary and tertiary health care facilities was created under the auspices of the Ministry of Health. The health care system in Uzbekistan is state- owned and almost all health personnel, of which more than 70,000 are physicians and 240,000 are mid-level professionals, are government employees (Ministry of Health, 1995). Throughout all regions of Uzbekistan, health services, including antenatal care, delivery assistance, neonatal care, pediatric services, immunizations, family planning, outpatient services and specialized health care, are provided free of charge. Primary health care in Uzbekistan is provided in such institutions as polyclinics, outpatient clinics (ambulatories), doctor's assistant/midwife posts (FAPs), primary health facilities at large enterprises, women's consulting centers (which are a primary source of family planning services in urban areas) and delivery hospitals. The main focus of the health services in these institutions is disease prevention (for example, immunization against infectious diseases), and providing antenatal care services, delivery assistance and family planning services. On the secondary level, health services are provided by specialized dispensaries, departments of polyclinics and hospitals in which screening programs are carried out to identify individuals with early manifestations of disease and to prevent disease progression. Tertiary health services in Uzbekistan are provided within the departments of regional, municipal and district general hospitals, specialized hospitals and dispensaries, and clinical research institutes. The clinical treatment offered at these facilities is aimed at minimizing the effect of disease and disability. Maternal and child health services in Uzbekistan are mostly provided through primary health care institutions. Almost all deliveries occur at the delivery hospitals and, in rare cases, at regular hospitals or, in rural areas, FAPs. Antenatal care is provided mainly by doctors at the women's consulting centers (parts of urban polyclinics), rural hospitals and rural ambulatories, or by the doctors' assistants at the FAPs. Antenatal care starts early in pregnancy (usually during the first trimester of pregnancy) and continues on a monthly basis throughout the pregnancy. One of the procedures that is used during antenatal care is to identify early complications of pregnancy and extragenital diseases. Pregnant women who have developed such conditions usually receive special attention from health personnel and may be treated further and hospitalized at the institutions of the secondary and tertiary levels. In certain cases, a woman is encouraged to postpone her next pregnancy by using contraception. The Ministry of Health of Uzbekistan promotes greater access of women to various methods of contraception, providing a better chance for safe motherhood. Sometimes when pregnancy complications or extragenital diseases are severe and threaten the outcome of pregnancy, a woman may be counseled by a doctor to terminate her pregnancy. After pregnancy termination, women are offered special rehabilitation courses to ensure that the next pregnancy will be safe. Child health services in Uzbekistan include neonatal care, which is usually provided within the first week after delivery while a woman and her newborn stay in the delivery hospital, and other pediatric services at older ages. After discharge from the delivery hospital, a child is visited by a patronage nurse who provides the mother with general counseling on child care and carries out a physical examination of the child. Pediatric services are mainly provided by the institutions of primary health care. A mother is required to bring her child in for a regular checkup and vaccination at the polyclinic or outpatient clinic several times during the first two years of life. A doctor in the polyclinic can refer the child to a specialized pediatrician in case the child develops disease or other conditions that require special care or hospitalization. The child vaccination schedule in Uzbekistan requires that BCG and oral polio vaccines are given in the delivery hospital during the first 3-4 days of life. Revaccinations with oral polio vaccine are usually done at 2, 3, 4, 16, and 18 months and 6-7 years of the child's life. The vaccination schedule for diphtheria, pertussis and tetanus toxoid (DPT or DT) is similar to the schedule for the polio vaccination, except that the first DPT vaccine is given at the age of 2 months. Measles vaccinations are given at 9 and 16 months of age (Ministry of Healtb, 1993). The vaccination schedule is controlled throughout childhood by several mechanisms. During the first two years of life, the patronage nurse is responsible for maintaining vaccination records and ensuring that the child receives vaccinations at the appropriate time. After that period, the vaccination schedule may still be under the control of the pediatric department staff of polyclinics or the records can be transferred to a day care center if the child attends one. In the latter case, vaccination is coordinated by the day care nurse. Finally, when the child starts to attend primary school at the age of seven, the school nurse becomes responsible for the child's vaccinations. The system of maternal and child health care has proven efficient and successful in providing adequate services for the majority of the population of Uzbekistan, including those wbo reside in rural and remote areas. However, maintaining such a system requires substantial and continuous budgetary support and enormous resonrces of manpower and managerial skill. The challenge for the Uzbekistan Government is to reform the health system in such a way that it will be both financially viable and provide comprehensive service to the population. This can be 4 accomplished by preserving and improving the existing primary health care system, promoting new mechanisms of healthcare financing and focusing on emerging health issues. The Ministry of Health has developed the top priorities of health care reform, which can be outlined as follows: reorganize the network of public health institutions and the distribution of health manpower in order to provide better control, management and quality of health services on each level of health care; focus on maternal and child health by integrating forces of health institutions, public and community based services, religious organizations, and attracting state legislative and executive power to protect and strengthen the health of mothers and children; reform the health care financing system by using a long-term approach with the focus on individual community members instead of a curative approach which is oriented to cover hospital bed spending; focus on disease prevention and promote outpatient medical services by introducing new efficient forms of preventive and curative medicine, such as day hospitals, home medical care, centers of outpatient surgery, specialized health complexes providing ambulatory treatment, and community health centers; and make the best use of local, regional, and national resources, and potential community-based services; optimize the distribution and relative size of health facilities in terms of their capacity and optimal staffing requirements and reduce the number of hospital beds; improve the quality of health services in rural areas, and provide adequate access for people living in rural areas to the primary, secondary and tertiary levels of health services; reform the medical education system by optimizing the medical training curricula with a focus on training general practitioners; and reconsider the capacity of the national medical training system to train only the required number of health professionals; develop the national pharmaceutical and medical industry to meet the country's requirements in supply of medicine and medical equipment; promote research and development in the area of medicine and medical technology; attract foreign investments and resources of other sectors of the medical industry; assign top priority to efforts to identify the most frequent and serious conditions affecting the health of community members; develop and implement programs addressing socioeconomic, environmental and other causes of these conditions; develop vertical programs to prevent tuberculosis, cancer, viral hepatitis, HIV infection, drug abuse, sexually transmitted diseases, etc.', develop and introduce new forms and principles of health care financing and management based on fee-for-services, market orientation and private competition. 1.5 Family Planning Policies and Programs For many years, the Government of Uzbekistan promoted policies to encourage women to have more children. Women in Uzbekistan who, in the past, had seven or more children were traditionally glorified and recognized as "mother-heroes" and were provided with a number of benefits, including bonuses, housing assistance, extensive paid maternity leave, child benefits, support for day care, etc. The Ministry of Health has revised this pronatalist policy and is now promoting family planning services to improve reproductive health. The Ministry of Health is responsible for providing family planning services throughout the country. The main goal of the family planning policy is to ensure low risk pregnancy and safe motherhood, to reduce complications due to inadequately spaced pregnancies and to reduce the incidence and prevalence of pregnancy complications and extragenital diseases among women of reproductive age. The Ministry of Health manages a broad spectrum of activities including intensive family planning education of the population and supplying contraceptives throughout the country. The private sector is also involved in marketing contraceptives. While promoting awareness of family planning and access of women to a variety of contraceptives, the Ministry also is concerned with the quality, safety and effectiveness of contraceptive methods. In order to control family planning services, the Ministry of Health considers them as part of maternal and child health care and requires that adequate counseling on the selection and use of contraceptive methods be done by health professionals with skills in obstetrics and gynecology. In Uzbekistan, one of the primary methods of birth control is induced abortion which is usually done at the outpatient departments of general hospitals or at delivery hospitals. Induced abortion is legal in Uzbekistan if done during the first 12 weeks &pregnancy. In some cases induced abortion can be performed after 12 weeks if certain medical or social conditions exist. These cases require strong supervision of qualified medical personnel in a hospital setting (Ministry of Health, 1996). Abortion can be done free of charge, but lately fee-for-services facilities became available to perform mini-abortions by the vacuum aspiration technique. Despite some indications that the number of induced abortions has declined in recent years, the abortion issue remains a great public health concern in Uzbekistan due to the prevalence of complications and the overall adverse effects on women's health. Due to the policy of promoting use of safe methods of family planning, a strong trend of substituting contraception for abortion has been observed in Uzbekistan during the last several years. Among the most popular methods of contraception is the intrauterine device. Traditionally, many women continue to rely on the intrauterine device as a convenient and safe method. For many years oral contraceptives were much less available in Uzbekistan because of a document, On the side effects and complications of oral contraceptives, published by the Ministry of Health of the former Soviet Union in 1974 which practically banned the distribution and use of oral contraceptives (United Nations, 1995). Women in Uzbekistan now have broad access to a variety of methods of contraception including oral contraceptives, injectables, etc. They are distributed centrally through government pharmacies and women's consulting centers and privately via private pharmacies. Decreasing maternal mortality from a rate of 65 per 100,000 live births in 1991 to 39 in 1994 in part resulted from improved access of women to family planning services in Uzbekistan (Ministry of Health, 1995). In order to support this trend an International Charity Fund "Soglom Avlod Uchum" (For a Healthy Generation) has been established in Uzbekistan. The fund will coordinate naultidisciplinary and international efforts to protect and improve the health of the mothers and children of Uzbekistan. 1.6 Demographic and Health Data Collection System in Uzbekistan The demographic and health data collection system in Uzbekistan is based on the registration of events and periodic censuses. The data on births, deaths, marriages, and divorces are registered at the local administrative level of an internal passport control system. These data are then forwarded to the State Committee on Statistics and Analysis ("Goskomprognozstat") through the ralph and oblast level statistical offices. Goskomprognozstat is responsible for conducting censuses and maintaining this registration system. The last census in Uzbekistan was conducted in 1989, and the census results were published in 1990 (Goskomprognozstat, 1990). In addition, Goskomprognozstat is responsible for tabulating and publishing an annual report of demographic data generated by the registration system. Collection of health data is a primary responsibility of the Statistical Department of the Ministry of Health. Health information is generated by staff at the facilities delivering services and then sent to the Statistical Department through the raion and oblast level health departments. The Statistical Department of the Ministry of Health compiles and analyzes these data and issues annual reports entitled Health of the Population of the Republic of Uzbekistan and Health Services. The health data collected and published by the Statistical Department consist of the following major categories: 1) morbidity specified by type of disease (infectious and non-infectious); 2) mortality specified by causes of death; 3) infant deaths, including data on antenatal, perinatal, and early neonatal deaths; 4) maternal mortality specified by causes of maternal death; 5) data on maternal and child health, including antenatal care and delivery assistance, contraceptive clients, induced abortion rates, pediatric services, etc; 6) number of health facilities, medical personnel, hospital beds, and length of average stay in the hospital; and 7) health data specified by type of medical services including medical care for patients with cancer, tuberculosis, mental disorders, drug abuse, and sexually transmitted diseases. These data are usually tabulated at the national and oblast levels, and for some categories, by the age groups 0-14 and 15 or more years. 1.7 Objectives and Organization of the Survey The purpose of the 1996 Uzbekistan Demographic and Health Survey (UDHS) was to provide an information base to the Ministry of Health for the planning of policies and programs regarding the health of women and their children. The UDHS collected data on women's reproductive histories, knowledge and use of contraception, breastfeeding practices, and the nutrition, vaccination coverage, and episodes of illness among children under the age of three. The survey also included, for all women of reproductive age and for children under the age of three, the measurement of the hemoglobin level in the blood to assess the prevalence of anemia and measurements of height and weight to assess nutritional status. A secondary objective of the survey was to enhance the capabilities of institutions in Uzbekistan to collect, process and analyze population and health data so as to facilitate the implementation of future surveys of this type. The 1996 UDHS was the first national-level population and health survey in Uzbekistan. It was implemented by the Research Institute of Obstetrics and Gynecology of the Ministry of Health of Uzbekistan. The 1996 UDHS was funded by the United States Agency for International development (USAID) and technical assistance was provided by Macro International Inc. (Calverton, Maryland USA) through its contract with USAID. 1.7.1 Sample Design and Implementation The UDHS employed a nationally representative probability sample of women aged 15 to 49, representative of 98.7 percent of the country. Seven raions were excluded from the survey because they were considered too remote and sparsely inhabited. These raions are: Kungradskiyi, Muyinakskiyi, and Takhtakupyrskiyi in Karakalpakstan; Uchkudukskiyi, Tamdynskiyi, and Kanimekhskiyi in Navoiiskaya; and Romitanskiyi in Bukharaksya oblast. The remainder of the country was divided into five survey regions (Figure 1.1). Tashkent City constituted a survey region by itself while the remaining four survey regions consisted of groups of contiguous oblasts. The five survey regions were defined as follows: Figure 1.1 OBLAST COMPOSITION OF REGIONS IN UZBEKISTAN, 1996 AFGHANISTAN "! ) -~ %" su~,ey = AFGHANINTAN Survey TASHKENT CITY ~ k . S i J r v S y TASHKENT egron <: Region 2 ct~ ~ >N> I (3 ~° AFGHANISTAN SURVEY REGION 1 4- ~-~'h %~" S0~ey Survey TA,T~K~NT Region 4 Region 2 ~ / i AFGHANISTAN SURVEY REGION 2 Region 2 Survey z AFGHANISTAN SURVEY REGION 4 SURVEY REGION 3 CITY OF TASHKENT SURVEY REGION 1 Republic of Karakalpakstan and Khorezmskaya Oblast SURVEY REGION 2 Navoiiskaya, Bukharskaya, SURVEY REGION 3 Samarkandskaya, Dzhizakskaya, Syrdaryinskaya, and Tashkentskaya Oblast SURVEY REGION 4 Namanganskaya, Ferganskaya, and Andizhanskaya Oblast Kashkadaryinskaya, and Surkhandaryinskaya Oblast 8 Survey Region 1: Survey Region 2: Survey Region 3: Survey Region 4: Survey Region 5: Karakalpakstan and Khorezmskaya oblast. Navoiiskaya, Bukharskaya, Kashkadaryinskaya, and Surkhandaryinskaya oblasts. Samarkandskaya, Dzhizakskaya, Syrdaryinskaya, and Tashkentskaya oblasts. Namanganskaya, Ferganskaya, and Andizhanskaya oblasts. Tashkent City. In the rural areas, the primary sampling units (PSUs) were the raions which were selected with probability proportional to size, the size being the population size as published by Gozkomprognozstat in 1994. At the second stage, one village was selected in each selected raion. This resulted in 64 rural sample clusters. A complete listing of households in the selected clusters was carried out. The lists of households served as the frame for third-stage sampling; i.e., the selection of the households to be visited by the UDHS interviewing teams. In each selected household, women age 15-49 were eligible to be interviewed. In the urban areas, the PSUs were the cities and towns thelnselves. In the second stage, one health block was selected from each town except in self-representing cities (large cities that were selected with certainty), where more than one health block was selected. In total, 104 urban health blocks were selected. The selected health blocks were segmented prior to the household listing operation which provided the household lists for the third stage selection of households. On average, 21 households were selected in each urban cluster, and 27 households in each rural cluster. It was expected that the sample would yield interviews with approximately 4,000 women between the ages of 15 and 49. Because of the non-proportional distribution of the sample to the different survey regions, sampling weights have been applied to the data in this report. Details of the UDHS sample design are given in Appendix A and the estimation of sampling errors for selected variables is given in Appendix B. 1.7.2 Questionnaires Two questionnaires were used for the UDHS: the Household Questionnaire and the Individual Questionnaire. The questionuaires were based on the model survey instruments developed in the DHS program. The questionnaires were adapted to the data needs of Uzbekistan during consultations with specialists in the areas of reproductive health and child health in Uzbekistan. Both questionnaires were developed in English and then translated into Russian and Uzbek. A pretest was conducted in March-April 1996. Based on the pretest experience, the questionnaires were further modified. The Household Questionnaire was used to enumerate all usual members and visitors in a sample household and to collect information relating to the characteristics of the dwelling unit. In the first part of the Household Questionnaire, information was collected on age, sex, educational attainment, and relationship to the head of household of each person listed as a household member or visitor. The primary objective of collecting this information was to identify women who were eligible for the individual interview. In the second part of the Household Questionnaire, questions were included on the dwelling unit, such as number of rooms, flooring material, source of water, type of toilet facilities, and on the availability of a variety of consumer goods. The Individual Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following major topics: • Background characteristics Pregnancy history Pregnancy outcome and antenatal care Child health and nutrition practices Child immunization and episodes of diarrhea and respiratory illness Knowledge and use of contraception Marriage and fertility preferences Husband's background and woman's work experience Maternal and child anthropometry Hemoglobin measurement of women and children One of the major efforts of the UDHS was testing women and children for anemia. Testing was done by measuring hemoglobin levels in the blood, using a portable machine called a Hemocue. Before collecting the blood sample, women were asked to sign a consent form, giving permission for the collection of a blood droplet from herself and her children. Results of anemia testing were kept confidential (as are all UDHS data); however, strictly with the consent of respondents, local health care facilities were informed of women who had severely low levels of hemoglobin (less than 7 g/dl). 1.7.3 Training and Fieldwork The UDHS qnestionnaires were pretested in March-April 1996. Eight interviewers were trained over a two-week period at the Institute of Obstetrics and Gynecology. The pretest included one week of interviewing in an urban area (Tashkent City) and one week in a rural area. A total of 120 women were interviewed. Pretest interviewers were retained to serve as supervisors and field editors for the main survey. Staff members of the Institute of Obstetrics and Gynecology and female nursing students of the National Medical College were recruited as field supervisors, editors, interviewers and medical technicians for the main survey. A total of 50 people were trained for three weeks during June 1996. Training consisted of in-class lectures and practice, as well as conducting practice interviewing in the field. Interviewers were selected based on their performance during the training period. The UDHS data collection was carried out by five teams. Each team consisted of eight members: the team supervisor, one editor, one household interviewer, four individual women interviewers, and one medical technician (responsible for height and weight measurement and anemia testing). All interviewers were female, while most of the supervisors and technicians were males. All five interviewing teams began work in Region 5 (Tashkent City) on June 24. After three weeks of interviewing in Tashkent City, four survey teams were assigned to the remaining survey regions and fieldwork started in Regions I through 4 on July 14. One team continued data collection in Tashkent City. Data collection was completed on October 12, 1996. 1.7.4 Data Processing Questionnaires were returned to the Institute of Obstetrics and Gynecology in Tashkent for data processing. The office editing staff checked that questionnaires for all selected households and eligible respondents were returned from the field. The few questions which had not been precoded (e.g., occupation, type of chronic disease) were coded at this time. Data were then entered and edited on microcomputers using the ISSA (Integrated System for Survey Analysis) package, with the data entry software translated into Russian. Office editing and data entry activities began on August 5, and were completed on October 31, 1996. 10 1.7.5 Response Rates Table 1.1 presents information on the coverage of the UDHS sample including household and individual response rates. A total of 3,945 households were selected in the sample, of which 3,763 were occupied at the time of conducting fieldwork. The main reason for the difference was that some dwelling units which were occupied at the time of the household listing operation were either vacant or members of the household were away for an extended period at the time of interviewing. Of the 3,763 occupied households, 3,703 were interviewed, yielding a household response rate of 98 percent. In the interviewed households, 4,544 women were eligible for the individual interview (i.e., all women 15-49 years of age who were either usual residents or visitors who had spent the previous night in the household). Interviews were completed with 4,415 of these women, yielding a response rate of 97 percent. The principal reason for nonresponse was a failure to find an eligible woman at home after repeated visits to the household. The overall response rate for the survey, the product of the household and the individual response rates, was 96 percent. Table I.I Results of the household and individual interviews Number of households, number of interviews and response rates, Uzbekistan 1996 Residence Result Urban Rural Total Household interviews Households sampled 2,228 1,717 3,945 Households found 2,099 1,664 3,763 Households interviewed 2,062 1,641 3,703 Household response rate 98.2 98.6 98.4 Individual interviews Number of eligible women 2,388 Number of eligible women interviewed 2,306 Eligible woman response rate 96.6 2,156 4,544 2,109 4,415 97.8 97.2 11 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Damin A. Asadov and Mila A. Li Data pertaining to the background characteristics of household members and respondents to the Woman's Questionnaire are presented in this chapter. Since demographic and health parameters are influenced by sociobiological factors, this information is important in interpreting results. Moreover, data on characteristics of households and respondents can serve as an indicator of the representativeness of the sample and of the quality of the data obtained. This chapter includes three sections: characteristics of the household population (household structure, age-sex characteristics and level of education of the household members); housing characteristics (presence of electricity, source of drinking water, sanitation, etc.) and background characteristics of respondents to the Woman's Questionnaire (residence, age, ethnicity, marital status, occupation, etc.). 2.1 Household Population The UDHS Household Questionnaire collected data on the sociodemographic characteristics of the members and visitors in each sampled household. A household was defined as a person or group of persons usually living and eating together and jointly running the household's economy (de jure population). Visitors were persons who were not household members but had spent the night before the interview in a sampled household. All female household members and visitors 15-49 years of age were eligible as respondents for the individual interview. The total de facto population in the selected households was 19,028 people. 2.1.1 Sex and Age Composition Table 2.1 presents the distribution of the de facto household population by five-year age groups according to sex and residence. Almost one-third of the population consists of children under 14 years of age (38 percent), with the proportion of children in rural areas being higher than in urban areas (41 and 34 percent, respectively). Starting from age group 10-14, there is a gradual decrease in the proportion of the population in subsequent age groups. In urban areas, the number of women exceeds the number of men, while in rural areas the opposite is true--the number of men exceeds the number of women. Almost 50 percent of the de facto household population are women 15-49 years of age who are the main UDHS respondents. As seen in Figure 2.1, the age-sex structure of the Uzbekistan population has the form of a pyramid with a wide base, gradually tapering to a sharp peak. The relatively small size of the male and female population in the age interval 50-54 is a reflection of the low birth rates during World War II (i.e., 50 to 55 years prior to the UDHS). The percent distribution of the UDHS population by broad age groups is presented in Table 2.2. Thirty-eight percent of the population of Uzbekistan are people under 15 years of age, 57 percent are 15-64 years of age, and 5 percent are 65 and older. The dependency ratio, calculated as the ratio of persons under 15 and age 65 and over to persons age 15-64, is 74 percent. 13 Table 2.1 Household PoPulation by age, residence and sex Percent distribution of the de facto household population by age, according to sex and residence, Uzbekistan 1996 Urban Rural Total Age Male Female Total Male Female Total Male Female Total 0-4 11.5 11.1 11.3 13.4 13.5 13.4 12.7 12.5 12.6 5-9 11.8 11.1 11.5 14.5 14.1 14.3 13.5 12.9 13,2 10-14 11.4 10.7 11.1 12.2 14.4 13.3 11.9 I2.9 12.4 15-19 10.1 9.2 9.7 11.7 11.2 11.5 11.1 10.4 I0.8 20-~ 9,2 9.1 9,1 8.8 8.5 8,7 8,9 8,8 8.8 25-29 8.8 7.7 8,2 8.0 7.5 7.8 8.3 7.6 8.0 30-34 7.5 7.1 7.3 7.0 6.4 6.7 7.2 6.7 6.9 35-39 6.5 6.1 6.3 5.6 6,0 5.8 5.9 6.1 6.0 40-44 4.4 5.5 5.0 4.5 4.0 4.3 4.5 4.6 4.6 45-49 4.5 4.2 4.3 3.3 2.8 3.1 3.8 3.4 3.6 50-54 2.8 3.I 3.0 2.1 2.2 2.2 2.4 2.6 2.5 55-59 3.5 4.1 3.8 2.4 2.5 2.5 2.8 3.1 3.0 60-64 2.9 3.4 3.2 2.2 2.4 2.3 2.5 2.8 2.7 65-69 2.5 2.7 2.6 1.6 1.9 1.7 1.9 2.2 2.1 70-74 1.3 2.1 1.7 1.5 0.9 1.2 1.5 1.4 1.4 75-79 0.5 1.3 0.9 0.5 0.8 0.6 0.5 1.0 0.7 80+ 0.6 1.4 1.0 0.5 0.8 0.7 0.6 1.0 0.8 Missin~ Don'tknow 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 I00.0 100.0 100.0 100.0 100.0 100.0 Number 3,606 3,816 7,422 5,921 5,686 11,606 9,527 9,502 19,028 Age 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Figure 2.1 Population Pyramid of Uzbekistan 9 6 4 2 0 Percent 8 UDHS 1996 14 Table 2.2 Potmlation bv a~e Percent distribution of the de jure population by age group, Uzbekistan 1996 Age Percent <15 37.7 15-64 57.3 65+ 4.9 Total 100.0 Median age 20.6 Dependency ratio 74.3 Table 2.3 Household comnosition Percent distribution of households by sex of head of household, household size, and percentage of households with foster children, according to residence, Uzbekistan 1996 Characteristic Residence Urban Rural Total Household headship Male 64.4 88.4 77.8 Female 35.6 I 1.6 22.2 Total 100.0 100.0 100.0 Number of members 1 9.4 2.0 5.3 2 13.3 4.5 8.4 3 13.2 8.3 10.5 4 17.3 15.8 16.5 5 14.7 19.0 17.1 6 12.4 17.1 15.0 7 8.1 13.8 11.3 8 4.8 8.5 6.9 9+ 6.5 11.0 9.0 Total 100.0 I00.0 100.0 Mean size 4.6 5.7 5.2 Percent with foster children 1.0 0.9 0.9 Note: Table is based on de jure members; i.e., usual residents. 2.1.2 Household Composition Table 2.3 presents information on the size and composition of households according to urban-rural residence. The head of household (as recognized by other members) and the relationship of each household member to the head was determined in each household. In general, heads of households are mainly males (78 percent). In urban areas the proportion of households headed by men (64 percent) is less than in rural areas (88 percent). About 41 percent of households consist of between one and four members, with the average size of a household in Uzbekistan being 5.2 members. There are significant differences in the household size between urban and rural areas, with the average urban household consisting of 4.6 members compared to 5.7 in rural households. Only 1 percent of households include a child under 15 neither of whose parents were household members. Table 2.4 presents information on children under age 15 by survival status of the parents accord- ing to selected sociobiological factors. Ninety-three percent of children under age 15 live with both parents. As children get older, fewer of them live with both parents; 97 percent of children in the age group 0-2 live with both parents, compared to 90 percent in the age group 12-14 years. Rural chil- dren are more likely than urban children to live with both parents. Five percent of children under 15 are living with only their mother; of these, 2 percent have lost their fathers and 3 percent have fathers who are still alive. Regarding orphanhood, about 2 percent of children under age 15 have fathers who have died, and less than 1 percent have mothers who have died, while an insignificant proportion (0.1 percent) have lost both parents. 15 Table 2.4 Fosterhood and ort~hanhood Percent distribution of de facto children under age fifteen by their living arrangement and survival status of parents, according to child's age, sex, residence, and region, Uzbekistan 1996 Living Living with mother with father Not living with but not father but not mother either parent Living Missing with Father Mother info. on Number Background both Father Father Mother Mother Both only only Both lather/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children Age 0-2 96.6 2.6 0.5 0.1 0.1 0.1 0.0 0.0 0.0 0.0 100.0 1,360 3-5 95.0 3.2 1.1 0.1 0.3 0.3 0.0 0.0 0.0 0.0 100.0 1,549 6-8 93.2 3.3 1.7 0.2 0.8 0.6 0.0 0.0 0.0 0.2 100.0 1.486 9-11 91.3 3.3 2.8 0.4 1.2 0.4 0.0 0.1 0.0 0.4 100.0 IA94 12-14 89.5 3.5 3.6 0.7 0.9 1.4 0.1 0.1 0.2 0.1 100.0 1,382 Sex Male 93.1 3.0 2.0 0.3 0.9 0.4 0.0 0.0 0.1 0.1 100.0 3,631 Female 93.2 3.4 1.8 0.2 0.4 0.7 0.0 0.1 0.0 0.1 100.0 3,639 Residence Urban 89.7 5.5 2.8 0.1 0.5 0.8 0.0 0.1 0.1 0.4 100.0 2,509 Rural 94.9 2.0 1.5 0.4 0.8 0.4 0.0 0.0 0.0 0.0 100.0 4,761 Region Region I 91.1 2.3 3.7 0.6 1.0 0.9 0.2 0.1 0.1 0.0 100.0 992 Region 2 94.8 2.5 1.6 0.0 0.4 0.5 0.0 0.0 0.0 0.1 100.0 1,952 Region 3 94.1 2.5 1.8 0.4 0A 0.4 0.0 0.0 0.1 0.4 100.0 1,812 Region 4 93.3 3.4 1.4 0.3 I.I 0.4 0.0 0.1 0.1 0.0 100.0 2,050 Tashkent City 86.1 9.5 1.9 0.1 0.4 1.4 0.0 0.0 0.1 0.4 100.0 466 Total 93.1 3.2 1.9 0.3 0.7 0.6 0.0 0.0 0.1 0.1 100.0 7,271 Note: By convention,foster children are those who are not living with either parent. This includes orphans, i.e., children both of whose parents are dead. 2.1.3 Educational Level of Household Members Uzbekistan's primary and secondary educational system has three levels: primary (classes 1-4, age 6/7 - 10/11 years); principal (classes 5-9, age 1 1-15 years); secondary (classes 10-1 1, age 16-17 years). The primary and principal education levels are compulsory. Those who leave after the principal level of education (9 classes) may continue in secondary-special (vocational) education. Those who finish all three levels of primary/secondary school can continue their education at a higher level - -at universities or academic training institutes. The secondary-special (vocational) educational system in Uzbekistan provides a combination of general education and technical skills to students age 15-20 during 2-4 years of schooling. The number of years in the secondary-special schools depends on the curriculum under study. The UDHS confirms the high educational level of the Uzbekistan population. As can be seen in Table 2.5, 96 percent of women have had at least some education. A high percentage of the women have secondary-special and higher education, especially those in the 20-49 age group. Overall, the median years of schooling for women age 7 and above is 10 years. The educational level of urban women is higher than for rural women. There are also educational differences between women in Tashkent City and other regions. 16 Table 2.5 Educational level of the female household Dotmlation Percent distribution of the de facto female household population age seven and over by highest level of education auended, and median number of years of schooling, according to selected background characteristics, Uzbekistan 1996 Level of education Background No Primary/ Secondary- characteristic education Secondary Special Higher schooling Missing Total Number Median years of Age 7-9 17.7 82.3 0.0 0.0 0.0 100.0 754 2.0 10-14 0.0 99.8 0.1 0.0 0.0 100.0 1,225 6.5 15-19 0.5 81.7 15.0 2.7 0.2 100.0 989 10.3 20-24 0.7 58.8 29.2 11.4 0.0 100.0 833 10.7 25-29 0.5 57.4 30.6 11.5 0.0 100.0 722 10.6 30-34 0.3 56.7 29.0 14.0 0.0 100.0 634 10.7 35-39 0.3 60.8 25.3 13.6 0.0 100.0 578 10.7 40-44 0.7 57.4 26.5 15.3 0.1 100.0 441 10.7 45-49 0.6 60.1 21.5 17.8 0.0 100.0 322 10.7 50-54 2.3 73.9 16.0 7.7 0.0 100.0 244 10.3 55-59 3.4 76.0 11.2 8.6 0.9 100.0 296 10.1 60-64 6.7 81.0 6.6 4 6 1.1 100.0 268 8. I 65+ 17.4 74.0 3.5 4.3 0.8 100.0 535 5.6 Residence Urban 3.2 62.4 21.8 12.5 0.2 100.0 3,244 10.3 Rural 3.9 80.7 11.6 3.8 0.1 100.0 4,598 10.0 Region Region 1 4.5 66.0 22.1 7.4 0.2 100.0 988 10.1 Region 2 3.2 77.4 14.2 5.1 0.1 100.0 1,967 10.1 Region 3 3.8 76.2 13A 6.2 0.4 100.0 2,002 10.0 Region 4 3.8 77.4 12.9 5.9 0.1 100.0 2,153 10.1 Tashkent City 2.5 50.0 26.8 20.7 0.0 100.0 732 10.7 Total 3.6 73.1 15.8 7.4 0.2 100.0 7,842 10.1 Data in Table 2.6 show that men in Uzbekistan also have a high educational level. Thirty percent of men have secondary-special and higher education, and in certain age groups, the proportion is about 42 percent. The proportion of men with higher education is greater in urban than in rural areas (16 and 10 percent, respectively) and greater in Tashkent City (27 percent) than in the other regions (7 to 15 percent). To predict a general educational level of the population of the country, it is important to have information about school enrollment of the children and young people under age 24. As can be seen in Table 2.7 and Figure 2.2, 83 percent of children age 7-17 were enrolled in school, with only slight differences by residence and sex. Not everyone continues studying in secondary-special and higher educational institutions after secondary school. Only one in six of those age 18-20 and only one in 12 of those age 21-24 are enrolled in school. Enrollment rates among women and men are about the same except for the age group 21-24 for which enrollment among men is higher than among women. 17 Table 2.6 Educational level of the male household oooulation Percent distribution of the de facto male household population age seven and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Uzbekistan 1996 Level of education Background No Primary/ Secondary- characteristic education Secondary Special Higher schooling Missing Total Number Median years of Age 7-9 16.4 83.4 0.I 0.0 0.0 100.0 736 1.9 10-14 05 99.5 0,0 0.0 0.0 100.0 1,137 6.4 15-19 0,4 85,0 11,7 2.8 0.0 100,0 1,058 10.3 20-24 0.1 58,4 25,7 15.8 0.0 100.0 850 10.7 25-29 0.2 49.5 31.2 19,1 0.0 100.0 792 10.8 30-34 0,3 46,5 336 19.5 0.0 100.0 685 10.8 35-39 0.0 45.6 31.6 22.8 0.0 100.0 565 10.8 40-44 0.0 46,0 31,3 228 0.0 100.0 427 10.8 45-49 0.0 40.7 30.2 29.1 0.0 100.0 359 11.0 50-54 0.0 52.9 21.4 25.8 0.0 100.0 228 10,8 55-59 10 63.8 13.8 210 0.5 100.0 271 10.6 60-64 3.0 73.0 12.2 10.7 1.2 100.0 238 9.5 65+ 73 76.4 7.7 8.2 0.4 100.0 421 7.8 Residence Urban 2.3 61.8 20.1 15.6 0.1 100.0 3,008 10,4 Rural 2.3 71.0 16,4 10,2 0.0 I00.0 4,760 10.2 Region Region 1 3.4 65.0 20.9 10.6 0,1 100.0 965 10.3 Region 2 2.6 60.9 21.7 14,7 0.0 100.0 1,942 10.3 Region 3 2.1 67.9 18.2 11.6 0.3 100.0 2,030 10.3 Region 4 2.0 78.7 12.0 7.3 0.0 100.0 2,187 10.2 Tashkent City 1.3 51.4 20.6 26.6 0.0 100.0 645 109 Total 2.3 67.5 17.9 12.3 0,1 100.0 7,768 10.3 Tgbl9 2-7 $¢ho01 ¢nr011men~ Percentage of the de facto household population age 7-24 years enrolled in school, by age, sex, and residence, Uzbekistan 1996 Male Female Total Age Urban Rural Total Urban Rural Total Urban Rural Total 7-17 82.7 83.5 83,2 84,8 82,2 83.1 83.7 82.8 83.1 18-20 18.4 12.6 14.9 16.7 14.9 15.6 17.5 13.7 15.3 21-24 10,3 10.9 10.7 7.7 5.0 6.1 9.0 8.0 8.4 18 Figure 2.2 School Enrollment by Age and Sex 100 80 60 40 20 0 Percent 7-17 18120 21124 Age Group -*-Male ~ Female I UDHS 1996 2.2 Housing Characteristics In order to assess the socioeconomic conditions of respondents, appropriate information on housing was collected. Table 2.8 presents the data on availability of electricity, source of drinking water, sanitation facilities, type of floor and persons per sleeping room, all of which are determinants of the health status of household members, particularly of children. As can be seen from Table 2.8 and Figure 2.3, virtually all sampled households are supplied with electricity. The source of drinking water usually determines its quality. Seventy-eight percent of households in Uzbekistan have piped water, mostly piped into the residence. Most other households use well water. Almost all urban households use piped water (93 percent), almost all of which have tile pipes inside. In rural areas, 66 percent of households have piped water, while more than one-fifth of the population uses water from wells. Almost 90 percent of households in Uzbekistan are within 15 minutes of the source of their water. One indicator of sanitary conditions is the type of toilet in a household. In Uzbekistan, a majority of households (77 percent) have pit toilets (latrines) and 21 percent have flush toilets. In urban areas, 46 percent of households have flush toilets, while in rural areas, 97 percent have pit toilets. During the interview, interviewers noted the type of material from which the floor in each household was made. As can be seen from the data, 74 percent of households have a wooden floor, 15 percent of households use earth and 8 percent of households use linoleum. In rural areas, floors are mainly made from wood (7l percent) and in urban areas, along with wood, people use linoleum (15 percent). 19 'Fable 2.8 Housin~ characteristics Percent distribution of households by housing characteristics, according to residence, Uzbekistan 1996 Characteristic Residence Urban Rural Total Electricity Yes 100.0 99.3 99.6 No 0.0 0.7 0.4 Total 100.0 I00.0 100.0 Source of drinking water Piped into residence 87.4 37.8 59.7 Public tap 5.8 27.7 18.0 Wcll in residence 5.5 16.7 11.7 Public well 0.7 6.2 3.7 Spring 0.0 1.0 0.5 River/stream 0.4 5.7 3.4 Pond/lake 0.0 0.1 0.1 Rainwater 0.1 0.3 0.2 Tanker truck 0.2 4.0 2.3 Bottled water 0.0 0.5 0.3 Total 100.0 100.0 100.0 Time to water source (in minutes) <15 minutes 97.2 79.3 87.2 Median time to source 0.5 0.9 0.7 Sanitation facility Own flush toilet 45.6 0.8 20.7 Shared flush toilet 2. I 1.7 1.9 Traditional pit toilet 52.2 97.3 77.3 Ventilated improved pit latrine 0.1 0.1 0. I No facility/bush 0.0 0.1 0.0 Total I00.0 100.0 100.0 Floor material Earth/sand 1.9 24.8 14.7 Tezek 0. I 0.6 0.4 Wood planks 77.0 70.7 73.5 Straw/sawdust 1.4 1.1 1.2 Parquet/polished wood 4.6 0.2 2.1 Linoleum/asphalt 14.5 1.9 7.5 Ceramic tiles 0.0 0.1 0.0 Cement 0.3 0.6 0.4 Carpet 0.0 0. I 0.0 Other 0. I 0.0 0.0 Total 100.0 100.0 100.0 Persons per sleeping room 1-2 81.1 65.1 72.2 3-4 16.4 28.8 23.3 5-6 1.7 4.7 3.4 7+ 0.3 1.1 0.7 0.4 0.3 0.4 Total 100.0 100.0 100.0 Mean persons per sleeping room 2.1 2.6 2.4 Number of households 1,639 2,064 3,703 An important indicator of housing conditions is the level of crowding, which was estimated by the number of persons sleeping in one room and the average number of persons per sleeping room. The average number of persons per sleeping room is significantly higher in rural areas than in urban areas (2.6 and 2.1 percent, respectively). 2.2.1 Househo ld Durable Goods One criterion of the socioeconomic well- being of a household is ownership of various durable goods (radio, television, telephone, and refrigerator), and means of transport (bicycle, motorcycle, and private ear). The presence of a radio and television set in a household is also an indicator of the availability of information to household members. Table 2.9 shows that urban households are more likely than rural households to have these durable goods, especially radios, telephones, tele- vision sets, and refrigerators. An approximately equal proportion of urban and rural households own bicycles and private vehicles. The higher proportion of rural than urban households owning a motorcycle is due to the greater need for transport in rural areas. Urban areas are served by excellent public transport systems and, in Tashkent City, there is an extensive subway system. Overall, 91 percent of households in Uzbekistan have television, and 68 percent have refrigerators. Sixty-two percent of households have radios and 29 percent have telephones. More than one in five households owns a car. 2.3 Character i s t i cs o f Survey Respondents 2.3.1 Background Character ist ics The information in this section is important for the interpretation of the results of the study. Table 2.10 presents the percent distribution of women 15-49 by age, marital status, residence, region, educational level, religion, and ethnicity. To obtain the age of a respondent, the UDHS Woman's Questionnaire included two questions: "In what month and year were you born?" and "How old were you at your last birthday?" Special attention was given to these questions during the training of 20 Table 2.9 Household durable ~o0ds Percentage of households possessing various durable consumer goods, by residence, Uzbekistan 1996 Residence Durable goods Urban Rura l Total Radio 67.6 57.6 62.0 Television 95.7 86.8 90.7 Telephone 50.0 12.7 29.2 Refrigerator 88.1 52.2 68.1 Bicycle 16.7 22.5 20.0 Motorcycle 4.7 14.6 10.2 Private car 23.4 19.4 21.2 None of the above 1.3 7.6 4.8 Number of households 1,639 2,064 3,703 Figure 2.3 Housing Characteristics by Residence Percent of Households 100 80 60 40 2O 0 Electricity Piped Water (in residence) i~::!i':i ii:iiiii . : ,> : . Flush Toilet UDHS 1996 21 the interviewers. Interviewers learned how to use probing techniques for situations in which respondents did not know their date of birth. As shown in Table 2.10, the number of female respondents declines in a steady manner from ages 15-19 to 45-49. The majority of the women are married or living with a man (70 percent), but a significant proportion are never- married (25 percent), or are widowed, divorced, or separated (5 percent). More than half of women age 15-49 live in rural areas (62 percent). All women have at least some edu- cation and 36 percent have secondary-special or higher education. Ten percent are still in school. Ninety-f ive percent of the female respondents are Muslim, while a small pro- portion are Christian (5 percent). Table 2.11 shows the distribution of women 15-49 by ethnicity, religion, and residence according to region. Eighty-three percent of respondents are ethnic Uzbeks. 2.3.2 Educat ional Level of the Respondents Table 2.12 shows the percent distribution of women by the highest level of education attended according to background characteristics. As will be seen later in tile report, differences in the reproductive health of the women in many respects are related to differences in the level of education. Sixty-four percent of respondents have attended primary/secondary schools, 26 percent have attended secondary-special schools, and 11 percent have reached higher education schools. There are significant differ-euces in education between urban and rural areas and between regions. The proportion of respondents with higher education in urban areas is twice that in rural areas, and almost Table 2. I 0 Background characteristics of respondents Percent distribution of women 15-49 by selected background characteristics. Uzbekistan 1996 Number of women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 22.2 981 943 20-24 18.3 806 816 25-29 16.1 710 700 30-34 14.1 624 619 35-39 12.7 561 576 40-44 9.6 422 437 45-49 7.0 310 324 Marital status Never married 24.9 1,099 1,100 Married 69.2 3,057 2,996 Living together 1.0 46 71 Widowed 1.8 80 90 Divorced 2.7 121 139 Not living together 0.3 13 19 Residence Urban 38.3 1,693 2,306 Rural 61.7 2,722 2,109 Region Region 1 10.7 471 982 Region 2 24.0 1,060 936 Region 3 28.3 1,249 755 Region 4 27.9 1,231 914 Tashkent City 9.2 404 828 Education Primary/secondary 63.8 2,817 2,525 Secondary-special 25.5 1,127 1,304 Higher 10.7 471 586 Respondent still in school Yes 9.9 439 474 No 90.1 3,976 3,941 Religion Muslim 94.5 4,173 4,048 Christian 4.6 205 307 Other 0. I 3 6 Not religious 0.7 30 46 Don't know 0. I 4 8 Ethnicity Uzbek 82.6 3,647 3,347 Russian 4.2 185 285 Kazak 3.5 155 256 Tadzhik 3.2 139 118 Tatar 2.0 87 106 Karakalpak 1.7 75 158 Ukrainian 0.2 9 13 Other 2.7 117 132 Total 100.0 4,415 4,415 three times more in Tashkent City than in the other regions. There is a strong relationship between level of education and ethnicity. Sixty-eight percent of Uzbek women have primary/secondary education, 23 percent 22 Table 2. I 1 Ethnicitv. reliaion and residence bv region Percent distribution of women 15-49 by ethnicity, religion and residence, according to region, Uzbekistan 1996 Region Background Tashkent characteristic Region 1 Region 2 Region 3 Region 4 City Total Ethnicity Uzbek 58.6 84.4 84.2 94.9 63.2 82.6 Russian 1.2 3.0 3.3 1.1 22.8 4.2 Kazak 20.8 1.1 3.2 0.1 1.1 3.5 Tadzhik 0.0 8.2 2. I 1.9 0.7 3.2 Tatar 1.1 1.3 3.1 0.7 5.2 2.0 Karakalpak 15.8 0. l 0.0 0.0 0.0 1.7 Ukrainian 0.2 0.0 0.2 0.1 1.0 0.2 Other 2.1 1.9 3.8 1.3 6.0 2.7 Religion Muslim 97.6 96.8 94.9 98.6 71.3 94.5 Christian 1.0 3.2 4.3 1.1 24.6 4.6 Other 0.0 0.0 0.0 0.0 0.7 0.1 Not religious 1.3 0.0 0.8 0.3 2.7 0.7 Don't know 0.1 0.0 0.0 0.1 0.7 0.1 Residence Urban 39.4 27.4 33.9 31.5 100.0 38.3 Rural 60.6 72.6 66.1 68.5 0.0 61.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 471 1,060 1,249 1,231 404 4,415 Table 2.12 Level of education Percent distribution of women by the highest level of education attended, according to selected background characteristics, Uzbekistan 1996 Highest level of education Number Primary/ Secondary- of Secondary special Higher Total women Background characteristic Age 15-19 82.2 15.2 2.6 100.0 981 20-24 58.8 30.3 11.0 100.0 806 25-29 56.9 31.8 11.3 100.0 710 30-34 56.4 29.9 13.6 |00.0 624 35-39 61.8 24.7 13.4 100.0 561 40-44 58.1 27.0 14.9 100.0 422 45-49 60.8 22.1 17.2 100.0 310 Residence Urban 48.6 33,6 17.8 100.0 1,693 Rural 73.2 20.5 6.2 100.0 2,722 Region Region 1 51.7 37.0 11.3 100.0 471 Region 2 69.2 22.9 7.9 100.0 1,060 Region 3 69.0 21.8 9.2 100.0 1,249 Region 4 68.2 23. l 8.7 100.0 1,231 Tashkent City 34.3 38.0 27.7 100,0 404 Ethnicity Uzbek 67.9 23.2 8.8 100.0 3,647 Other 44.2 36.4 19.4 100.0 768 Total 63.8 25.5 10.7 100.0 4,415 23 have secondary-special education, and 9 percent have higher education. Among women of other ethnic groups, more than one-third have attained a secondary-special level of education, and 19 percent have attained higher education. 2.3.3 School Attendance and Reasons for Leaving School Because of the association between education and many other demographic and health indicators, it is interesting to analyze the reasons why women leave school. As shown in Table 2.13, 24 percent of women age 15-24 currently attend school. The main reasons for leaving school are marriage and the perceived sufficiency of the obtained education. Four percent of the women declare that they left school in order to earn money. 2.3.4 Access to Mass Media During the UDHS interviews, women were asked about their expo- sure to the mass media which is an indicator of their access to information about health and family planning. Table 2.14 shows that 94 percent of women watch TV weekly, while 57 percent read a newspaper at least once a week. Daily radio listen- ing is also widespread at 56 percent. There is little difference by age in access to the mass media. Women in Tashkent City and Region 4 have more access to all three types of mass media (58 and 56 percent, respec- tively) than women in the Region 3 (25 percent). It is notable that there is an association between the availability of mass media and respondents' educa- tional level; the higher the educational level, the more often women watch TV, read newspapers, and listen to the Table 2.13 School attendance and reasons for leavine school Percent distribution of women 15 to 24 by whether attending school and reason for leaving school, according to highest level of education attended and residence, Uzbekistan 1996 Educational attainment Reason for Incomplete Complete leavingschool secondary secondary Higher Total TOTAL Currently attending 45.7 13.4 62.0 24.2 Got pregnant 0.0 0.1 0.0 0.1 Got married 6.3 9.0 0.0 7.8 Take care &younger children 0.2 1.3 0.4 1.0 Family need help 5.0 2.3 0.0 2.8 Need to earn money 3.3 4.6 1.4 4.1 Graduated/Enough school 28.7 62.1 34.9 52.4 Did not pass exams 0.8 2.9 1.2 2.3 Did not like school 7.2 2.5 0.0 3.5 School not accessible 0.2 0.2 0.0 0.2 Applying for school 1.3 1. I 0.0 1.1 Other 0.5 0.0 0.0 0.1 Don't know/missing 0.5 0.4 0.0 0.4 Total 100.0 100.0 100.0 100.0 Number 427 1,247 114 1,787 URBAN Currently attending 43.8 14.5 59.6 26.5 Got pregnant 0.0 0.3 0.0 0.2 Got married 7.3 9.4 0.0 8.0 Take care of younger children 0.6 1.4 0.8 1.1 Family need help 4.5 1.6 0.0 2.2 Need to earn money 3.2 4.4 0.0 3.6 Graduated/Enough school 29.8 59.4 37.4 49.6 Did not pass exams 0.8 4.9 2.3 3.6 Did not like school 7.7 2.8 0.0 3.8 School not accessible 0.0 0.1 0.0 0.1 Applying lbr school 0.6 0.9 0.0 0.7 Other 0.3 0.0 0.0 0.1 Don't know/missing 1.4 0.3 0.0 0.6 Total 100.0 100.0 100.0 100.0 Number 165 406 61 632 RURAL Currently attending 47.0 12.8 64.9 22.9 Got pregnant 0.0 0.0 0.0 0.0 Got married 5.7 8.8 0.0 7.7 Take care of younger children 0.0 1.3 0.0 0.9 Family need help 5.3 2.7 0.0 3.1 Need to earn money 3.4 4.8 3.0 4.4 Graduated/Enough school 28.0 63.5 32.1 54.0 Did not pass exams 0.8 1.9 0.0 1.6 Did not like school 6.9 2.4 0.0 3.3 School not accessible 0.4 0.2 0.0 0.3 Applying for school 1.8 1.1 0.0 1.2 Other 0.7 0.0 0.0 0.2 Don't know/missing 0.0 0.5 0.0 0.4 Total 100.0 100.0 100.0 100.0 Number 262 840 52 1,155 24 Table 2.14 Access to mass media Percentage of women who usually read a newspaper once a week, watch tele'~ision once a week, or listen to radio daily, by selected background characteristics, Uzbekistan 1996 Mass media No Read Watch Listen to All Number Background mass newspaper television radio 'three of characteristic media weekly weekly daily media women Age 15-19 2.8 61.3 95.1 56.4 41.1 981 20-24 4.5 57.5 92.7 53.6 37.4 806 25-29 4.6 56.2 92.7 54.4 37.6 710 30-34 3.9 54.0 94.1 54.6 35. I 624 35-39 1.7 56.5 95.6 57.1 40.1 561 40-44 2.7 55.3 96.5 58.9 38.7 422 45-49 2. I 56.9 95.7 63.3 41.0 310 Resldenee Urban 1.3 70.4 97.1 60.3 48.0 1,693 Rural 4.6 49.1 92.7 53.5 32.8 2,722 Region Region 1 2.8 60.6 95.2 45.5 32.2 471 Region 2 4.6 46.4 92.5 55.5 30.5 1,060 Region 3 5.5 41.1 91.9 49.8 24.9 1,249 Region 4 1.3 74.9 96.9 62.6 55.7 1,231 Tashkent City 0.2 78.0 98.3 70.0 58.0 404 Education Primary/Secondary 4.5 48.3 92.9 51.5 32.1 2,817 Secondary-special 2.0 66.5 96.4 62.0 44.8 1.127 Higher 0.1 88.8 98.2 69.6 63.3 471 Ethnieity Uzbek 3.1 55.1 94.7 55.5 37.8 3,647 Other 4.6 67.6 92.8 59.4 42.7 768 Total 3.4 57.2 94.4 56.1 38.6 4AI5 radio. Women of other ethnicities are somewhat more likely than Uzbek women to avail themselves of all three media. 2.3.5 Women's Employment Status Table 2.15 presents information on women's employment status according to age, residence, region, educational level, and ethnieity. Overall, 56 percent of women age 15-49 are not currently employed and 47 percent have not been employed for the last 12 months. Unemployment is more common among younger women, those l iving in rural areas, in Regions 2 and 3, those with a lower educational level, and Uzbek women. Almost 6 percent of the employed women work for less than five days a week and 7 percent of the women are employed only seasonally or occasionally. 25 Table 2.15 EmDIovment Percenl distribution of women by whether currently employed and distribution of employed women by continuity of employment, according to background characteristics, Uzbekistan 1996 Not currently employed Currently employed Did not work Worked All year in last in Background 12 last 12 5+ days <5 days Season- Occasion- characteristic months months per week per week ally ally Total Number Age 15-19 82.2 1.2 9.8 1.6 5.0 0A 100.0 981 20-24 52.2 15.3 23.3 3.8 5.2 0.1 100.0 806 25-29 37.4 18.1 32.8 6.7 4.8 0.1 100.0 710 30-34 29. 7 12.4 41.8 8. I 7.9 0. I 100.0 624 35-39 25.3 5.6 49.5 6.9 12.5 0. I 100.0 561 40-44 31.0 1.0 50.1 10.4 7.5 0.0 100.0 422 45-49 41.8 0.3 42.3 9.1 6.1 0.3 100.0 310 Residence Urban 44.1 9.2 37.5 7.7 1.3 0.3 100.0 1,693 Rural 49.0 8.2 28.1 4.6 10.0 0.0 100.0 2.722 Region Region 1 40.7 14.2 39.1 3.8 2.2 0.0 100.0 471 Region 2 55.0 5.3 29.2 6.7 3.8 0.0 100.0 1,060 Region 3 50.7 9.9 28.9 3.3 7.2 0.0 100.0 1,249 Region 4 40.9 7.1 31.9 7.9 12.1 0.0 100.0 1,231 Tashkent City 42.0 11.0 37.4 6.8 1.4 1.3 100.0 404 Education Primary/Secondary 57.4 5.3 23.3 4.3 9.6 0.1 100.0 2,817 Secondary-special 30.1 15A 43.6 9.0 1.9 0.3 100.0 1,127 Higher 26.7 12.4 53.6 6.8 0.5 0.0 100.0 471 Ethnicity Uzbek 48.5 8.6 29.4 5.9 7.6 0.0 100.0 3,647 Other 40.6 8.4 42.8 5.4 2.2 0.6 100.0 768 Total 47.1 8.6 31.7 5.8 6.7 0.1 100.0 4,415 2.3.6 Employer Table 2.16 shows the percent distribution of currently employed women by type of employer, according to background characteristics. Ninety-five percent of employed women work in state enterprises. Only 1 percent of women work in private firms. This type of employment is popular among women who live in urban areas and especially among women living in Tashkent City. 2.3.7 Occupation The agrarian sector is the most important sector in the Uzbekistan economy. Twenty-eight percent of employed women work in agriculture (Table 2.17) and the majority of them work on state land. Women in Regions 2, 3 and 4 are more likely to be working in agriculture mostly on state land. Seventy-two percent of employed women are not engaged in agriculture. Almost half work in professional, technical, and managerial occupations, 7 percent in sales and trade, and 18 percent in manual labor. These parameters differ by age, residence, region, and respondent's ethnicity. Significant differences are also seen by educational level--women with higher education are engaged mainly in professional and technical fields, with few employed in manual labor. 26 Tablq 2,16 Emolover Percent distribution of currently employed women by employer, according to background characteristics, Uzbekistan 1996 Employer Govel'n- ment or State Family, Private Background enter- own firm, Self- characteristic prise business person employed Missing Total Number Age 15-19 91.8 1.7 0.9 5.5 0.0 100.0 163 20-24 92.3 2.5 2.3 3.0 0.0 100.0 262 25-29 94.9 1.3 1.1 2.5 0.1 100.0 315 30-34 95.8 1.5 0.7 2.0 0.0 I00.0 361 35-39 95.0 1.8 1.5 1.7 0.0 100.0 388 40-44 96.5 0.7 1.0 1.7 0.2 100.0 287 45-49 94.2 1.3 0.8 3.0 0.8 100.0 180 Residence Urban 90.9 l.g 2.7 4.4 0.2 100.0 791 Rural 97.2 1.4 0.2 1.2 0.0 I00.0 1,164 Region Region 1 97.1 1.6 0.2 0.6 0.4 100.0 212 Region 2 97.8 0.8 0.0 1.4 0.0 100.0 421 Region 3 94.0 4.2 0.0 1.5 0.3 100.0 492 Region 4 97.2 0.O 0.4 2.4 0.0 100.O 640 Tashkent City 78. I 1.3 10.8 9.8 0.0 1O0.0 190 Education Primary/Secondary 94.8 2.1 0.5 2.5 0.1 100.0 1,050 Secondary-special 93.8 1.3 1.5 3.2 0,2 100.0 618 Higher 95.9 0.0 3.1 1.0 0.0 100.0 287 Ethuieity Uzbek 95.8 1.7 0.5 l.g 0.1 10O.0 1,563 Other 89.9 l.O 3.9 5.1 0.1 log.0 392 Total 94.6 1.5 1.2 2.5 0.1 100.0 1,955 27 Table 2.17 Occuoation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Uzbekistan 1996 Agricultural Nonagricultural ProfJ Background Family Rented Slate tech/ Sales/ Skilled Unskilled Number characteristic land land land manag, services manual manual Total of women Age 15-19 0.0 0.0 43.4 20-24 0.2 0.4 28.0 25-29 0.2 0.0 24.3 30-34 0.3 0.3 26.8 35-39 0.4 0,4 29.0 40-44 0.2 0.0 23.3 45-49 0.0 0.0 22.3 Residence Urban 0, 1 0.0 1.6 Rural 0.3 0.3 45.0 Region Region I Region 2 Region 3 Region 4 Tashkent City Education Prixnary/Secondar3' Secondary-special Higher Ethnicity 1.2 1.0 18.6 0.3 0.3 29.6 0.0 0.0 28.8 0.0 0.0 36.0 0.0 0.0 0.0 0.3 0.3 47.6 0.2 0.0 5.3 0.0 0,0 1.3 24.6 5.1 20.4 6.5 100.0 163 51.4 5.4 9.7 4.9 100.0 262 50.2 5.2 10.4 9.8 100.0 315 48.7 6.3 10.9 6.8 100.0 361 43.7 9.5 7.3 9.9 100.0 388 51.8 7.0 8.1 9.7 100.0 287 58.2 6.9 7.2 5.4 100.0 180 65.6 1(I.4 14.7 7.6 100.0 791 35.4 4.2 6.8 8.1 100.0 1,164 53.1 6.8 10.5 8.9 100.0 212 51.2 5.0 5.3 8.3 100.0 421 46.7 5.9 10.9 7.7 100.0 492 40.6 4.6 11.0 7.7 I00.0 640 59.6 19,3 13.9 7.2 100.0 190 20.2 6.8 12.4 12.4 100.0 1,050 72.2 8.5 10.0 3,9 I00.0 618 95.1 2.3 1.1 0.2 100.0 287 Uzbek 0,1 0.0 31.8 44.6 5.6 10.0 7.8 100.0 1,563 Other 0.4 0.9 10.0 59.7 11.1 9.8 8.1 100.0 392 Total 0.2 0.2 27.4 47.6 6.7 10.0 7.9 100.0 1,955 Note: Professional, technical, managerial includes professional, technical, clerical and managerial occupations. 28 2.3.8 Decisions on Use of Earnings When the status of women is assessed, their independence in making decisions on the use of their earnings is a valuable indicator. Table 2.18 shows that almost 27 percent of employed women make their own decisions on the use of their earnings, while 49 percent decide together with their husband or partner, and 3 percent make decisions jointly with someone other than a husband. Twelve percent of women report that their husbands alone decide how to spend their earnings. Independent decision making on use of earnings tends to be higher among women in urban areas, especially Tashkent City, and among unmarried women. Table 2.18 Decision on use of earnings Percent distribution of women receiving cash earnings by person who decides on use of earnings according to background characteristics, Uzbek stan 996 Person who decides how earnings are used Jointly with Jointly Background Self Husband/ husband/ Someone with characteristic only partner partner else someone Total Number A[5 .ge 19 34.9 1.3 5.0 42.2 16.5 100.0 153 20-24 29.3 13.4 34.9 15.0 7.5 100.0 247 25-29 25.4 10.8 50.1 11.0 2.0 100.0 293 30-34 26.9 12.5 56.4 3.4 0.8 100.0 336 35-39 19.9 13.9 63.5 1.9 0.7 10lh0 363 40-44 25.7 13.8 59.8 0.5 0.2 100.0 270 45-49 39.1 13.6 46.4 0.6 0.3 100.0 172 Residence Urban 38.6 6.4 45.9 5.9 3.2 100.0 755 Rural 19.3 15.9 51.5 10.2 3.0 100.0 1,079 Region Region 1 29.0 3.4 42.4 24.1 0.2 100.0 209 Region 2 23.6 4,4 67.8 2.2 0.0 100.0 421 Region 3 32.9 0.7 53.5 7.4 0.4 100.0 479 Region 4 15.7 34.0 38.0 10.9 0.0 100.0 535 Tasqakent City 51.6 4.7 36.0 0.8 0.0 100.0 189 Education Primary/Secondary 22.9 12.6 50.4 10.8 0.2 100.0 958 Secondary-special 31.0 12.3 46.6 6.7 0.1 100.0 594 Higher 33.8 9.3 50.6 3.9 2.3 100.0 282 Ethnieity Uzbek 22.6 14.4 50.7 9.1 3.0 100.0 1,447 Other 44.5 2.9 43.3 6.0 3.3 100.0 387 Marital status Not married 66.1 0.0 0.8 21.6 0.0 100.0 413 Currently married 15.9 15.5 63.2 4.6 0.2 100.0 1,420 Total 27.2 12.0 49.2 8.4 3.0 I00.0 1,833 2.3.9 Child Care While Working Preschool age children in the family pose employment obstacles, since child care requires significant time and energy. When child care is provided completely by the mother, her work possibilities are limited. As Table 2.19 shows, less than half of employed women have a child under age six at home. It is notable that the likelihood of a working woman having a child under six years is greater in rural areas (48 percent), the Region 4 (49 percent) and among Uzbeks (44 percent). Among employed women with young 29 children, only 6 percent care for the children themselves, 2 percent are cared for by the husband or partner, and 23 percent are cared for by relatives. One-third of employed women with young children use preschool child care institutions despite the mass shutdown during recent years. Use of institutional child care is greatest in urban areas (53 percent), Tashkent City (65 percent), and among women with higher education (49 percent). When other children are used as child care providers, the caretaker is much more likely to be a sister (12 percent) than a brother (4 percent). The role of other people (neighbors, servants) in providing child care is not significant. Table 2.19 Child care while workin~ Percent distribution of currently employed women by whether they have a child under six years of age, and the percent distribution of employed mothers who have a child under six at home by person who cares tbr child while mother is at work, according to background characteristics, Uzbekistan 1996 Background i characteristic :Residence Employed women with: One or mo~ No chil- Child's caretaker while mother is at work child dren Hus- under under Re- band/ Other six at six at spend- paa- rela- Neigh- Hired tional t~male male else- since Otheff home home ent net Serv- Child Not Number ants/ Institu- Other Other lives worked of employed tive bor help care child child where birth I Missing Total women Urban 700 300 53 2.2 176 (14 31 534 56 Rural 524 476 66 2.2 251 13 2.1 282 143 Education Primal/Secondary 580 420 82 1.9 226 I I I 5 287 15 I Secondary-special 603 39.7 45 2.5 244 14 3.6 42.6 74 nigher 636 364 20 26 202 00 33 493 71 Work status For family member 38.7 613 241 0.0 25.7 For someone else 873 127 00 00 0.0 Self-employed 681 319 536 28 31 Missing 81.5 185 00 00 100.0 Region Regionl 585 4t5 17 27 350 Region 2 603 397 12.3 37 134 Region 3 608 392 45 19 210 Region 4 513 487 57 I 2 269 Tashkent City 833 167 31 46 108 Ethnicity Uzbek 559 441 63 22 22.5 Other 74 0 260 57 22 254 Occupation Agricultural 519 481 67 20 273 Nonagricultural 624 376 60 23 207 Employment status All year, full week 618 382 58 22 214 All year, part week 599 401 72 2.0 257 Seasonal 479 52 1 71 24 262 Occasional 818 18.2 00 00 00 Total 595 405 62 22 228 I I 38 17 57 I000 791 58 51 32 62 1000 1,164 6.1 41 36 71 1000 1,050 2.0 60 14 41 1000 618 26 45 22 62 1000 287 O0 0.0 20.1 99 9.9 75 28 O0 I000 30 O0 O0 I00.0 O0 O0 O0 O0 O0 I00.0 24 00 O0 91 197 O0 O0 O0 II 7 I000 49 O0 O0 O0 O0 O0 O0 O0 O0 I000 2 18 22 314 161 44 I I II 27 I000 212 24 65 252 215 78 29 05 37 I000 421 O0 19 413 13 1 57 24 55 28 1000 492 08 05 362 48 20 84 28 107 I000 640 00 3 1 646 62 I 5 3 I I 5 I 5 1000 190 10 21 35.3 115 44 53 28 6.5 1000 1,563 10 42 384 127 41 09 22 32 1000 392 I I 12 241 190 77 48 21 40 I000 544 10 30 414 80 27 47 30 71 HX}O 1,412 l0 31 36.1 116 42 42 34 70 1000 1,399 00 23 39.4 93 40 3.8 15 49 1000 255 I 9 00 316 135 53 7 1 12 36 1000 295 00 00 1000 00 00 00 00 00 1000 5 10 24 357 11.7 44 47 27 61 1000 1,955 qote: Figures may not add to 100.0 due to rounding. Respondent was employed but had not actually worked since the birth; therefore, current caretaker status is not applicable. 30 2.4 Pensioners The UDHS Household Questionnaire contained questions to determine the pensioner status of all household members age 50 and over. Table 2.20 indicates that 58 percent of male and 9l percent of female household members age 50 and over are pensioners. There is a sharp increase in the proportion who are pensioners by age. For females the increase occurs between age groups 50-54 (70 percent) and 55-59 (93 percent). For males the increase occurs between age groups 55-59 (38 percent) and 60-64 (88 percent). Thus, in Uzbekistan almost all females age 55 and over and all males age 60 and over are pensioners. This is true in both urban and rural areas (data not shown). Table 2.20 Pensioners bv aae and sex Household population age 50 and over by age, sex and pensioner status, Uzbekistan 1996 Household population Pensioners Percent pensioners Age Male Female Total Male Female Total Male Female Total 50-54 405 297 702 66 207 273 16.4 69.8 38.9 55-59 354 319 673 133 295 428 37.6 92.6 63.7 60-64 266 281 547 234 279 513 87.7 99.5 93.8 65-69 181 169 350 170 166 336 94.1 98.2 96.1 70-74 119 133 253 119 133 253 100.0 100.0 100.0 75-79 50 91 141 50 90 140 100.0 98.5 99.0 80+ 63 118 182 62 115 177 98.4 97.0 97.5 Total 1,439 1,409 2,847 835 1,286 2,121 58.0 91.3 74.5 The UDHS data correspond well with the age requirements for retirement in Uzbekistan, i.e., 55 for females and 60 for males. In the remainder of this section, a simple age criteria with these age cutoffs will be used among the household population to define pensioners. Overall, the analysis is based on data for 1,792 pensioners. The 1,112 females pensioners exceed the 680 male pensioners by 64 percent. This difference is primarily due to sex differences in the age range which defines pensioners and to a lesser extent because there are more females than males in the older ages. Thus, considering only the population age 60 and over, the 793 females exceed the 680 males by 17 percent. 2.4.1 Composition of Households Containing Pensioners The welfare of pensioners is potentially influenced by whether or not they reside in a household which includes other adult members who can attend to their health needs and who may be economically active and able to provide monetary support. Table 2.21 shows the distribution of households containing pensioners by the number of nonpensioned household members age 20 and over. Separate distributions are shown for households containing a single pensioner and households containing more than one pensioner. Of 1,792 pensioners, 768 (43 percent) reside in households containing a single pensioner and 1024 (57 percent) reside in households containing more than one pensioner. Among households with a single pensioner, 82 percent have at least one other household member age 20 or over. Thus, in 18 percent of the households with a single pensioner, the pensioner is without the 31 benefit of support from an adult household member who is in the economically active age range. The percentage of single pensioner households with no other adult in the household is higher in urban (22 percent) than in rural areas (11 percent). Overall, among all 1,792 pensioners, 8 percent reside in a household where they are the only pensioner and there is no other adult household member. Table 2.21 Comoosition of households with oensioners Percent distribution of households with one pensioner and with two or more pensioners by number of nonpensioned household members age 20 and over by residence and region, Uzbekistan 1996 Households with one Households with two or more pensioner by the number of pensioners by the number nonpensioned household Number of nonpensioned household Number members age 20 and over of members age 20 and over of Background house- house- characteristic 0 1 2 3+ Total holds 0 I 2 3+ Total holds Residence Urban 22.3 17.6 33.0 27.1 100.0 440 34.5 12.9 30.9 21.7 100.0 210 Rural 11.2 14.1 43.8 30.9 100.0 329 17.4 14.5 39.8 28.3 100.0 285 Region Region 1 11.2 6.6 37.5 44.7 100.0 86 7.1 11.8 37.6 43.5 100.0 48 Region 2 9.3 15.8 40.0 34.9 100.0 155 I6.3 16.4 36.4 30.9 100.0 108 Region 3 23.7 23.7 30.1 22.4 100.0 219 31.3 15.8 32.6 20.3 100.0 153 Region 4 14.9 8.5 48.9 27.7 I00.0 194 26.2 9.0 41.0 23.8 I00.0 133 Tashkent City 26.0 22.1 29.9 22.1 100.0 115 34.6 16.8 30.8 17.8 100.0 53 Total 17.5 16.1 37.6 28.7 100.0 768 24.7 13.8 36.0 25.5 100.0 495 In households containing more than one pensioner, 25 percent have no other household member age 20 or over. The majority of these cases are probably households containing a married couple both of whom receive a pension. The percentage of households with more than one pensioner but no other adult member is higher in urban (3 5 percent) than rural areas (17 percent). 2.4.2 Housing Characteristics of Households Containing Pensioners The welfare of pensioners may also be influenced by the characteristics and possessions of the households in which they reside. Table 2.22 shows the distribution of households containing pensioners according to the source of drinking water and sanitation facilities. There is little difference in the sources of drinking water between households with pensioners containing no other adult household member and those with other adult household members. For example, in rural areas, the proportion of households served by piped water is 39 percent for both households with other adult members and for those without other adult household members. The only substantial difference occurs in the case of sanitation facilities. In urban areas, 66 percent of pensioner households which contain no other adult members have a flush toilet while only 31 percent of pensioner households which contain other adult members have a flush toilet. Table 2.23 shows the percent of households with pensioners which contain specific possessions according to whether or not the household contains other household members age 20 and over. There is little difference between households with or without other adult household members in terms of the percent possessing a radio, a television set, or a refrigerator. However, there are clear and substantial differences with respect to possession of a telephone or means of transport (i.e., a motorcycle or private car). For example, in urban areas, only 4 percent of households with no other adult member, as compared to 27 percent with other adult household members, have a private car. The difference in rural areas is also substantial. The indication is that pensioners living on their own are at a disadvantage in terms of communications and mobility. 32 Table 2.22 Housin~ characteristics of households with pensioners Percent distribution of households with pensioners by housing characteristics according to whether or not the household includes nonpensioned members age 20 and over, Uzbekistan 1996 Households with pensioners but no nonpensioned household member age 20 and over Households with pensioners and at least otte non- pensioned household member age 20 and over All households with pensioners Residence Residence Residence Characteristic Urban Rural Total Urban Rural Total Urban Rural Total Source of drinking water Piped into residence 94.7 39.1 76.0 85.1 38.6 60.8 87,6 38.7 63.8 Public tap 2.8 23.6 9.8 7.7 28.2 18.4 6.4 27.5 16.7 Well in residence 2.5 13.5 6.2 6,0 17.6 12.1 5.1 17.0 10.9 Public well 0.0 4.8 1.6 0.4 6.5 3.6 0,3 6.2 3.2 Tanker truck 0.0 8.8 3 0 0.4 3.4 1.9 0.3 4.1 2.1 Other 0.0 10.1 3.4 0.5 5.8 3.0 0.3 6.8 3.2 Total 100.0 I00.0 I00.0 100,0 I00.0 100.0 100.0 I00.0 100.0 Type of toilet facility Flush toilet 66.0 0.0 43.8 30.8 1.4 15.4 40.0 I. 1 21.2 Pit toilet 34.0 100.0 562 69.2 98.6 84.6 60.0 98.9 78.8 Total 100.0 100.0 100.0 100.0 100,0 I00.0 100.0 100.0 I00.0 Main floor material Wood planks 78.4 74.4 770 83.5 73.1 78.0 82.2 73.3 77.8 Linoleum 15.1 1.8 106 7.8 1.0 4.3 9.7 1.1 5.6 Earth 1.0 22.0 8.1 3.5 23,8 14.1 2.9 23.6 129 Parquet, polished wood 4.2 0.0 2.8 2.6 0,4 1.5 3. I 11.3 1.7 Other 1.2 1.8 1 4 2.5 1.7 2.1 22 1.6 1.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 170 86 257 479 527 1,006 649 614 1,263 Table 2.23 Possession of durable aoods for households with oensioners Percentage of households with pensioners by possession of various durable goods according to whether or not the household includes nonpensioned members age 20 and over, Uzbekistan 1996 Households with pensioners but no nonpensioned household member age 20 and over Households with pensioners and at least one non- pensioned household member age 20 and over All households with pensioners Residence Residence Residence Durable goods Urban Rural Total Urban Rural Total Urban Rural Total Radio 65.3 60.2 63.6 73.1 59.9 66.2 71.11 60,0 65.7 Television 86.7 77.9 83.8 97.7 88.7 93.0 94.8 87.1 91.1 Telephone 39.2 6.0 28.0 51.2 14.6 32.0 48.0 13.4 312 Refrigerator 86.8 43.0 72.0 87,9 55.2 70.8 87.6 53.5 71.(I Bicycle 2.8 17.2 7.7 18.0 28.1 23.3 14.11 26,6 20.1 Motorcycle 0.8 5.3 2,3 6.7 19.9 13.6 5.1 17.8 11.3 Private car 3.5 5.3 4.1 27.2 22,4 24.7 21.0 20.0 20,5 None of the above 2.6 16.2 7.2 1.2 5,5 3.4 1.5 7.0 4.2 Number of households 170 86 257 479 527 1,006 649 614 1,263 33 CHAPTER 3 FERTILITY Shavkat L Karimov, Akhror B. Yarkulov, and Damin A. Asadov A complete pregnancy history was collected from each woman interviewed in the 1996 UDHS. To encourage complete reporting of all pregnancies, respondents were asked separate questions about pregnancies that resulted in live births, induced abortions (including mini-abortions), miscarriages, and stillbirths. Accounting of live births was achieved by asking separately about the number of sons and daughters living with the respondent, the number living elsewhere, and the number who had died. To encourage complete reporting of all pregnancies, all pregnancy intervals of four or more years in duration were additionally probed for intervening pregnancies. The pregnancy history was collected in reverse chronological order from the most recent to the first pregnancy. Pregnancy outcome (live birth, abortion, miscarriage, or stillbirth) and date (month and year) of termination was recorded for each pregnancy. For each live birth, sex of the child, survival status, and age (for living children) or age at death (for dead children) were also collected. This chapter presents the findings pertaining to live births. Chapter 5 presents the findings pertaining to pregnancy loss. 3.1 Current Fertility Table 3.1 and Figure 3.1 present age-specific fertility rates for the three-year period preceding the survey.I Rates are expressed per 1,000 women. The sum of the age-specific rates, known as the total fertility rate (TFR), is used to summarize the current level of fertility. The TFR is interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific rates. Two other summary measures are presented in Tabte 3.1: the general fertility rate (GFR) and the crude birth rate (CBR). The GFR represents the annual number of births in the population per 1,000 women age 15-44. The crude birth rate is the annual number of births in the population per 1,000 population. The latter two measures are calculated from the birth history data for the three-year period preceding the survey, and the age and sex distribution of the household population. Numerators for age-specific fertility rates are calculated by summing the number of live births which occurred in the 1-36 months preceding the survey (determined from the date of interview and birth date of the child), and classifying them by age (in five-year groups) of the mother at the time of birth (determined from the birth date of the mother). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-36 months preceding the survey. 35 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by residence and ethnicity, Uzbekistan 1996 Residence Ethnicity Age Urban Rural Uzbek Other Total 15-19 60 62 64 46 61 20-24 218 294 283 171 266 25-29 154 190 183 133 176 30-34 86 132 118 92 114 35-39 22 50 43 26 39 40-44 4 13 3 22 9 45-49 0 (6) 4 (0) 3 TFR 15-49 2.71 3.74 3.49 2.45 3.34 TFR 15-44 2.71 3.71 3.47 2.45 3.33 GFR 99 137 131 81 I23 CBR 23 29 27 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Rates in parentheses indicate that they are based on I~wer than 250 woman-years of exposure. TFR: Total fertility rate, expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate. expressed per 1,000 population Figure 3.1 Age-specific Fertility Rates by Ethnicity Births per 1,000 Women 300 250 ~ 2O0 150 100 i i [ 15-19 20 24 25-29 30-34 35-39 40-44 45-49 Age Group [~,-Uzbek +Other -~rTotal 1 UDHS 1996 36 If fertility were to remain constant at current levels, an Uzbekistani woman would give birth to an average of 3.3 children. This national average is the result of two different levels of fertility. Fertility among rural women is higher than among urban women throughout all the childbearing years, resulting in a TFR among rural women that is one child higher than among urban women. If fertility were to remain constant at current levels, rural women would have 3.7 children, while urban women would have only 2.7 children. Both rural and urban women experience their peak childbearing years during their early twenties (age 20- 24). Ethnic differentials in fertility are of the same order of magnitude as urban/rural differentials. Ethnic Uzbeks achieve a TFR that is one child greater (3.5) than the TFR among women of other ethnicities (2.5). While ethnic Uzbeks and women of other ethnicities both achieve their peak fertility during their early twenties, the age-specific fertility rates (ASFRs) of ethnic Uzbeks are higher than those among women of other ethnicities at nearly every age. Table 3.2 and Figure 3.2 present TFRs for the three years preceding the survey by background characteristics. Fertility levels are re- markably similar (at about 3.4) across four out of the five regions of Uzbeki- stan. Only Tashkent City varies from the norm, with a TFR which is one child fewer than in the rest of the country. Women in Uzbekistan exhibit a childbearing pattern, observed in many societies, of decreasing fertility with increasing education. The TFR declines from 3.5 children per woman among women with primary or second- ary schooling to 3.1 among women with secondary-special schooling and then down to 2.8 children per woman among those with higher education. A crude assessment of trends in fertility over time can be made by comparing the TFR (a measure of current fertility) with the mean number Table 3,2 Fertility bv background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant and mean number of children ever born to women age 40-49, by selected background characteristics, Uzbekistan 1996 Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate I pregnant I age 40-49 Residence Urban 2.71 6.91 3.60 Rural 3.74 6.94 5.45 Region Region 1 3.45 6.98 5.78 Region 2 3.43 7.08 5.25 Region 3 3.34 8.25 4.50 Region 4 3.59 6.00 4.65 Tashkent City 2.30 5.19 2.80 Education Primary/Secondary 3.53 6.50 5.27 Secondary-special 3.13 7.05 3.77 Higher 2.78 9.16 3.42 Ethnieity Uzbek 3.49 7.24 4,97 Other 2.45 5.44 3.61 Total 3.34 6.93 4.61 I Women age 15-49 years of children ever born (CEB) to women age 40-49 (a measure of completed fertility). If there had been no change in fertility for three or more decades prior to the survey, the TFR and CEB would be nearly the same. The fact that the TFR (3.3 children per woman) is lower than the CEB (4.6) indicates that fertility has declined in Uzbekistan over the past three decades. The TFR is lower than the CEB among both rural and urban women, and in every region, every educational level, and among ethnic Uzbeks and women of other ethnicities. The largest regional decline seems to have occurred in Region 1, which has the highest number of CEB, but a TFR on par with Regions 2 through 4. 37 Figure 3.2 Total Fertility Rate by Background Characteristics UZBEKISTAN RESIDENCE Urban Rural EDUCATION Primary/Secondary Secondary-special Higher ETHNICITY Uzbek Other REGION Region 1 Region 2 Region 3 Region 4 Tashkent O.O 3.3 ~%%%.%~.'~'%%.%%.%.~,~ 2.7 ~ % % % % , ~ % , % ~ % ~ 3.7 ~ff//fJS/S~ff/////~'///JJ~f/ffJSf~'~ 3.5 ~/J//I~f.JZ/./././././././~///J~/Z//~ 2.5 " " " 3.5 3 .4 3.3 3.6 ~ , 2 , ~ \ ~ ' k ~ 2.3 1 .O 2 .0 3.0 4 .0 Births per Woman 5.0 6.0 UDHS 1996 Table 3.2 also presents the percent of women who report themselves to be currently pregnant. Because women at early stages of pregnancy may not yet know they are pregnant, this proportion may be underestimated. Per- centages look generally reasonable for the given levels of fertility. The level of fertility ascertained by the UDHS is very much in accordance with the Ministry of Health's reported levels of current fertility. Table 3.3 compares the 1994 ASFRs reported by the Ministry of Health with the UDHS rates. The agreement of these two independent data sources tends credence to both sources, and their estimates ofa TFR of 3.3. 3.2 Ferti l i ty Trends To examine fertility trends more directly, it is possible to look at the ASFRs over time. Age-specific fertility rates can be calculated for the preceding 20 years Table 3.3 Age-specifiefenilitvratesfrom othersource~ Age-specific fertility rates as reported by the Ministry of Health for 1994 and the UDHS three-year rate Age of MOH UDHS woman 1994 1993-95 15-19 73 61 20-24 282 266 25-29 173 176 30-34 95 114 35-39 30 39 40-44 5 9 45-49 0 3 TFR 3.31 3.34 Note: Age-specific fertility rates are per 1,000 women. The MOH rate is a one-year rate, while the UDHS rates are for the period 1-36 months preceding the survey (mid- 1993 to rnid-1996). 38 Table 3.4 Trends in aue-sDecific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of birth, Uzbekistan 1996 Number of years preceding the survey Mother's age 0-4 5-9 10-14 15-19 15-19 56 53 53 53 20-24 277 293 298 308 25-29 204 258 289 299 30-34 123 158 201 [238] 35-39 44 76 [107] 40-44 15 [46] 45-49 [8] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. from the UDHS data. 2 Table 3.4 presents age- specific fertility rates for five-year periods preceding the survey using data on live births from respondents' pregnancy histories. With the exception of 15-19 year-olds, there is evidence of a decline in fertility for all cohorts for which rates can be calculated. The decline in fertility from 5- 9 to 0-4 years prior to the survey increases from a 5 percent decline among 20-24 year-olds to a 42 percent decline among 35-39 year-olds. The UDHS data indicate that fertility among 25-29 year-olds has fallen by one-third over the past 20 years. Figure 3.3 shows a graphical represen- tation of these declines. Figure 3.3 Trends in Age-specific Fertility Rates Births per 1,000 Women 350 i:i O E - i 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Group ~F~ -~-5-9 -~-10-14 !15-191 UDHS1996 : Truncation progressively limits how far into the past fertility rates can be calculated. For example, rates cannot be calculated for women age 40-44 for the period 10-14 years before the survey because these women would have been over age 50 years at the time oftbe survey and therefore not interviewed. Partial rates (based on partial exposure time) can be calculated for women age 40-44 for the period 5-9 years before the survey because some of these women were age 45-49 at the time of the survey, and therefore included for interview. Partial rates which are subject to truncation are shown in brackets in Table 3.3. 39 Table 3.5 Trends in fertility by marital duration Fertility rates for ever-married women by duration (years) since first marriage for five-year periods preceding the survey, Uzbekistan 1996 Marriage duration at birth Number of years preceding the survey 0-4 5-9 10-14 15-19 0-4 346 378 382 382 5-9 210 243 293 300 10-14 99 158 204 267 15-19 49 94 137 * 20-24 15 53 * 25-29 I1 * Note: Duration-specific fertility rates are per 1,000 women. An asterisk indicates that a rate is based on fewer than 125 unweighted years of exposure and has been suppressed. The UDHS data allow calculation of the crude birth rate (CBR) and general fertility rate (GFR). As an additional indicator of fertility trends, Table 3.6 presents the CBRs and GFRs reported by the Ministry of Health. The UDHS data are consistent with the trend of decreasing fertility over the past decade. 3.3 Children Ever Born and Living Table 3,7 presents the distribution of all women and currently married women by number of children ever born. The greatest difference between the data for currently married women and the total sample occurs among young women, due to the large number of unmarried young women with minimal fertility. Differences at older ages reflect the general fertility- reducing impact of marital dissolution (divorce or widowhood). The table also shows the mean number of children ever born by five-year age group of the mother. It is apparent that the Table 3.5 presents fertility rates for ever-married women by duration since first marriage for f ive-year periods preceding the survey. The decline in fertility has occurred at all marital durations; however, the decline is greatest among women with longer marital durations. Fertility within the first several years of marriage typically remains less resistant to change, even when fertility is declining, because fertility decline usually begins among older women who want to stop their childbearing and not by young couples postponing births. Table 3.5 shows dramatic declines in fertility for all marital durations of five or more years. Table 3,6 Trends in birlh and fertility rates Crude birth rates and general tktility rates as reported by the Ministry of Health Year GFR CBR 1985 141 37.4 1990 141 33.7 1991 141 33.8 1992 139 32.9 1993 131 31.0 1994 126 29.4 1996 UDHS 123 26.7 GFR: Genera/ fertility rate, expressed per 1,000 women CI3R: Crude birth rate, expressed per 1,000 population Note: The MOH GFRs are calculated as the number of births divided by the number of women 15-49. The UDHS rate is calculated as births divided by the number of women 15-44, and pertains to the three-year period preceding the survey. distribution of women by CEB is fairly spread out; in other words, while the mean number of children ever born is 3.1, one cannot conclude that the average Uzbekistani family has three children (there are nearly as many women who have /tad four children as have had three). The modal number o f children among currently married women tends to increase by one with every increase in age group. In other words, most 20-24 year-olds have one or two children, most 25-29 year-olds have two or three children, and so on, concluding with the largest proportion of 45-49 year-olds having five children. This is reflected in the ever increasing mean number of children ever born, which increases steadily from 1.2 among married 20-24 year- olds to 4.9 among 45-49 year-olds. A cursory v iew of the survival status of children can be made by comparing the mean number of children ever born to the mean number surviving, also shown in Table 3.7. Overall, 94 percent of all children born had survived to the time of the survey, and the proportion surviving does not vary greatly by age of the mother. 40 3.4 Birth Intervals The length of birth intervals is an important component of childbearing. Research has shown that children born too close to a previous birth have an increased risk of dying, especially when the interval between births is less than 24 months. Table 3.8 presents the percent distribution of second- and higher- order births in the five years prior to the survey by the number of months since the previous birth. The median birth interval length is 30.6 months or about 2.5 years. Overall, 30 percent of births occur within 24 months of the previous birth (see Figure 3.4). Table 3.7 Children ever born and livina Percent distribution ofaU women aJad of currently marcied women age 15-49 by number of children ever born (CEB~ and mean number ever born and living, according to five-year age groups, Uzbekistan 1996 Number of children ever born (CEB) Number Mean no. Mean no. Age of of of living group 0 1 2 3 4 5 6 7 8 9 I0+ Total women CEB children ALL WOMEN 15-19 93.8 5.5 0.5 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 981 0.07 0.07 20-24 40.4 30.5 25.9 2.7 0.4 0.0 0.0 0.0 0.0 0.0 0.0 100.0 806 0.92 0.88 25-29 11.3 15.9 33.9 27.1 9.4 2.3 0.1 0.1 0.0 0.0 0.0 100.0 710 2.15 2.02 30-34 4.2 6.9 20.1 28.4 24.4 10.5 5.2 0.0 0.2 0.1 0.0 100.0 624 3.16 3.00 35-39 2.3 4.7 11.2 20.1 20.6 20.3 12.7 5.1 2.4 0.3 0.3 100.0 561 4.08 3.82 40-44 1.9 4.8 11.4 14.5 18.2 19.2 10.9 11.4 4.1 2.2 1.3 100.0 422 4.52 4.23 45-49 2.8 7.2 11.8 11.5 13.8 16.7 13.4 10.0 5.0 4.5 3.5 100.0 310 4.73 4.41 Total 31.3 11.9 16.5 13.7 10.4 7.4 4.3 2.5 1.1 0.6 0.4 100.0 4,415 2.26 2.12 CURRENTLY MARRIED WOMEN 15-19 52.7 41.7 4.1 1.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 125 0,54 0.49 20-24 22.0 38.9 34.9 3.7 0.6 0.0 0.0 0.0 0.0 0.0 0.0 100.0 599 1.22 1.16 25-29 5.1 15.6 36.6 29.5 10.4 2.5 0.1 0.1 0.0 0.0 0.0 I00.0 640 2.33 2.I8 30-34 2.0 5.2 19.7 29.4 26.3 11.4 5.7 0.0 0.2 OA 0.0 100.0 572 3.32 3.15 35-39 0.6 3.4 10.5 20.0 22.0 21.5 13.5 5.5 2.3 0.4 0.4 I00.0 520 425 3.98 40-44 1.2 3.2 10.6 15.1 18.9 19.4 11.4 12.5 3.9 2.4 1.5 100.0 383 4.66 4.35 45-49 1.2 6.0 10.6 11.5 14.8 18.2 13.7 9.5 5.6 5.2 3.7 100.0 264 4.94 4.62 Total 8.1 14.9 22.0 18.5 14.4 10.2 5.9 3.3 1.4 0.8 0.6 100.0 3,102 3.06 2.87 Three-quarters of closely spaced births occur to women in their twenties. As many as 41 percent of births to women in their twenties were born within 24 months of the previous birth. Because these are young women, the lowest birth orders (2 or 3 births) also show the greatest likelihood of being born soon after the previous birth. Births which occur after a prior death are twice as likely as births following a living child to be born within 24 months. Aside from age of the mother, parity, and survival status of the previous birth, the distribution of birth interval lengths is fairly similar across the other background characteristics shown in the table. It should be noted that while births to mothers in Tashkent City exhibit the longest median birth interval length of all the regions, these births are no less likely than births in other regions to be born within 24 months of the previous birth. The longer median interval is due to more births in Tashkent City occurring at the longest interval lengths (four or more years), than at intermediate lengths (two or three years), but not, however, due to fewer births being born at the shortest durations (32 percent of births to mothers in Tashkent City were born within 24 months of the previous birth). 41 3.5 Age at First Birth The age at which childbearing begins has important demographic consequences for society as a whole as well as for the health and welfare of mother and child. Early initiation into childbearing is generally associated with large family size and rapid population growth when family planning is not widely practiced. Table 3.8 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Uzbekistan 1996 Median Number of months since previous birth number of Number months since of 7-17 18-23 24-35 36-47 48+ Total previous birth births Characteristic Age of mother 15-19 * * * * * 100.0 * 9 20-29 16.3 24.5 35.7 14.9 8.6 100,0 25.9 901 30-39 6.1 10.3 31.0 19.2 33.3 11)0.0 37.4 712 40+ 2.2 8.8 26.5 15.0 47.5 100.0 40.9 82 Birth order 2-3 13.8 22.2 32.4 15.6 16.0 100.0 28.1 1,104 4-6 7.8 11.0 34.0 18.1 29.1 100.0 35.0 520 7 + 5.7 4.6 35.9 21,4 32.4 100.0 38.7 80 Sex of prior birth Male 9.1 16.1 34.9 17.7 22.3 100.0 32.4 826 Female 13.9 19.6 31.4 15.6 19.4 100.0 29.4 878 Survival of prior birth Living 10.2 17.7 33.8 16.9 21.4 100.0 31.1 1,599 Dead 32.4 21.6 22.5 12.7 10.9 100.0 22.3 105 Residence Urban 14.3 15.3 29.8 15.6 25.1 100.0 31.7 504 Rural 10.4 19,0 34.5 17.1 19.0 100.0 30.3 1,200 Region Region 1 17.3 15.3 35.1 14.8 17.5 100,0 29.3 196 Region 2 12.4 17.5 35.3 15.5 19.2 100.0 29.7 412 Region 3 12.0 19.9 31.5 16.1 20.5 100.0 29.4 511 Region 4 7.1 17.8 33.9 19.3 21.9 100,0 32.4 492 Tashkent City 17.4 14.7 23.2 14.2 30.5 100.0 33.0 93 Education Primary/Secondary 10.7 18.7 33.9 17.0 19.8 100.0 30.3 1,088 Secondary-special 14.2 16.1 33.8 15.4 20.5 IO0.O 30.5 462 Higher 10.1 17.7 25.2 18.2 28.8 100.0 34.5 155 Ethniclty Uzbek 11.7 17.9 33,1 16.1 21.3 100.0 30.5 1,502 Other 10.3 18.4 33.3 20.9 17.1 100.0 32.0 202 Total I 1.6 17.9 33.1 16.6 20.8 100.0 30.6 1,704 Note: First births are excluded. The interval for multiple births is Ibe number of months since the preceding pregnancy that ended in a live birth. An asterisk indicates that a figure is based on fewer than 25 unweiglrted cases and has been suppressed. Tab le 3.9 presents the percent d is t r ibut ion o f women by age at f i rst b i r th accord ing to cur rent age. The med ian age at wh ich women beg in ch i ldbear ing has been ho ld ing s teady at about 21.5. Most women have their f irst b irth wh i le in their ear ly twent ies, a l though about one-quar ter o f women g ive birth before age 20. 42 While the median age at first birth is close to 21.5 years for most age cohorts, there is some variability by background characteristics of respondents. Table 3.10 presents the median age at first birth for cohorts age 25 and above across background characteristics. Urban women have a median age at first birth (22.2 years) that is one year older than rural women (21.2 years). Women in Regions 1, 2, and 3 all exhibit similar median ages, while women in Region 4 have the lowest median age (21 years), and women in Tashkent City the highest (22.5 years). The educational differentials are as one would expect--women initiate childbearing later as their educational level increases. The median age at first birth increases successively by one year as education rises from primary/secondary to secondary-special and on to higher levels. Figure 3.4 Percent of non-first births born within 24 months of previous birth UZBEKISTAN AGE 20-29 30-39 40+ RESIDENCE Urban Rural Region Region 1 Region 2 Region 3 Region 4 Tashkent 30 ~:~':ii~i:;i::iiiiiiiiii:;iii~ 16 ~;?2:i::iii::iiiiiiiii{~ 11 ~///////////////////////////////~,////////f,~ 3o Fff~/./////,/////////////////////////~ 29 33 3032 25 32 10 20 30 40 50 UDHS1996 Table 3.9 A~e at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Uzbekistan 1996 Women Median with Age at first birth Number age at no of first Current age births <t5 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 93.8 0.0 2.3 3.9 NA NA NA 100.0 981 a 20-24 40.4 0.0 2.6 22.7 27.7 6.6 NA 100.0 806 a 25-29 11.3 0.3 1.9 25.2 33.4 24.9 3A 100.0 710 21.4 30-34 4.2 0.0 2.6 20.3 28.6 31.5 12.7 100.0 624 21.9 35-39 2.3 0.3 2.7 23.1 31.9 29.3 10.4 100.0 561 21.5 40.44 1.9 0.0 4.7 24.0 31.7 25.4 12.4 100.0 422 21.3 45-49 2.8 0.0 3.9 18.0 27.7 23.3 24.3 100.0 310 22.0 NA = Not applicable a Omitted because less than 50 percent of the women in the age group x to x+4 have had a birth by age x 43 3.6 Pregnancy and Motherhood Among Women Age 15-19 Fertility among women age 15-19 warrants special attention because young mothers at this age as well as their children are at high risk of encountering social and health problems. There has been much research done on this topic, but the causality of the problems has proven difficult to identify. Children born to young mothers are associated with higher levels of illness and mortality during childhood than are children born to older mothers. Table 3.10 Median ace at first birth Median age at first birth among women age 25-49 years, by current age and selected background characteristics, Uzbekistan 1996 Current age Background Ages characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 21.8 22.4 22.4 21.9 22.9 22.2 Rural 21.1 21.6 21.0 20.9 21.0 21.2 Region Region 1 21.9 21.9 21.5 21.6 20.2 21.6 Region 2 21.9 21.8 21.8 21.1 22.2 21.7 Region 3 21.3 21.9 21.4 22.0 23.3 21.7 Region 4 21.0 21.5 20.9 20.6 21.0 21.0 Tashkent City 21.8 22.8 22.5 23.0 22.8 22.5 Education Primary/Secondary 21.0 21.2 20.9 20.7 20.9 21.0 Secondary-special 21.7 22.1 22.3 22.1 23.3 22. I 11igher 23.0 24.0 23.5 23.2 23,9 23.5 Elhnicity Uzbek 21.3 21.7 21.4 21.0 21.6 21.4 Other 22.7 23.0 22.4 22.6 23,3 22.7 Total 21.4 21.9 21.5 21.3 22.0 21.6 Note: The medians for cohorts 15-19 and 20-24 could not be determined because half the women had not had a birth before reaching age 15 and age 20, respectively. Table 3.11 presents the percentage of women age 15-19 who are mothers or are pregnant with their first child. Early childbearing is not very prevalent in Uzbekistan; 10 percent of women age 15-19 have begun childbearing (have already given birth, or are pregnant with their first child at the time of the survey). However, giving birth at age 19 is not at all uncommon; nearly one-third (31 percent) of women age 19 have given birth or are pregnant with their first child. 44 Table 3.11 Preunancv and motherhood amon~ women ~g¢ 15-19 Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Uzbekistan 1996 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 0.0 0.0 0.0 198 16 0.0 0.0 0.0 217 17 0.3 2.9 3.2 195 18 6.4 9.0 15.4 184 19 26.1 5.2 31.3 187 Residence Urban 6.6 2.8 9.4 319 Rural 6.1 3.5 9.6 662 Region Region I 4.9 3.7 8.6 105 Region 2 5.0 2.3 7.3 266 Region 3 7.2 3.6 10.8 280 Region 4 6.7 3.8 10.5 262 Tashkent City 7. I 2.9 10.0 68 Education Primary/Secondary 5.9 3.4 9.3 807 Secondary-special 8.5 1.0 9.5 149 Higher (3.1) (12.8) (15.9) 26 Ethnicity Uzbek 6.5 3.3 9.8 838 Other 4.5 3.2 7.7 143 Total 6.2 3.3 9.5 98 I Note: Figures in parentheses are based on 25-49 unweighted cases. Tab le 3 .12 ind icates that 23 percent o f women age 19 have one ch i ld , and that 4 percent have two or more ch i ld ren . T~ble 3.12 Children born to women a~e 15-19 Percent distribution of women 15-19 by number of children ever born (CEB), according to single year of age, Uzbekistan 1996 Age 0 Number of Mean children ever born number Number of of 1 2+ Total CEB women 15 100.0 0.0 0.0 100.0 0.00 198 16 100.0 0.0 0.0 100.0 0.00 217 17 99.7 0.3 0.0 100.0 0.00 195 18 93.6 6.l 0.3 100.0 0.07 184 19 73.9 22.6 3.5 I00.0 0.31 187 Total 93.8 5.5 0.7 100.0 0.07 981 45 CHAPTER 4 CONTRACEPTION Damin A. Asadov, Farida M. Ayupova, Feruza T. Faizieva and Mila A. Li A primary function of family planning programs is to advocate conscious entry into parenthood for both men and women, i.e., to grant families the right to define their desired number of children and provide them the means to achieve that goal. Family planning involves the control of reproductive behavior, including conception, preservation of the fetus, and childbearing, as well as prevention of conception and interruption of pregnancy. Family planning not only helps couples to avoid undesired pregnancies, but also allows them to control the timing of their childbearing. By controlling the time they enter into parenthood, the time they stop childbearing, and the intervals between births, couples can achieve their ultimate desired family size. Family planning has positive effects on the overall health of both mother and child, and is also a contributing factor in the reduction of maternal and infant mortality, and secondary sterility. The efficacy of family planning depends on people's knowledge of methods and on the availability of methods to meet the varying needs of a wide spectrum of potential users. Availability of methods, in turn, depends on the quality and quantity of service providers and on available financial and technical resources. In Uzbekistan as well as in other republics of the former Soviet Union, induced abortion has been for years a primary method of fertility control. Only recently has the Ministry of Health actively engaged in efforts to reduce the heavy reliance upon abortion by providing safe and effective modern contraceptive methods. Family planning is considered as a part of maternal and child health services and is provided by the staffofwomen's consulting centers as well as obstetricians and gynecologists working in polyclinics and hospitals throughout the country. The Ministry of Health is responsible for the supply of contraceptives which are available free of charge from many government pharmacies, women's consulting centers and hospitals. In addition, in recent years private marketing of contraceptives (mainly oral contraceptives and injectables) through private pharmacies has become a significant source of supply of family planning methods. Family planning topics addressed in this chapter include knowledge of contraceptive methods, sources of supply, use of methods in the past and present, reasons for nonuse, desire to use in the future, and attitudes and exposure to family planning messages. These data can serve as an information base for the Ministry of Health and family planning organizations to better define the need for contraceptives and better define the allocation of resources. 4.1 Knowledge of Contraceptive Methods Determining levels of knowledge and use of contraceptive methods was one of the major objectives of the UDHS. Data on contraceptive knowledge were collected by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked if she recognized it. The respondent was also asked whether she had ever used each method. Current use of contraception was determined by asking whether the respondent (or her partner) was currently using a method, and if so, which one. Contraceptive methods include both modem and traditional methods. Modern methods include the pill, IUD, injectables, female sterilization, and the barrier methods (diaphragm, foam, jelly, and condom). Traditional methods include periodic abstinence (rhythm method), withdrawal, and vaginal douching. 47 Information on knowledge of contraceptive methods is presented in Table 4.1 for all women interviewed, and separately for currently married women ~ and women who have never had sexual intercourse. The knowledge of at least one method of contraception is high (89 percent). Also, 89 percent of respondents know at least one modern method and 32 percent know at least one traditional method. Women know, on average, four methods of contraception. Currently married women know an average of four methods, while women who have never had sex know on average two methods. Table 4.1 Kn0wled~e of contraceotive methods Percentage of all women, of currently married women and of women who have never had sex, who know specific contraceptive methods, by specific methods, Uzbekistan 1996 Women Currently who Contraceptive All married never method women women had sex Any method 88.8 95.7 69.5 Any modern method 88.7 95.5 69.4 Pill 68.5 75.7 46.7 IUD 87.4 95.0 65.7 lnjectables 55.5 63.7 31,9 Diaphragm/Foam/Jelly 15.8 18.4 6.7 Condom 48.8 54.1 32.1 Female sterilization 22. I 26.8 8.0 Any traditional method 32.2 39.0 10.8 Periodic abstinence 22.0 26.0 8.8 Withdrawal 22.8 28.0 5.7 Douche 2.2 2.9 0.3 Other 2.0 2,3 0,3 Any traditional/folk method 32.4 39.2 10.8 Number of women 4,415 3.102 1,099 The most commonly known method is the IUD (known by 87 percent of all women). The pill, injectables and condom are the next most commonly known methods, known by 69, 56 and 49 percent of women, respectively. The lesser known modem methods are still known by a significant proportion of women- -22 percent have knowledge of female sterilization and 16 percent know vaginal barrier methods such as the diaphragm, foam or jelly. The data in TaMe 4.1 show that knowledge of all methods is higher among currently married women than all women. Two-thirds of women who have never had sex know of the IUD (66 percent), while almost half have heard of the pill. For purposes of communicating family planning information, women of reproductive age who have not yet engaged in sexual intercourse are an equally important audience as are sexually active women because tbese women are certain to engage in sexual activity in the near future. Mean number of methods 3.5 3.9 2.1 Periodic abstinence is known by 26 percent of currently married women and Note: All women includes 14 unmarried sexually active women, withdrawal is known by 28 percent of these women. Traditional methods are not as commonly known among women who have never had sex (9 percent have heard of periodic abstinence and 6 percent have heard of withdrawal). Vaginal douche is known to 3 percent of currently married women. Folk methods mentioned by respondents include herbs, segment of a lemon, aspirin, iodine, vinegar, wine and others. They are known to 32 percent of all women, 39 percent of currently married women, and 11 percent of women who never had sex. Table 4.2 presents the percentage of currently married women who know of at least one method of contraception (modern or traditional) and the percentage who know of at least one modern method, by background characteristics. A high percentage of currently married women in all categories (more than 86 percent) know of at least one modern method of contraception. The currently married category includes women in both formal unions (civil or religious) and informal unions (living together). 48 4.2 Ever Use of Contraception All respondents who had heard of a method of contraception were asked whether they (or a partner) had ever used the method; each method was inquired about separately. Results are presented in Table 4.3 for all women and for currently married women by five-year age groups. Overall, 68 percent of currently married women have used a method of contraception at some time in their life. Fifty percent of all women age 15-49 have used a method at some time. Levels of ever- use among all women are somewhat lower than among currently married women because the former includes women who are not sexually active; the most significant differential is among 15-19 year-old women. While 16 percent of currently married 15-19 year-olds have ever used a method, only 2 percent of all 15-19 year-olds have done so; however, only 13 percent of all 15-I9 year- olds have ever had sex. The women most likely to have ever used contraception are those age 30-44 among both currently married and all women (74-84 percent have used a method of contraception). These women are also the most likely to have used a modern method of contraception. Table 4.2 Knowledae ofcontracentive methods bY I~ackground characteristics Percentage of currently married women who reported having heard of at least one method and at least one modem method by selected background characteristics, Uzbekistan 1996 Knowledge of contraception Knows Knows Number Background any modern of characteristic method method women Age 15-19 85.7 85.7 125 20-24 93.8 93.8 599 25-29 95.7 95.7 640 30.34 97.0 96.9 572 35-39 97.4 97.4 520 40-44 97.4 96.2 383 45-49 95.6 95.3 264 Residence Urban 97.2 97.0 1,168 Rural 94.7 94.5 1,935 Region Region 1 99.8 99.8 319 Region 2 94.2 93.6 705 Region 3 96.6 96.4 884 Region 4 93.2 93.2 917 Tashkent City 99.8 99.8 278 Education Primary/Secondary 94.3 93.9 1,903 Secondary-special 98.2 98.2 830 Higher 97.4 97.4 366 Ethniclty Uzbek 95.4 95.3 2,592 Other 96.9 96.5 511 Total 95.7 95.5 3,102 Note: Total includes four women with no education. By far the most widely ever used method is the IUD. Overall, 43 percent of all women of reproductive age and 59 percent of currently married women have ever used the IUD. More than 70 percent of currently married women 30-39 have used an IUD at some time in their life. Condoms are the next most commonly used modem method with 11 percent of currently married women having used a condom at some time. Pills are the third most commonly tried modem method with 6 percent of currently married women having used them at some time in their ~ife. Other modern methods (injectables, diaphragm and female sterilization) have been used at some time by only 4 percent of currently married women. While more women have used modern than traditional methods, many women have in fact used a traditional method at some time. Overall, 16 percent of currently married women have ever used a traditional method while 12 percent of all women have done so. Periodic abstinence and withdrawal are the traditional methods most likely to have been used by women at some time in their life. Six percent of currently married women have used periodic abstinence and 12 percent have used withdrawal. Two percent of currently married women have used vaginal douching as a method of contraception. 49 Tablg 4.3 Ever use of contraception Percentage of all women and of currently married women who have ever used any contraceptive method, by specific method and age, Uzbekistan 1996 Modem method Traditional method Any Any Female Any Periodic uad./ Number Any modern Inject- sterili- Other trad. absti- With- Other folk o1" Age method method f'iff IUO ables Condom zation modern method hence drawal Douche methods method women ALL WOMEN 15-19 2.1 2.0 0.2 I 7 0.0 0.1 0.0 0.0 0.3 0.0 0.3 0.0 0.0 03 981 20-24 34 1 306 2.6 26.3 0 8 57 0.2 0.3 9.0 2.4 7.2 1.0 0.3 9.1 806 25-29 63.1 61.4 62 555 2.7 106 0.3 0.5 13.5 5.0 10.0 1.1 0.7 13.6 710 30-34 77.3 74.6 7.5 68.2 4.1 10.8 0.3 0.2 14 7 5.3 10.0 1.6 0.6 15.1 624 35-39 79.9 77.7 7.6 709 50 13.8 0.9 1.4 18.1 6.6 139 2.2 1.5 18.8 561 40-44 74.4 70.4 9.1 62.4 3.8 13.7 1.4 1.1 20.0 9.4 13.9 3.1 1.5 21.0 422 45-49 66.1 621 4.0 56.1 07 14.6 2.4 1.0 24.9 12.0 16.9 4.1 1.3 25.3 310 Total 49.7 47A 4 7 42.7 22 84 05 0.5 I 1.9 4.6 8.7 1.5 0.7 12.2 4,415 CURRENTLY MARRIED WOMEN 15-19 16.2 15.8 1.8 129 0.0 1.0 0.0 0.0 2.1 0.0 2.1 0.4 0.0 2.1 125 20-24 45.2 40.6 3.4 35.0 0.9 7.2 0.2 0.3 11.8 3.2 9.3 1.4 0.2 I 1.9 599 25-29 682 66.2 66 60.2 2.8 11.3 0.4 0.6 14.9 5.5 IIA 1.3 0.8 15.0 640 30-34 81.5 785 78 72.1 4.5 I LO 0.3 0.2 14.9 5.5 10.1 1.7 0.7 15.4 572 35-39 83.8 81.4 7.9 74.3 5.2 13.9 I0 1.5 18.4 6.6 14.1 2.2 IA 19.2 520 40J.4 78.5 74.5 9.1 66.5 41 13.7 1.3 1.1 21.1 10.1 14.3 3.4 1.4 22.1 383 45-49 66.8 64.6 2.9 59.0 0.8 13.5 2.1 1.0 23.0 10.0 15.6 4.3 1.1 23.4 264 Total 67.9 649 6.2 58.7 3.0 10.9 0.7 0.7 158 6.0 11.5 2.0 0.8 16.2 3,102 4.3 Current Use of Contraception Tab le 4.4 presents levels o f current use o f contracept ion for al l women and for current ly marr ied women by f ive-year age groups. F igure 4.1 shows the distr ibut ion o f current ly marr ied women by method current ly used. More than one out o f every three women o f reproduct ive age (37 percent) is current ly us ing a modern method o f contracept ion, wh i le only 3 percent are using a tradit ional method. Among current ly marr ied women more than ha l f (51 percent) are using modern methods o f contracept ion and 4 percent are us ing tradi t ional methods. The IUD is by far the most commonly used method- -a lmost ha l f o f current ly marr ied women are using the 1UD (46 percent). Other modem methods o f contraception account for only a smal l amount o f use among currently marr ied women: pil ls and condoms (2 percent each), and injectables and female steri l izat ion (1 percent each). Thus, the pract ice o f fami ly p lanning in Uzbek is tan p laces h igh re l iance on a s ingle method, the IUD, although the pill, condom and injectables are wide ly known (each known to more than 50 percent o f marr ied women). The situation with respect to female steri l ization is dist inctly different; i.e., both the level o f knowledge (27 percent) and the level o f use are low. S ince the goal o f the fami ly p lann ing program is to provide each woman with a choice o f safe and effect ive methods which are appropriate to her, more effort should be made to provide information about female steri l ization to women, especia l ly those who want no more chi ldren and wish to avoid any risk o f chi ldbearing. This point wi l l be raised again in Chapter 7 where contracept ion is considered in relat ion to the fert i l i ty desires o f women. 50 Table 4.4 Current u$¢ of contraception Percent distribution ofaU women and of currently married women who are currently using a contraceptive method by specific method, according to age, Uzbekistan 1996 Modem method Traditional method Any Female Any Periodic Douche/ Not Number Any modem Inject- sterili- trad. absti- With- other currently of Age method method Pill IUD ables Condom zation method nenee drawal methods using Total women ALL WOMEN 15-19 2.0 1.9 0.2 1.7 0.0 0.1 0.0 0.l 0,0 0.O 0.0 98.0 100.0 981 20-24 26,4 24.0 1.2 21.4 0.5 0.6 0.2 2.4 0.3 2.0 0.l 73.6 100.0 806 25-29 50.5 48.7 1.9 43.8 0.9 1.7 0.3 1.8 0.5 1.3 0.I 49.5 100.0 710 30-34 63.8 58.5 1.0 53.g 2.1 1.3 0.3 5.2 1.1 3.9 0.3 36.2 100.0 624 35-39 70.2 66.1 2.5 58.3 2.3 2,2 0.9 4.0 0.8 2.8 0.5 29.8 100.0 561 40-44 58.7 51.8 1.6 44.3 1.6 2.9 1.4 6.9 2.6 3.5 0.7 41.3 100.0 422 45-49 37.3 32.7 0.0 28.7 0.5 l.I 2.4 4.3 2.0 2.0 0.6 62.7 100.0 310 Total 39.6 36.6 1.2 32.6 1.0 1.2 0.5 3.0 0.8 2.0 0.3 60.4 100.0 4,415 CURRENTLY MARRIED WOMEN 15-19 15.8 15.0 1.5 12.9 0.0 0.6 0.0 0.8 0.0 0.4 0.4 84.2 100.0 125 20-24 35.5 32.2 1.7 28.8 0.6 0.8 0.2 3.3 0.4 2.7 0.2 64.5 100.0 599 25-29 55.1 53.1 2.2 47.8 1.0 1.8 0.4 2.0 0.5 1.4 0.l 44.9 100.0 640 30-34 68.9 63.2 1.0 58.1 2.3 1.4 0.3 5.7 1.1 4.3 0.4 31.1 100.0 572 35-39 74.7 70.3 2.6 62.3 2.4 2.1 1.0 4.3 0.9 3.0 0.6 25.3 I00,0 520 40-44 64.2 56.6 1.8 48.4 1.8 3.2 1.3 7.6 2.9 3.9 0.8 35.8 I00.0 383 45-49 42.3 36.9 0.0 32.9 0.6 1.3 2,1 5.0 2.3 2.3 0.7 57.7 100.0 264 Total 55.6 51.3 1.7 45.8 1.4 1.7 0.7 4.2 l.l 2.8 0.4 44.4 I00.0 3,102 Figure 4.1 Use of Specific Contraceptive Methods among Currently Married Women IUD 46% Condom 2% Other modern 2% Traditional/folk method 4% Pill 2% Not currently using 44% UDHS 1996 51 Use of modern methods of contraception increases steadily by age, peaking at age 35-39 (70 percent of currently married women) and then declines. Use of traditional methods remains relatively constant over all ages. Of course, the desire to avoid pregnancy varies greatly over the course of one's reproductive life; use of contraception in relation to the age and fertility preferences of women is discussed in Chapter 7. Levels of contraceptive use by background characteristics of respondents are presented in Table 4.5 and Figure 4.2 for currently married women. Perhaps the most significant finding of Table 4.5 is that the level of modern contraceptive use observed for the population as a whole is maintained across background characteristics of respondents. Most of the differentials observed in overall levels of use can be attributed to differential levels of use of traditional methods. For example, urban women, women living in Tashkent City, women with higher education and women of other than Uzbek ethnic groups are much more likely to be using a traditional method of contraception than women with other background characteristics. Approximately half of currently married women living in the Regions 2, 3, and 4 are using a method of contraception, compared to two-thirds of women living in Region 1 and Tasbkent City. The correlation of contraceptive use with fertility levels is not very clear by region. For example, a high level of contraceptive use in Tashkent City (65 percent) corresponds with the relatively low fertility rate (the TFR in Tashkent City is 2.3, compared to the national TFR level of 3.3). However, Region I with a high fertility rate (TFR is 3.5) also has high contraceptive prevalence (64 percent). A more complete investigation of regional fertility differentials would have to consider factors such as age at marriage, breastfeeding practices, and induced abortion, in addition to the use of contraception. Table 45 Current use ofcontraceotion bv backeround characteristics Percent distribution of currently married women by contraceptive method currently used, according to selected background characteristics, Uzbekistan 1996 Modern method Traditional method Any Female Any Periodic Douche/ Not Number Any modem Inject- sterili- trad. ahsti- With- other currently of Characteristic method method Pill IUD ables Condom zation method nence drawal methods using Total women Residence Urban 564 502 2(I 420 16 38 08 60 23 29 10 436 10O0 1,168 Rural 551 520 I4 482 14 04 06 3 I 04 27 O0 449 lOg.0 1,935 Region Region I 640 617 (13 593 15 1) 3 03 23 18 04 0.I 360 1000 319 Region 2 529 496 0 b 445 2 1 16 O 8 33 07 25 00 47.1 1000 705 Region3 496 442 20 385 15 18 05 54 07 47 0O 504 1000 884 Region 4 578 566 20 529 08 02 07 12 05 07 00 422 1000 917 Tashkent City 646 488 37 342 16 81 I I 149 49 68 41 354 1000 278 Education Primars,/Secondars, 53 I) 49 4 I I 45 3 I 5 I I 04 3 6 04 3.2 0 I 47 0 10O0 1,903 Secondary-special 60 7 566 2 8 48.6 1 7 2 3 I 2 39 1 1 22 0.8 39.3 1000 830 lligher 581 500 20 429 06 33 lO 80 51 21 09 419 100.0 366 E I h nicil3,' Uzbek 549 512 14 466 13 I I 07 36 0.6 28 02 451 100.0 2,592 Other 594 518 29 419 20 44 06 72 3.5 28 13 406 100O 511 Number of living children 0 56 47 I 5 11 0.6 16 O0 09 07 02 00 944 lO00 272 1 354 310 22 264 05 19 00 43 08 2.9 117 646 1000 496 2 625 582 I 8 52 1 13 2 I 10 40 16 20 07 375 100.0 708 3 646 604 18 551 14 20 02 42 10 30 03 354 1000 583 4+ 685 633 13 574 22 12 12 51 I I 39 02 315 1000 1,043 Total 556 513 17 458 14 I 7 07 4.2 I I 28 04 444 I000 3,102 Note: Total includes Ibur ~somen with no education 52 Figure 4.2 Current Use of Family Planning by Background Characteristics Currently Married Women Age 15-49 UZBEKISTAN I RESIDENCE I Urban } Rural I i i i REGION Region 1 == = ~ ;==~=:i Region 2 ; i Region 3 - - -~: - - Re ion 4 Tas~ kent EDUCATION Primary/Secondary Secondary-special Higher NO. LIVING CHILDREN 0 1 3 4+ i:i:~i~i~ii~ii~i~i;ii~:i~ii~i~:i~iiiii~i~i`~i~ii~i~iiiii~i~i~ii~i~ii~i~ii~i~i~]~i~i~i~im 55,5 i~ ~ i!i~ii~ i~i i~i~ i~i~ ~ill i~i ~i~ii~i~ ~ii~i~ii~ i illlilli~ii~i~ii~i~illli~ili~i~ili~iii~iiiii~illi~il ~il ;i,li~i~il ~6 ,2 i~iii~ii!~iiii~ii~ii~i~ii;~ii~iiiii;ii[~1~i!ii~!~!i!~!i~i!iiiii~!~ii!ii~ii:~i~ii~iiii!!i~iHi~iiiiiii:iii!ii!i!i!iii!iiiii!i!!i!~i!~i~i~ii!i~ii!~i!~ I~11 ~S.1 ~iiiiiii | 6 .9 10 20 30 40 50 60 Percent [~Modern Methods ITraditional/FolkMethod I 70 80 Note: Currently married women age 1549 UDHS 1996 Women with primary or secondary education have lower levels of contraceptive use (53 percent) than do women with secondary-special or higher education (61 and 58 percent, respectively). Uzbek women and women of other ethnicities are equally likely to be using a modem method of contraception (51 and 52 percent, respectively). However, women of other ethnic backgrounds are more likely than Uzbek women to be using a traditional method (7 and 4 percent, respectively) resulting in slightly higher contraceptive use among women of other ethnicities (59 percent versus 55 percent for Uzbek women). The level of contraceptive use increases with an increasing number of living children. Use of contraception among married women with no children is quite low (5 percent are using a modern method and 1 percent are using a traditional method). Any differentials in the method mix are overshadowed by the heavy reliance on the IUD among women of all background characteristics (the only exception being women with one or no children). However, the broadest method mix is observed among women in Tashkent City. While use of the IUD still predominates (34 percent), use of modem methods other than the IUD is higher in Tashkent City than any other region: condoms (8 percent) and the pill (4 percent). Nevertheless, even with this broader mix of modem methods, withdrawal still ranks as the third most commonly used method (7 percent) among women in Tashkent City. Withdrawal is the second most commonly used method among women in Regions 2 and 3. In order to gather data on pill brands, users of the pill were asked to present their pill package to the interviewer, who then recorded the brand name of the pills. Overall, 65 percent of pill users were able to present their packets to the interviewer. Respondents who were unable to present the package were asked to report the brand name of their pills. In total, brand information was obtained from 52 respondents. 53 Table 4.6 presents the distribution of pill users by their brand of pills. The table presents data for all pill users, regardless of marital status. Table 4.6 indicates that nine brands of pills were reported as being used, with the most commonly used brand being Rigevidon (62 percent). 4.4 Number of Children at First Use of Contraception To make some assessment of the motivations behind using family planning methods, women were asked how many living children they had at the time they first used a method of family planning. Women who use a method before ever having a child presumably want to delay their childbearing to some time in the future. Women who first employ a method after they have had one or two children may either want to delay the next child or limit their childbearing to one or two children. Women who use a method for the first time after having several children are more likely to be using family planning to stop childbearing, rather than simply spacing their childbearing. Table 4.7 presents the percent distribution of all ever- married women by the number of living children they had at the time they first used a method of family planning. Use of family planning to delay the first pregnancy is uncom- mon in Uzbekistan (2 percent of women have done so). Three percent of ever-married 20-24 year-olds and more than 1 percent of 15-19 Table 4.6 Use of Dill brands Percent distribution of pill users by the brand of pills used, Uzbekistan 1996 Pill brand Total Bisecurin 0.9 Diane-35 2.8 Microgynon 3.0 Non-ovlon 0.9 Ovidon 6.2 Postinor 0.9 Rigevidon 61.6 Triziston 0.9 Triquilar ED Fe 8.0 Don't know/missing 14.6 Total 100.0 Number 52 year-olds have used a method before ever having a child. Tile decreasing median number of l iving children at t ime of first use at younger ages also indicates that more women are now acting to delay their first pregnancy than they have in the past. Older women (over the age of 35) had a median of 4.0 children before they first used contraception; younger women have a median of approximately 2.0 children at their first use of contraception. Table 4.7 Number of children at the lime of first use of contracet~tion Percent distribution of ever-married women by number of living children at the time of first use of contraception, and median number of children at first use, according to current age, Uzbekistan 1996 Never Number of living children at time used of first use of contraception Number contra- of Current age ception (I I 2 3 4+ Total women Median 15-19 84.1 1.4 11.3 3.3 0.0 0.0 100.0 127 1.6 20-24 56.0 3.4 22.8 16.6 1.0 0.1 100.0 622 1.8 25-29 33.4 1.4 17.0 28.7 13.6 5.8 100.0 673 2.5 30-34 21.2 1.3 I 1.3 23.1 22.7 20.3 100.0 613 3.2 35-39 19.1 0.9 11.2 12.4 17.8 38.7 100.0 555 3.9 40-44 25.3 0.9 10.1 11.5 11.8 40.5 100.0 420 4.2 45-49 33.0 1.0 12.9 10.9 9.3 32.9 100.0 306 3.9 Total 33.9 1.6 14.6 17.9 12.5 19.6 100.0 3,316 2.9 Fifteen percent of ever-married women had one living child at the time they first used a method of contraception; this percent does not change greatly with age, with the exception of 20-24 year-olds and 25-29 year-olds, among whom 23 and 17 percent, respectively, first used a method after having one living child. 54 4.5 Knowledge of the Fertile Period and of the Contraceptive Effect of Breastfeeding Knowledge &reproductive physio- logy is an important prerequisite for effective use of traditional contraceptive methods. To successfully practice periodic sexual abstinence, a woman must know at which point during the ovulation cycle she is most likely to become pregnant. All women were asked whether they thought there was a time during their monthly cycle that they were more likely to become preg- nant, and if so, to identify when that was. Table 4.8 presents the percent distribution of all women, women who have ever used any form of periodic abstinence, and women who have specifically ever used the calendar rhythm method by their knowledge of the fertile period. Only 10 percent of all respondents properly identified the middle of the cycle as the most likely time to become pregnant. Table 4.8 Knowledge of the fertile oeriod Percent distribution of all women and of those v,'bo currently use periodic abstinence or the calendar rhythm method, by knowledge of the fertile period during the ovulatory cycle, Uzbekistan 1996 Current users off Perceived All Periodic Calendar fertile period women abstinence rhythm During menstrual period 0. I 0.0 (0.0) Right after period has ended 2.6 11.3 (12.0) In the middle of the cycle 10.3 74.4 (72.9) Just before period begins 0.2 0.0 (0.0) At any time 55.4 13.0 (13.8) Other 0.0 0.0 (0.0) Don't know 31.3 1.3 (1.3) Total 100.0 100.0 100.0 Number 4,415 35 33 Note: Three respondents reported using the symptothermal method. Figures in parentheses are based on 25-49 unweighted cases. Most of the remaining respondents said either that there is no time which is more likely than another (55 percent of all women), or simply did not know (31 percent of all women). On the other hand, most women who are using either periodic abstinence or the calendar rhythm method know about the varying likelihood to become pregnant. Seventy-four percent of women who are using periodic abstinence and 73 percent of women who are using the calendar method could properly identify the time during which they are most fertile. Exclusive and frequent breastfeeding can prolong the period of time following a birth during which a woman is amenorrheic (not menstruating) and anovulatory (not ovulating). It has also been shown that even after the resumption of menstruation the probability of pregnancy is lower among women who continue to breastfeed than among women who have stopped (Hobcraft and Guz, I99 l; Ports et al., 1985). Women were asked what effect, if any, breastfeeding has on the risk of pregnancy. Women were also asked whether they have ever relied on breastfeeding as a method of contraception and whether they are currently doing so. These data are shown in Table 4.9 for currently married women. Only one-sixth of women (16 percent) report that breastfeeding reduces the risk of becoming pregnant. The great majority of women (81 percent) believe that breastfeeding has no effect on the risk of becoming pregnant; this level is maintained across most background characteristics. Thirteen percent of currently married women have used breastfeeding as a means of contraception at some time in their lives, and 10 percent of women report they are currently doing so. Women in Region 3 and Tashkent City are the most likely to have used breastfeeding for family planning purposes (both 18 percent) and are also the most likely to be current users (15 and 12 percent, re

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