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, respectively). 55 Table 4.9 Perceived contraceptive effect of breastfeedine Percent distribution of currently married women by perceived risk of pregnancy associated with breastfeeding and percentage who previously relied on bre~tfeeding to avoid pregnancy, who currently rely on breastfeeding to avoid pregnancy and who meet lactational amenorrheic method (LAM) criteria, according to selected background characteristics, Uzbekistan 1996 Perceived risk of pregnancy associated with breastfeeding Reliance on breast feeding to avoid pregnancy Don't Meet Number Background Un- In- De- know/ Previ- Cur- LAM of characteristic changed creased creased Depends missing Total ously rently criteria I women Age 15-19 91.1 4.3 4.5 0.0 0.0 100.0 1.5 1.5 2.3 125 20-24 86.9 0.9 I 1.0 0.3 0.9 100.0 8.4 6.1 2.3 599 25-29 79.6 2.5 17.1 0.4 0.4 100.0 13.7 11.2 1.2 640 30-34 81.4 2.4 15.4 0.4 0.4 100.0 11.9 10.0 1.0 572 35-39 76.9 4.1 17.6 0.9 0.4 100.0 15.3 13.4 0.0 520 40-44 78.5 1.8 19.1 0.4 0.2 100.0 14.6 12.8 0.0 383 45-49 78.9 0.2 19.6 0.8 0.5 100.0 16.9 12.0 0.0 264 Residence Urban 78.4 1.6 18.6 1.0 0.4 100.0 14.6 12.2 0.7 1,168 Rural 82.9 2.6 13.9 0.2 0.5 100.0 11.2 9.1 I.I 1,935 Region Region 1 79.4 0.7 19.4 0.0 0.5 100.0 12.7 9.3 1.7 319 Region 2 81.4 5.6 12.9 0.1 0.0 100.0 9.1 8.1 0.7 705 Region 3 76.6 1.8 20.6 0.2 1.0 100.0 17.6 14.6 0.6 884 Region 4 89.8 0.9 8.3 0.7 0.3 100.0 8.6 7.6 1.3 917 Tashkent City 68.6 1.6 26.8 2.5 0.5 100.0 17.7 11.6 0.7 278 Education Primary/Secondary 83.0 2.3 14.4 0.2 0.2 100.0 12.0 9.8 1.1 1,903 Secondary-special 78.8 2.3 17.1 1.0 0.7 100.0 13.7 11.2 0.7 830 Higher 76.9 1.9 18.9 I,I 1.2 100.0 12.1 10.4 0.6 366 Ethnicity Uzbek 81.6 2.3 15.1 0,5 0.5 100.0 12.3 10.1 0.9 2,592 Other 78.9 1.9 18.2 0.6 0.5 100.0 13.5 10.9 1.2 511 Total 81.2 2.2 15.6 0,5 0.4 100.0 12.5 10.2 1.0 3,102 Note: Total includes four women with no education. i Currently fully breastfeeding, child is less than 6 months old, and mother is postpartum amenorrheic Tab le 4.9 also presents the proport ion o f current ly marr ied women who meet the lactat ional amenorrheic method (LAM) cr iter ia. In order to meet these cr iter ia, a woman must be fu l ly breast feed ing a chi ld who is less than six months old, and she must also be amenorrheic. One percent o f women meet the LAM cr i ter ia. 4.6 Source of Family Planning Methods In Uzbekistan, modem methods of contraception, such as the IUD, the pill, condoms, and injectables, are d is t r ibuted through the publ ic medica l sector free o f charge. Publ ic sector sources inc lude de l ivery hospitals, polycl inics, women's consult ing centers and pharmacies. Modem contracept ives are also avai lable for a fee at commerc ia l faci l i t ies. 56 All women currently using a modern method were asked where they most recently obtained their method. ~ Table 4.10 shows the percent distribution of current users of modern contraceptives by the source from which they most recently obtained their method. Table 4.10 Source of suonlv for modem contracentive meth9ds Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Uzbekistan 1996 Method Female sterili- Source of supply Pill IUD lnjectables Condom zation Total Public 88.3 98.7 100.0 96.5 100.0 98.3 Hospital 25.3 57.8 33.0 0.0 100.0 54.8 Polyclinic 8.6 14.5 31.5 1,8 0.0 14.2 Women's consulting center 15.3 18.9 15.2 2.5 0.0 17.8 Pharmacy 25.7 2.0 11.0 89.6 0.0 5.9 Community health worker 3.5 0.5 1. I 2.6 0.0 0,7 Other 10.0 5.0 8.2 0.0 0.0 5.0 Private medical 2.8 0.2 0,0 0.9 0.0 0.3 Pharmacy 2.8 0.0 0.0 0.9 0.0 0.2 Other 0.0 0.2 0.0 0.0 0.0 0. I Other 8.9 0.| 0.0 2.6 0.0 0.4 Friends/relatives 6.3 0.0 0.0 0.0 0.0 0.2 Other 2.6 0.0 0.0 2.6 0.0 0.2 Missing 0.0 1.1 0.0 0.0 0.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 52 1,440 44 54 24 1,614 The vast majority of women obtained their contraceptives through the public sector (98 percent). Fifty-five percent obtained their method from a hospital, while 18 percent obtained their method from a womens' 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 use consulting centers or polyclinics to obtain their pills (24 percent), and some obtain their pills from friends or relatives (6 percent). Figure 4.3 summarizes the distribution of current users of modern methods by source of method, All current users of modern methods were asked whether they know a source for family planning other than the source from which they most recently obtained their method. Women who do know an alternative source were asked to explain the main reason they went to their most recent source instead of the alternative source. Results are presented in Table 4.11 by background characteristics of respondents. 2 Data collection included recording of the name of the source so that team supervisors and editors could verify the type of source. 57 Figure 4.3 Distribution of Current Contraceptive Users by Source of Supply Pharmacy Other Public Sector 5% Other 2% Women's consulting center 18% ~olyelinic 14% Hosplta( 55% UDHS 1996 Eighty-four percent of women went to their current source of supply because they do not know any other source. Among users who do know more than one place to obtain methods, 61 percent went to the place they did because it was closer to home (reason given by 9 percent of all users). Two percent of users chose their source because it had a more competent and friendly staff. There was some variability by background characteristics of respondents in whether or not users of modem methods know more than one place to obtain methods. Rural women are much more likely than urban women to know only one source of supply (91 and 72 percent, respectively). The greatest differentials are seen across the regions of Uzbekistan. In Tashkent City, only 37 percent of users know only one source to obtain a method, while in Regions 1-4, as many as 86, 97, 83, and 88 percent of women, respectively, know only one source. 4.7 Intention to Use Family Planning Among Nonusers Intentions of women to use family planning methods in the future provide a basis for forecasting potential requirements of family planning services. The UDHS asked nonusers of contraception whether they intend to use a method at some time in the future, and more specifically, whether they intend to do so within the next 12 months. Table 4.12 presents the results for currently married women according to their past experience with contraception and by the number of living children they have. Overall, 43 percent of currently married nonusers intend to use a method of family planning at some time in the future; 22 percent intend to use within the next 12 months, 19 percent at some more distant time in the future, and the remaining 2 percent are unsure as to when they would use a method. Thirty-six percent of nonusers who intend to use a method at some time in the future are women who have used a method at some time in the past. 58 Tablo 4.11 Satisfaction with current sources of suvDlv for contracevtive methods Percent distribution of current users of modem contraceptive methods by satifraction with most recent source of supply, according to selected background characteristics and reason for using a method, Uzbekistan 1996 Main reason for using current source of supply Staff" Longer Use Know Trans- compe- hours other no Closer Closer port tent, Offers Shorter of sere- Low Don~ Number Background other to to avail- friend- Cleaner more waiting opera- ices cost, know/ of characteristic source home work able ly facility privacy time tion there cheaper Other Missing Total users Residence Urba~ 72.4 16.1 2.5 0.6 4.3 0,2 0.6 0.6 0.2 0.1 0.2 1.6 0.6 10033 603 Rural 90.5 5.1 0.8 0,2 1.0 0.1 0.2 0.1 0.0 0.1 0.0 0.5 1.6 100.0 1,011 Region Region 1 86.2 7.4 0.2 0.0 0.4 0.5 0.7 0.5 0.0 0.5 0.0 3.7 0.0 100.0 200 Region 2 96.8 1.9 0.2 0.2 0,2 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.4 100.0 352 Region 3 82,6 12.1 1.5 0.0 0.5 0.0 1.2 0.3 0.0 0.0 0.3 0.7 0.8 100.0 400 Region 4 87.6 5.4 1.8 0.3 2,1 0.0 0.0 0.2 0.0 0.0 0.0 0.0 2.6 100.0 520 Tashkent City 36.8 35.7 4.5 2.1 15.1 0.3 0.0 0.3 0.7 0.0 0.0 3.4 1.0 100.0 142 Education Primary/Secondary 88,8 6.8 0.5 0.2 1.5 0,0 0.1 0.2 0.1 0.1 0.1 0.5 1.1 I00.0 948 Secondary-special 79.4 11.2 3.0 0.6 2.3 0.2 0.8 0.0 0.1 0,2 0.0 1.2 1.0 100.0 478 Higher 69.1 16.4 2.0 0.5 5.5 0.2 0.7 1.0 0.0 0.0 0.0 2.3 2.2 100.0 188 Ethnlcity Uzbek 85.7 7.8 1.3 0.2 2.1 0.1 0.3 0.3 0.1 0.1 0.1 0.7 1,4 100.0 1,339 Other 74.0 16.2 2.0 0.9 3.0 0.2 0,8 0.2 0.0 0.2 0.0 2.1 0.5 100.0 275 Reason for using To space To limit Total 84.5 6.8 1.2 0.2 2.1 0.1 0.6 0.3 0.0 0A 0.0 1.3 2.7 I00.0 593 83.2 10.6 1.6 0.4 2.3 0.1 0.2 0.2 0.1 0.1 0.1 0.7 0.3 100,0 1,021 83.7 9.2 1.4 0.3 2.2 0.1 0.4 0.2 0.1 0.1 0.1 0.9 1.2 100.0 1,614 Nonusers who intend to use a method later in the future tend to be women with fewer children. While most nonusers with one or no children say they intend to use a method at some time beyond the coming 12 months, most nonusers with two or more children who intend to use a method say they intend to do so within the next 12 months. Forty-one percent of all currently married nonusers of contraception do not intend to use a method of family planning at any time in the future. The percent who do not intend to use increases as number of children increases; 31 percent of nonusers with one child say they do not intend to use, while 61 percent of nonusers with four or more children say they do not intend to use. The UDHS results (data not shown) indicate that more than 21 percent of all nonusers of contraception 3 visited a health facility at some time in the 12 months prior to the survey but were not spoken to about family planning. This represents a significant lost opportunity on the part of the health community to impart knowledge about family planning to the population. In addition, 66 percent of the nonusers did not visit a health facility within the 12 months prior to the survey; this translates to 88 percent of all nonusers having had no contact with a health professional regarding family planning in the previous 12 months. 3 These data, which are not presented, refer to all nonusers regardless of marital status. 59 Table 4.12 Future use ofeontraeeotion Percent distribution of currently married women who are not using a contraceptive method by past experience with contraception and intention to use in the future, according to number of living children, Uzbekistan 1996 Past experience with contraception and future intentions • . . 1 Number of living children 0 1 2 3 4 + Total Never used contraception Intend to use in nex~ 12 months 2.5 18.9 17.0 10.1 7.0 12.4 Intend to use later 34.0 20.8 13.5 8.8 2.2 13.6 Unsure as to timing 1.2 3.2 1.1 0.0 0.4 1.3 Unsure as to intention 23.0 16.9 14.2 11.0 10.5 14.2 Do not intend to use 35.1 28.8 23.8 30.0 37.8 30.8 Previously used ctmtraceptlon Intend to use m next 12 months 1.6 2.8 12.4 15.7 12.4 9.4 Intend to use later 2.3 3.9 7.2 9.9 3.3 5.3 Unsure as to timing 0.0 0.5 0.7 02 0.8 0.5 [Insure as to intention 0.4 1.8 2.5 4.8 2.8 2.6 Do not intend to use 0.0 2.5 7.7 9.6 22.8 98 Total 100.0 100.0 100.0 100.0 1/10.0 100.0 All currently married nonusers Intend to use in next 12 months 4.1 21.7 29.4 25.7 19.4 21.9 Intend to use later 36.3 24.7 20.7 18.7 5.5 18.9 LTnsure as to timing 1.2 3.7 1.7 0.2 1 2 1.8 Unsure as to intention 23.4 18.6 16.7 15.8 13.3 16.8 Do not i~ltcnd to use 35.1 31.3 31.5 39.6 60.7 40.6 Tolal 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 126 364 304 230 354 1,378 IIncludes current pregnancy 4.8 Reasons for Nonuse of Contracept ion The UDHS asked all nonusers who do not intend to use a method o f family p lanning at any t ime in the future the reason they do not intend to use. These results are presented for all women in Table 4.13, and for women be low and above age 30. Overal l , the most common reason given for not using contraception is opposition to family p lanning on the part o f the respondent (29 percent); this was the most common reason for older (34 percent) nonusers compared to younger (19 percent) nonusers. The second most COlmnon reason for nonuse was the desire for more chi ldren (22 percent o f all nonusers); this reason was more common among yotmger than older nonusers. 4.9 Preferred Method of Contracept ion for Future Use Nonusers o f contraception who intend to use at some t ime in the future were asked which method they would prefer to use. Data are presented for currently marr ied women in Table 4 .14 according to whether the non- users intend to use within the next 12 months or later. Eighty-four percent o f nonusers who intend to use report the 1UD to be the method they would use. The pil l and injectables are the second most commonly reported methods (5 and 4 percent, respectively). Neither the rank order nor the magnitude o f reporting varies greatly between nonusers who intend to use soon (within the next 12 months) and nonusers who intend to use at some later date. 60 4.10 Exposure to Family Planning Messages in the Electronic Media The mass media provides an opportunity to communicate family planning information to a broad spectrum of the population. Sixty-two percent of the households in Uzbekistan own a radio and 91 percent own atelevision (see Table 2.9). All UDHS respondents were asked whether they had heard a family planning message on the radio or television in the few months prior to the interview. Results are presented in Table 4.15 by background characteristics of respondents. While 14 percent of respondents have recently heard or seen a family planrfmg message on both radio and television, television is by far the most common sunrce--56 percent of all respondents have seen a televisior~ message and 16 percent have heard a raffle message. More than two-thirds of urban dwellers have seen a television message, compared to 47 percent of rural dwellers. As it was presented in Section 2.3.4, television is a more ready source to reach both urban and rural dwellers as 94 percent of all respondents report watching television at least once a week. Ownership of radio and television in urban households is 68 and 96 percent, respectively, while 58 percent of rural households own a radio and 87 percent own a television. Regional variation in exposure to television messages is greater than the urban/rural differential. Eighty-eight percent of women in Tashkent City and 49, 41, 56, and 61 percent of women in Regions 1, 2, 3, and 4, respectively, have recently seen a television family planning message. While television messages are available to viewers of all educational levels, the likelihood that a respondent has recently seen a television message increases steadily with increasing education. Forty-eight percent of respondents with primary or secondary education have recently seen a television message, while 67 and 78 percent of Table 4.13 Reasons for not usine contraception Percent distribution of women who are not currently using a contraceptive method and who do not intend to use in the future, by main reason Ibr not intending to use in the future, according to age, Uzbekistan 1996 Age Reason for not using contraception <30 30-49 Total Infrequent sex 2.3 7.2 5.5 Menopausal/hystareetomy 0.5 2(I.1 13.1 Subfecund/infeeund 5.7 9.3 8.1 Want children 51.5 6.0 22.1 Respondent opposed 19.2 34.0 28.7 Husband opposed 8.1 7.9 8.0 Religion 0.8 0.0 0.3 Knows no method 5.6 1.4 2.9 Knows no source 0.0 0.4 0.3 Health concerns 3.0 8.8 6.8 Side effects 0.0 0.3 0.2 Costs too much 0.0 0.4 0.2 Inconvenient 0.0 0.1 0.l Interferes with body 0.2 0.1 0.2 Other 0.5 1.3 1.0 Don't know 2.6 2.6 2.6 Total 100.0 100.0 100.0 Number of women 198 362 559 Table 4.14 Preferred method of eonlracet~tion thr future use Percent distribution of currently married women who are not using a contra- ceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Uzbekistan 1996 Intend to use In next Atler Unsure Preferred method 12 12 as to of contraception months months timing Total Pill 5.5 4.5 (7.6) 5.1 1UD 81.8 86.2 (78.7) 83.6 Injeetables 5.9 2.3 (0.0) 4.0 Diaphragm[Foam/Jelly 0.0 0.2 (0.0) 0.1 Condom 2.1 1.7 (2.0) 1.9 Periodic abstinence 1.6 1.1 (0.0) 1.3 Withdrawal 1.2 0.2 (0.0) 0.7 Douche 0.2 O.5 (13.0) 0.3 Missing 1.7 3.2 (11.8) 2.8 Total 100.0 100.0 100.0 100.0 Number of women 301 261 25 587 Note: Figures in parentheses are based on 25-49 unweighted cases. women with secondary-special and higher education have seen such a message. Uzbek women are less likely than women of other ethnicities to have recently seen a television message (55 percent and 63 percent, respectively). 61 Table 4.15 Heard about family Dlannin~ on radio and television Pement distribution of women by whether they have heard a radio or television message about family planning in the last few months prior to the interview, according to selected background characteristics, Uzbekistan 1996 Heard family planning message on radio or television Heard Tele- Heard Number Background on Radio vision on of characteristic neither only only both Total women Residence Urban 28.8 1.3 52.7 17.3 100.0 1,693 Rural 50.2 2.4 34.9 12.5 100.0 2,722 Region Region 1 46.5 4.3 41.4 7.8 100.0 471 Region 2 56.9 2.0 31.9 9.1 100.0 1,060 Region 3 42.7 1.4 47.1 8.9 100.0 1,249 Region 4 36.8 2.0 37.6 23 6 100.0 1,231 Tashkent City 11.4 0.7 63.8 24.2 100.0 404 Education Primary/Secondary 49.9 2.1 36.3 11.7 100.0 2,813 Secondary-special 30.7 2.0 49.8 17.4 100.0 1,127 Higher 21.2 1.0 54.8 22.9 100.0 471 Ethnicity Uzbek 43.5 2.0 40.3 14.3 100.0 3,647 Other 34.9 2.0 48.6 14.5 100.0 768 Total 42.0 2.0 41.7 14.3 100.0 4,415 Note: Total includes four women with no education. Figures may not add to 100.0 due to rounding. 4.11 Acceptability of Use of Electronic Media to Disseminate Family Planning Messages In the 1996 UDHS, all respondents were asked i f they find it acceptable or not for family planning messages to be broadcast over the radio or television. Results are presented in Table 4.16 by background characteristics of respondents. Most women (78 percent) find it acceptable to have family planning messages on radio and television. The youngest women (age 15-19) are less likely than older women to say they find broadcast messages acceptable (62 percent) because they are more likely to report being unsure (34 percent). Women in rural areas, women with primary or secondary education, and Uzbek women all have approval levels that are slightly lower than their counterparts, but the overall levels of approval are high (approximately three-quarters of women in these categories approve). Overall, 4 percent of women feel that broadcasting of family planning messages is not acceptable. 4.12 Exposure to Family Planning Messages in Print Media The high level of literacy in Uzbekistan makes the print media a possible mechanism for communicating family planning information. Fifty-seven percent of all respondents report that they read a newspaper at least once a week. The UDHS asked women whether they saw a message about family planning in a newspaper or magazine, a poster, or a leaflet in the few months preceding the interview. Results are presented in Table 4.17 by background characteristics of respondents. 62 Table 4.16 Aecetrtabilitv of madia messages on family vlannin~ -Percent distribution of women by acceptability of messages about family planning on the radio or television, according to selected background characteristics, Uzbekistan 1996 Acceptability of family planning messages on radio or television Not Number Background Accept- accept- of characteristic able able Unsure Tota l women Age 15-19 61.9 4.6 33.5 100.0 981 20-24 80.3 3.4 16.3 100.0 806 25-29 85.8 2.8 11.4 100.0 710 30-34 82.7 2.8 14.5 100.0 624 35-39 83.4 3.6 13.0 100.0 561 40-44 78.1 3.9 18.0 100.0 422 45-49 78.5 6.7 14.6 100.0 310 Residence Urban 80.8 4.1 15.1 100.0 1,693 Rural 75.5 3.6 21.0 100.0 2,722 Region Region 1 96.3 2.6 1.0 100.0 471 Region 2 73.9 8.5 17.6 100.0 1,060 Region 3 84.6 3.0 12.4 100.0 1,249 Region 4 64.4 0.8 34.7 100.0 1,231 Tashkent City 82.7 4.2 13.0 100.0 404 Education Primary/Secondary 72.1 4.1 23.7 100.0 2,813 Secondary-special 85.8 3.2 11.0 100.0 1,127 Higher 89.7 3.2 7.0 100.0 471 Ethnicity Uzbek 76.0 3.6 20.4 100.0 3,647 Other 84.6 4.5 10.8 100.0 768 Total 77.5 3.8 18.7 100.0 4,415 Note: Total includes four women with no adueation. Figures may not add to 100.0 due to rounding. About one-fifth (17 percent) of all respondents have recently seen information about family planning in the print media. Twenty-eightpercent ofurbanwomen and 10 percent ofrural women have recently seen a family planning message in print. More than one-half of women in Tashkent City have recently read a printed family planning message, while 37, 16, 7, and 9 percent of women living in Regions 1, 2, 3 and 4, respectively, have read such a message. The likelihood that a respondent has recently seen or read a message increases steadily with increasing education. Ten percent of respondents with primary or secondary education have recently read a message, while 25 and 37 percent, respectively, of women with secondmy-special and higher education have seen such a message. Women of other ethnicities are more likely than Uzbek women to have recently seen printed information on family planning (35 percent and 13 percent, respectively). 63 Table 4.17 Family Nannin~ messages in orint Percentage of women who received a message about family planning through the print media in the last few months prior 1o the interview, according to selected background characteristics, Uzbekistan 1996 Type of print media containing family planning message Number Background No Newspaper/ Leaflet/ of characteristic source magazine Poster brochure women Residence Urban 71.6 23.9 6.9 6.5 1,693 Rural 90.0 8.9 1.5 1.0 2,722 Region Region 1 63.2 33.1 8.9 3.8 471 Region 2 84.0 13.5 2.5 2.3 1,060 Region 3 92.6 6.8 1.3 0.1 1,249 Region 4 91 2 7.8 1.1 1.4 1,231 Tashkent City 48.4 41.5 14.5 18.8 404 Education Primary/Secondary 89.7 8.9 1.7 1.2 2,813 Secondary-special 74.5 22.1 5.6 4.6 1,127 Higher 62.8 31.6 9.7 11.0 471 Ethnicily Uzbek 868 11.3 2.5 2.2 3,647 Other 64.9 30.6 8.4 7.4 768 Total 83.0 14.7 3.6 3.1 4,415 Note: Total includes four women with no education. Newspapers and magazines are the most common printed source in which family planmng messages are seen (15 percent), although respondents also get messages from leaflets and brochures (3 percent) and posters (4 percent). 4.13 Attitudes of Couples toward Family Planning Married women were asked how often they had discussed contraception with their husbands or partners in the previous year. Data are presented in Table 4.18 for currently married women who know of at least one contraceptive method by age. Overall, about one-fourth of married women (26 percent) have not discussed family plamfing with their husbands at all in the previous year, one-half have discussed the topic once or twice, and one-fifth have discussed the topic more often. Whether or not a woman spoke with her husband about family planning depends on the age of the woman. The percent of married women who have discussed family planning at least once in the previous year decreases from 65 percent among 45-49 year-olds to 52 percent of 15-19 year-olds. Currently married women were asked whether they think their husband approves or disapproves of couples using family planning to avoid pregnancy. Table 4.19 presents the results of the wives' perceptions of their husbands' attitudes by background characteristics of respondents. 64 Table 4.18 Discussion of family plarl~in~ bv counles Percent distribution of currently married women who know a contraceptive method by the number of times family planning was discussed with their husband in the year preceding the survey, according to current age, Uzbekistan 1996 Age Number of times family planning discussed Number Once o~ More of Never twice often Total women 15-19 47.6 42.8 9.6 100.0 108 20-24 35.1 45.5 19.5 100.0 561 25-29 22.7 53.3 24.0 100.0 610 30-34 19.8 54.4 25.7 100.0 553 35-39 17.4 54.6 27.9 100.0 502 40-44 25.1 53.8 21.1 100.0 368 45-49 34.9 48.7 16.4 100.0 246 Total 25.8 51.5 22.6 100.0 2,947 Note: Figures may not add to 100.0 due to rounding. Perhaps the most interesting finding in Table 4.19 is the fact that women report a lower approval level for their husbands than for themselves across every single background characteristic of respondents. Overall, 91 percent of women report that they approve of contraception, but only 72 percent report that their husbands approve; this translates to 70 percent of all married couples in which both the husband and wife approve of contraception. If there exists a difference of opinion, it is usually that the woman reports that she approves, and that her husband disapproves (although not exclusively). Only 1 percent of women report that both they and their husbands disapprove of family planning. The percent of couples in which both husband and wife approve of family planning has a pattern by background characteristics which generally mimics the pattern observed in the percent of women currently using family planning. 4.14 Social Marketing of Contraceptives 4 The Uzbakistan Contraceptive Social Marketing Program began in the cities of Tashkent and Samarkand in September, 1995, in collaboration with the Ministry of Health. Its purpose is to make modern contraceptive choices available to women through commercial pharmacies as an alternative to abortions and government provision of family planning. The program includes five brands of oral contraceptives and two types of injectables. A "Red Apple" program logo, a symbol of a red apple encircling a man and a woman holding hands, was developed and placed in doctor's offices, pharmacies, clinics and kiosks. The Red Apple logo and information about pills, injectables, and where to buy Red Apple contraceptives have been advertised on television, radio and in newspapers. Advertising was supported by an extensive public relations campaign. 4 Written by Ms. Karen Foreit, The Futures Group. 65 T~blg 4.19 Wives' Derceotions of their husbands' attitude toward family nlannine Percent distribution of currently married women who know of a contraceptive method by wife's attitude toward family planning and wife's perception of her husband's attitude toward family planning, according to selected background characteristics. Uzbekistan 1996 Wife approves of Wife disapproves of couples using couples using family planning family planning Hus- Hus- Husband band's Both band's Number Background Both disap- attitude disap- Husband attitude Wife Husband wife of characteristic approve proves unknown prove approves unknown unsure Total approves L approves women Age 15-19 43.9 16.6 31,1 0.0 0.0 0.0 8.4 100.0 44.7 91.6 108 20-24 56.6 8.4 24.0 0.4 2.2 1.2 7.1 100,0 57.9 89.0 561 25-29 73.9 6.6 12.0 1,0 0.8 0.4 5.2 100.0 75.9 92.6 610 30-34 75.3 6.2 12.8 1.2 1.3 0.1 3.2 100.0 78.2 94.3 553 35-39 79.8 5.9 8.5 0.6 1.3 1.3 2.5 100.0 81.0 94.3 502 40-44 73.4 4.8 10.9 0.5 2.6 1.4 6.3 100.0 77,0 89.2 368 45-49 60.4 8.9 15.6 0.9 1.7 4.0 8.3 100.0 64.8 84.9 246 Residence Urban 72.7 7.0 12.7 0.9 1.5 0.9 4.3 100.0 74.8 92.4 1.125 Rural 67.7 7.2 15.9 0.7 1.6 1.2 5.8 100.0 70.0 90.8 1,822 Region Region 1 82.4 5.7 9.3 0.3 0.3 0.3 1.6 100.0 83.7 97.4 318 Region 2 64.9 8.9 16.4 1.5 3.3 0.9 4.1 100.0 67,2 90.2 658 Region 3 65.5 4.0 20.6 0.8 1.1 1.5 6.5 100.0 67,1 90.1 849 Region 4 69.7 102 11.2 0.2 1.0 1.0 6.6 100.0 72,8 91.1 848 Tashkent City 78.7 4.3 9.6 1,1 1.2 1.1 4.1 100.0 81,0 92.5 275 Education Primary/Secondary 66.2 7.5 15.9 0.6 1,8 1.5 6.6 100.0 68,8 89,6 1,786 Secondary-special 72.6 6.8 13.9 0.9 1.3 0.4 4.1 100.0 74,3 93.3 805 Higher 80.3 5.8 10.3 1.2 0.6 0.7 1.1 100.0 81,7 96.4 353 Ethnieity Uzbek 68.4 7.3 15.2 0.8 1.6 1.2 5.6 100.0 70,7 90.9 2,455 Other 75.6 6.0 12.4 0.7 1.2 0.4 3.6 100.0 77.8 94.0 492 Total 69.6 7.1 14.7 0,8 1.5 1.1 5,2 100.0 71,8 91.4 2,947 Note: Total includes three women with no education J Includes cases in which the wife is unsure about her own attitude but knows her husband's In addition to asking respondents if they had heard or seen a family planning message, the UDHS showed women the Red Apple symbol and asked them if they bad ever seen it before. Respondents who answered that they had seen the symbol were asked where they had seen it, and what the symbol stood for. To check for false positive recognition, respondents were also shown a symbol of a green pear and asked whether they had seen it, where they had seen it, and what it stood for. Results are presented for Tashkent City, where Social Marketing activities have been strongest. Ninety - four percent o f al l women in Tashkent C i ty repor ted hav ing seen the Red App le logo, and on ly three respondents fa l se ly recogn ized the green pear (Tab le 4.20) . Seventy - two percent o f women recogn ized the Red App le logo and knew it s tood for cont racept ives . Most (76 percent ) had seen it on te lev is ion , w i th another 21 percent repor t ing that they had seen it in a pharmacy . Recogn i t ion was h igher among women over the age o f 20, and among women who were marr ied or l i v ing w i th a man. 66 Table 4.20 Knowledue of the Red Annie social marketinu loan Percent distribution of all women in Tashkent City by recognition of the Red Apple symbol, according to selected background characteristics, Uzbekistan 1996 Knowledge of Red Apple Social Marketing logo Never Knew logo Number saw Recognized stands for of Characteristic logo logo contraception Total women Age 15-19 5.7 46.4 47.9 100.0 140 20-24 4.9 20.8 74.3 100.0 144 25-29 2.4 14.2 83.5 100.0 127 30-34 4.8 18.1 77.1 100.0 105 35-39 9.2 13.3 77.5 100.0 120 40-44 7.1 15.2 77.8 100.0 99 45-49 9.7 20.4 69.9 100.0 93 Marital status Never married 5.0 40.2 54.7 100.0 179 Currently married 6.1 17.0 76.8 100.0 570 Total 6.0 22.0 72.0 100.0 828 Note: Total includes previously married women. Figures may not add to 100.0 due to rounding. Correct knowledge of the Red Apple logo (that is, both recognizing the symbol and stating that it stood for contraceptives) was strongly associated with exposure to family planning messages in the media: 77 percent of women in Tashkent City who reported having seen a family planning message on radio or television also knew that the Red Apple logo stands for contraceptives, compared to only 16 percent of the women who had not seen a family planning message on television (Table 4.21). Women who had seen family planning messages in the newspaper, on posters, or on brochures were also more likely to correctly identify the Red Apple logo, but the differences were not as large. These results suggest that the electronic media were more influential in transmitting the Red Apple image. They also suggest that the high rates of exposure to family planning messages were due in large part to Red Apple advertising and its public relations campaigns. 67 Table 4.21 Exposure to familv nlannin~ messages and knowledge of the Red Annie social marketin~ 1o~o Percent distribution of all women in Tashkent City by recognition of the Red Apple symbol, according to exposure to family planning messages, Uzbekistan 1996 Knowledge of Red Apple Social Marketing logo Exposure to Never Knew logo Number family planning saw Recognized stands for of messages logo logo contraception Total women Heard a family planning message on radio or television Heard on neither 30.9 53.2 16.0 100.0 94 Radio only . . . . . . 100.0 6 Television only 2.8 19.9 77.3 100.0 528 Heard on both 3.0 12.0 85.0 100.0 200 Received a family planning message through the print media No source 7.7 32.4 59.9 100.0 401 Newspaper/magazine 4.7 12.8 82.6 100.0 344 Poster 3.3 8.3 88.3 100.0 120 Leaflet/brochure 3.8 9.0 87.2 100.0 156 Total 6,0 22.0 72.0 100,0 828 Note: Figures may not add to 100.0 due to rounding. 68 CHAPTER5 INDUCED ABORTION Feruza T. Faizieva, Jeremiah M. Sullivan, and Alisa D. Podporenko Induced abortion as a means of fertility control has a long history in the republics of the former Soviet Union. Induced abortion was first legalized in the Soviet Union in 1920 but was banned in 1936 as part of a pronatalist policy emphasizing population growth. This decision was reversed in 1955 when abortion for nonmedical reasons was again legalized throughout the former Soviet Union. The practice of induced abortion can adversely affect a woman's health, reduce her chances for further childbearing, and contribute to maternal and perinatal mortality. The Ministry of Health (MOH) of the Republic of Uzbekistan has been concerned about the impact of abortion and, in particular, the repeat use of abortion on women's health. In an effort to curtail this practice, the MOH is committed to providing the population with a broad choice of modern, safe, and effective contraceptive methods. International experience with the collection of abortion data in population surveys has been relatively unsuccessful in many populations because of respondent reluctance to report events which are associated with social stigmas. However, in the republics of the former Soviet Union and in many Eastern European countries, induced abortion is an accepted means of fertility control, In several of these countries, household surveys have collected data on this topic with apparent success (IMCHC and CDC, 1995; NIN and M1, 1996; RCPOMR and CDC, 1997). Accordingly, questions on abortion were pretested and included in the final questionnaires for the UDHS. Information about induced abortion was collected in the reproductive section of the Woman's Questionnaire (Appendix E). The section began with a series of questions to determine the total number of live births, induced abortions, miscarriages and stillbirths that a respondent has had. When reporting the number of abortions, respondents were told to include pregnancies terminated by vacuum aspiration (i.e., mini-abortions). ~ Next, an event-by-event pregnancy history was collected. For each pregnancy, the type of outcome and year and month of termination were recorded. 2 5.1 Pregnancy Outcomes For the three-year period preceding the survey (i.e., from mid-1993 to mid-1996), Table 5.1 shows the percent distribution of pregnancies by outcome for all women 15-49. In Uzbekistan, the great majority of pregnancies---80 percent---end in a live birth and the remaining 20 percent terminate in fetal wastage (i.e., i The term abortion as used in the remainder of this report includes mini-abortions unless indicated otherwise. The pregnancy history was structured to ensure complete reporting of abortions as much as possible, especially for the period immediately prior to the survey. Data were collected in reverse chronological order (i.e., information was first collected about the most recent pregnancy and then about the next-to-last, etc.). This procedure should result in more complete reporting of events for the years immediately prior to the survey compared with a procedure which collects data in chronological order. At the end of a pregnancy history, interviewers ',vere required to check the consistency between the aggregate data collected at the outset of the reproductive section and the number of events reported in the pregnancy history. Finally, interviewers were required to probe pregnancy intervals of four years or more to detect omitted events. 69 an induced abortion, miscarriage or stillbirth). Induced abortion is the most commonly reported type of fetal wastage, accounting for 14 percent of all pregnancy terminations. Table 5.1 Pregnancy OUtcomes bv backaround characteristics Percent distribution of pregnancies terminating in the three years preceding the survey, by type of outcome, according to selected background characteristics, Uzbekistan 1996 Pregnancy outcome Number Background Live Induced Mis- Still- of characteristics binhs abort ion carriage births Total pregnancies Residence Urban 69.4 22.0 8.4 0.3 100.0 618 Rural 85.8 9.2 4.5 0.5 100.0 1,122 Region Region 1 78.9 12.6 7.0 1.4 I00.0 199 Region 2 81.1 14.1 4.2 0.7 100.0 411 Region 3 78.4 14.8 6.5 0.4 100.0 492 Region 4 88.0 7.6 4.4 0.0 100.0 490 Tashkent City 57.0 30.8 11.9 0.3 100.0 147 Education Primary/Secondary 85.3 9.7 4.4 0.6 100.0 1,043 Secondary-special 73.7 18.5 7.5 0.3 100.0 498 Higher 67.7 22.8 9.3 0.2 100.0 199 Ethnicity Uzbek 81.8 12.0 5.6 0.5 100.0 1,504 Other 68.1 24.4 7.3 0.2 100.0 236 Total 80.0 13.7 5.9 0.5 100.0 1,740 Table 5.1 also shows information on pregnancy terminations by background characteristics of respondents. In urban areas, pregnancies are twice as likely to end in abortion (22 percent) than in rural areas (9 percent). Substantial regional differences are also evident. The proportion of pregnancies ending in abortion is lowest in Region 4 (8 percent), higher in Regions 1, 2, and 3 (between 13 and 15 percent) and highest in Tashkent City (31 percent). It is worth noting that the ranking of regions by pregnancies ending in abortion is inversely correlated with the fertility levels. As shown in Table 3.2, the total fertility rate for the three years Preceding the survey is highest in Region 4 (3.6 children per woman), somewhat lower in Regions 1, 2 and 3 (between 3.3 and 3.5 children per woman) and lowest in Tashkent City (2.3 children per women). Education and ethnicity are also associated with pregnancy outcome. When progressing from primary/secondary to secondary-special and higher education, the proportion of pregnancies terminating in abortion increases (10, 19 and 23 percent, respectively). Similarly, substantially fewer pregnancies end in abortion among women of Uzbek ethnicity (12 percent) than among women of other ethnicities (24 percent). 5.2 Lifetime Experience with Induced Abortion Lifetime experience of women with abortion is shown in Table 5.2. It should be noted that the statistics on the proportion of women who have ever had an abortion are based on all women 15-49 irrespective of their exposure to the risk of pregnancy. 70 Overall, 16 percent of women of reproductive age in Uzbekistan have had at least one abortion. As expected, the percentage who have had an abortion increases rapidly with age from 4 percent of women 20- 24 to 34 percent of women 35 and over. Differences are also large by urban/rural residence; experience with abortion being less among rural women (11 percent) compared with urban women (24 percent). Regional differences are even greater with the proportion being lowest in Region 2 (10 percent) and highest in Tashkent City (39 percent). Table 5.2 also presents information on repeat use of induced abortion. Among the 16 percent of women who have ever had an abortion, about half(49 percent) have had more than one. Among women age 35 or more who have had an abortion, 57 percent have had more than one. Thus, among women who have had an abortion, repeat use has been common. T~ble 5.2 Lifetime exnerience with induced abortion Percentage of women who have had at least one induced abortion and, among these women, the percent distribution by the number of induced abortions and the mean number of induced abortions according to selected background characteristics, Uzbekistan 1996 Percentage of Number of induced abortions among women who had women who have had an induced abortion Number Background an induced of characteristics abortion 1 2-3 4-5 6+ Total Mean women Age <20 0.0 * * * * 100.0 * 981 20-24 4.4 81.0 17.9 i.1 0.0 100.0 1.3 982 25-34 19.2 63.0 29.7 5.5 1.8 100.0 1.6 1,158 35+ 33.5 42.5 39.5 13.8 4.2 I00.0 2.2 1,294 No. of live births None 1.0 * * * * 100.0 * 1,406 1 12.9 56.1 28.0 12.0 4.0 100.0 2.0 560 2-3 23.7 52.1 36.5 6.8 4.6 100.0 2.0 1,363 4-5 26.9 49.6 33.6 14.9 1,9 I00.0 2.0 804 6+ 26.3 46.2 42.8 10.3 0.7 100.0 1.9 283 Residence Urban 23.7 44.7 38.6 12.1 4.6 100.0 2.2 1,693 Rural 10.9 60.3 30.4 8.0 1.3 100.0 1.8 2,722 Region Region 1 15.7 61.2 30.4 7.7 0.7 100.0 1.7 471 Region 2 9.9 51.5 37.6 8.7 2.2 100.0 1.9 1,060 Region 3 17.3 53.1 33.5 10.0 3.4 100.0 2.0 1,249 Region 4 11.9 58.0 30.0 8.8 3.2 100.0 1.8 1,231 Tashkent City 38.9 38.2 42.5 14.6 4.7 100.0 2.4 404 Education Primary/Secondary 10.9 57.0 32.9 8.8 1.3 I00.0 1.8 2,817 Secondasy-speeial 22.6 50.7 31.8 12.7 4.9 100.0 2.1 I, 127 Higher 29.3 40.2 46.0 9.5 4.3 100.0 2.3 471 Ethnieity Uzbek 13.9 56.4 33.8 8.4 1.4 100.0 1.8 3,647 Other 25.1 38.3 38,4 15.4 8.0 100.0 2.6 768 Marital status Never married 0.0 * * * * 100.0 * 1,099 Currently married, living together 21.0 51.1 35.9 9.9 3.2 100.0 2.0 3,102 Ever married 22.7 55.5 24.4 16.4 3.6 I00.0 2. I 214 Total 15.8 51.4 35.1 10.4 3.2 100.0 2.0 4,415 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 71 5.3 Rates of Induced Abortion Rates of abortion for the three-year period prior to the survey (i.e., from mid-1993 to mid-1996) are shown in this section. Age-specific rates represent the probability that a woman of a particular age will have an abortion in a period of one calendar year. These rates are shown per 1,000 women. Table 5.3 shows age-specific rates of abortion for all Uzbekistan, by urban/rural residence and by ethnicity. The age patterns of the rates are similar in each population group. Rates are very low for women in the age interval 15-19, they increase in the primary years of childbearing to peak at the age intervals 25-29 and 30-34, and decline at the older ages. At the national level, the age-specific abortion rates exceed the corresponding age-specific fertility rates only in the age intervals 40-44 and 45-49 (Figure 5.1). The age- specific data also indicate that for many age intervals abortion rates in urban areas exceed those for rural areas by 50 percent or more. Table 5.3 Induced abortion rates Age-specific induced abortion, total abortion, and general abortion rates for the three-year period prior to the survey, by residence and ethnicity, Uzbekistan 1996 Residence Ethnicity Age Urban Rural Uzbek Other Total 15-19 1 2 I 4 2 20-24 38 7 14 40 18 25-29 41 27 31 42 32 30-34 52 26 31 59 36 35-39 38 13 23 22 23 40-44 8 22 19 6 15 45-49 15 (0) 3 (18) 7 TAR 15-49 0.97 0.48 0.62 1.00 0.67 TAR 15-44 0.89 048 0.50 0.90 0.63 GAR 30 14 20 29 20 Note: Rates arc for the period 1-36 months preceding the survey. Rates in parentheses indicate that they are based on l~wer than 250 woman-years of exposure. TAR: Total abortion rate expressed per woman GAR: General abortion rate (induced abortions divided by number of women 15- 44) expressed per 1,000 women Age-specif ic abortion rates can be expressed in a summary index called the total abortion rate (TAR). This rate is expressed on a per woman basis and is interpreted as the number o f abortions a woman would have during her lifetime if she experienced the age-specific rates of a specified t ime period. For Uzbekistan, the total abortion rate 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) and Romania (3.4 abortions per woman), and for Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively) ( IMCHC and CDC, 1995; N IN and MI, 1996; RCPOMR and CDC, 1997). Total abortion rates by background characteristics of respondents are shown in Table 5.4 and Figure 5.2. Substantial differences are evident: the TARs differ by approximately a factor of two between urban/rural residence, region, level of education and ethnicity. 72 300 Figure 5.1 Age-specific Rates of Fertility (ASFR) and Induced Abortion (ASAR) Rates per 1,000 Women 250 200 150 100 50 O 15-19 i [ [ i i 20-24 25-29 30-34 35-39 40-44 Age Group ~ASFR~ASAR I 45-49 U£)HS 1996 5.4 Time Trends in Induced Abortion An indication of time trends for induced abortion can be obtained by comparing values of the TAR with the mean number of abortions reported by women who are nearing the end of their fertile years (i,e., women age 40-49). Table 5.4 indicates that, for all Uzbekistan, the TAR (0.7 abortions per woman) is marginally less than the mean number of abortions reported by women age 40-49 (0.8 abortions per woman). For almost all population groups, Table 5.4 shows TARs which are less than the mean number of abortions reported by older women. However, the magnitude of the difference is particularly large for women residing in Tashkent City (1.3 versus 1.8 abortions per woman), women with a higher level of education (I.0 versus 1.4), and women belonging to other ethnicities (1.0 versus 1.3). This implies that the movement away from induced abortion, which is observed at the national level, is primarily concentrated in population groups where abortion was practiced the most in past years. The UDHS data allow for a more direct assessment of time trends in abortion. Table 5.5 shows age- specific rates of induced abortion for consecutive five-year time periods prior to the survey. The age-specific rates can be summarized in terms of the TAR restricted to women age 15-44, Table 5.5 shows that between the periods 5-9 and 0-4 years before the survey, the TAR declined by approximately 25 percent (i.e., from 1.0 to 0.7 abortions per woman). 5.5 Abortion Rates from the Ministry of Health The Ministry of Health (MOH) of the Republic of Uzbekistan has collected abortion data since 1978 through a registration system which operates in all of its facilities. The data have been published in a 73 compendium of health statistics covering the Central Asian Republics of the former Soviet Union (Church and Koutanev, 1995). The published rates are in tenns of the annual number of abortions per 1,000 women of childbearing age or the general abortion rate (GAR). Table 5.6 shows rates of abortion per 1,000 women age 15-44 for the time periods 1986-90 and 1993-95. For the period 1993-95, the rate from the UDHS (20 per 1,000) is somewhat lower than that of the MOH (24 per 1,000), but not greatly so. Given that abortion data collected in most retrospective surveys is of notoriously poor quality, the fact that these rates are o f the same order of magnitude tends to substantiate the accuracy of both rates. The ditTerence between the rates is probably due to some omission of events in the UDHS. For the earlier period of 1986-90, the rate from the UDHS (29 per 1,000) is decidedly lower than that from the MOH (42 per 1,000). Again, the difference is probably due to underreporting in the survey? Notwithstanding these differences, an important conclusion to be drawn from Table 5.6 is that recourse to the practice of abortion is declining in Uzbekistan. During the five-year interval between time periods, the GAR declined by 31 percent according to the UDHS data and by 43 percent according to the MOH data. Table 5.4 Induced abortion rates by background characteristics Total induced abortion rates for the three-year period prior to the survey and mean number of induced abortions bad by women age 40-49, by selected background characteristics, Uzbekistan 1996 Total Mean induced number of Background abortion abortions characteristic rate I 40-49 Residence LIrban 0.97 1.10 Rural 0.48 0.58 Region Region 1 0.66 0.67 Region 2 0.67 0.50 Region 3 0.78 0.94 Region 4 0.35 0.52 Tashkent City 1.32 1.82 Education Primary/Secondary 0.46 0,48 Secondary-special 0.95 1.24 ttigber 1.00 1.40 Ethnieity Uzbek 0.61 0.65 Other 0.95 1.28 Total 0.67 0.82 1 Women age 15-49 5.6 Use of Contraception before Abor t ion For each pregnancy terminated by abortion in the three years preceding the survey, respondents were asked whether they were using a method of contraception at the time they became pregnant, and if so, what method. Table 5.7 shows the relevant statistics. Twelve percent of abortions are preceded by a contraceptive failure? Method failure primarily occurs while using the 1UD although failure also occurs while using withdrawal, the condom, the pill and injectables. It is clear that the availability of more reliable methods of contraception and greater consistency of method use would reduce the incidence of induced abortion. 3 In any retrospective survey, underreporting of events is a possibility. Respondent recall is probably less accurate and less complete for time periods which are more distant from the survey date, and that may explain the greater divergency between the GAR of the UDHS and the MOH for the earlier time period. A recent study of the reproductive practices among women of reproductive age in Kazakstan found that 23 percent of abortions, which occurred during the time period from mid- 1992 to mid-1995, were preceded by contraceptive failure (NIN and MI, 1996). 74 Figure 5.2 Total Induced Abortion Rate by Background Characteristics UZBEKISTAN RESIDENCE Urban Rural REGION Region 1 Region 2 Region 3 Region 4 Tashkent ETHNICI'fY Uzbek Other 0.8 1.0 o.~ i~i~i~i~i~i~i~!~f<!<i!i!i!i!5!i~i~i~i~f~it 0.7 ~: i~ i{~i{ i~ i ! i ! i i i~ 0.7 i~i~i!i~i~i~i~i~{f~i{~i{i~i~i<i~i~i~i~i~i~i~H 0.8 F~:f~i{i~i~{i~ 0.4 ~i~i~i~i~i~i~i~i~i~i{i{i~i~i~i!!~i~i~i~i~i~i~i~i{i~i!~:[~!~i~i~ 1.3 0.9 0.5 1.0 1,6 Abortions per Woman 2.0 L, UDRS 1996 Table 5.5 Trends in age-snecific induced abortion Age-specific induced abortion rates for five-year periods preceding the survey, Uzbekistan 1996 Number of years preceding the survey Age 0-4 5-9 10-14 15-19 15-19 2 3 2 2 20-24 21 22 16 24 25-29 34 48 44 40 30-34 42 44 46 [73] 35-39 25 43 [35] 40-44 20 [30] 45-49 [6] TAR 0.72 0.95 GAR 22 29 Note: Age-specific induced abortion rates are per 1,000 women. Estimates in brackets are truncated. TAR: Total aborttion rate expressed per woman GAP,: General abortion rate (induced abortions divided by number of women I5-44) expressed per 1,000 women 75 5.7 Service Providers and Medical Procedures All women who had an abortion in the three years prior to the survey were asked where the abortion was performed, who assisted or provided the service, and what method was used. Table 5.8 indi- cates that virtually all reported abortions are performed in government-operated facilities. The great majority, 87 percent, are performed in a hospital and another 8 percent in a polyclinic. Ahnost all abortions, 98 percent, are performed under the supervision of a doctor. Table 5.8 also indicates that most abortions are performed followine the dilation and curettage procedure (81 percent) and that vacuum aspiration is used in a minority of cases (9 percent). In both hospitals and polyclinics, approxi- mately 80 percent of abortions are performed by dilation and curettage (statistics not shown). 5.8 Compl icat ions o f Abor t ion and Med ica l T reatment Respondents who had an abortion in the three years preceding the survey were also asked i f they experienced any health problems following tile abortion, the type of problem they experienced and i f they were hospitalized. Nine percent of respondents report having had health problems. The most common problems are infection, lack of menstruation and excessive bleeding (Table 5.9). Two percent of women report that they had been hospitalized as a result of health problems following the abortion. The mean length of hospital stay for these women is 12 days. This rate of hospitali- zation is about what would be expected given that almost all abortions were performed in a hospital under the Table 5.6 Comparison of abortion rates Genera/abortion rates by time period, Ministry of Health and UDHS. 1986-95 Time period Percent Source 1986-90 1993-95 decline Uzbekistan DIIS 29 20 31 Ministry of Health 42 24 43 Note: Rates tbr the UDItS are displaced six months from the dates shown. The UDHS rate lbr 1993-95 is calculated for the three years preceding the survey, fi'om mid-1993 to mid-1996 (see Table 5.3). Similarly. the rate for 1986-90 is tbr mid-1986 to mid-1991 (see Table 5.5t. General abortion rate: induced abortions divided by number of women 15-44, expressed per 1,000 women Sources of MOtt rates: 1986-90: Church and Koutanev (1995) 1993-94: Ministry of Iteallh (1995) 1995: Research Institute of Obstetrics and Gynecology (I 996) Table 5.7 Use ofcontraceotion oriorto pregnancy Percentage of pregnmlcies ending during the three years preceding the survey by outcome ,and use of contraception at the time of conception, Uzbckistan 1996 Use of Live Induced All contraception births abortions pregnancies L No contraception 99.3 88.3 97.5 Any method 0.7 I 1.7 2.5 Any modern method 0.6 9.3 1.9 Pill 0.0 0.8 0.1 IUD 0.6 7.1 1.6 Condom 0A 1.2 0.2 Injectables 0.0 0.2 0.0 Any traditional method 0.1 2.5 0.5 Periodic abstinence 0.0 0.6 0.2 Withdrawal 00 1.4 0.2 Douche 0.1 0.4 0. I Total 100.0 100.0 100.0 Number of pregnancies 1,392 239 1,740 J Includes stillbirths and miscarriages supervision of a doctor. Although the average length of hospital stay is lengthy, the severity of health problems can not be inferred from this information alone because hospitalization is a common treatment for health problems in Uzbekistan, as it is in most of the republics of the former Soviet Union. 76 Toble ~,8 Source of services, tvDe of provider, and procedure used for abortion Percent distribution of induced abortions in the three years peceding the survey by source of services, type of provider, and procedure, Uzbekistan 1996 Characteristic Percent Source of servlces Public sector 98.8 Hospital 86.5 Polyclinic 8. I Public, fee for service 0.6 Other 3.6 Not stated 1.2 Type of provider Doctor 97.5 Nurse. midwife 1.3 Not stated 1.2 Procedure Dilation and curettage 80.9 Vacuum aspiration 8.5 Not stated 10.6 Total 100.0 Number of induced abortions 239 T~.bl¢ 5.9 Health omblems followin~ abortion Percentage of induced abortions during the three years preceding the survey which resulted in specific health problems and the percentage requiring hospitalization, Uzbekistan 1996 Type of health problem Percent Specific health problems Inl~ction 1.0 Lack of menstruation 5.8 Excessive bleeding 4.6 Complications requiring hospitalization 2.3 Number of induced abortions 239 77 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Akhror B. Yarkulov, Kia L Weinstein, Rano M. Usmanova, and Gulistan Bekbaulieva This chapter addresses the principal factors, other than contraception and abortion, that affect a woman's risk of becoming pregnant. These include nuptiality, sexual activity, postpartum amenorrhea and abstinence from sexual relations. Marriage is an overall indicator of exposure to the risk of pregnancy. More direct measures of exposure relate directly to sexual activity: age at first sexual intercourse and the frequency of intercourse. Postpartum amenorrhea and abstinence affect the interval between births. These factors determine the length and pace of reproductive activity and are, therefore, important in understanding fertility. 6.1 Marital Status Table 6.1 and Figure 6.1 show the distribution of all women by marital status at the time of the survey. The term "married" refers to legal or formal marriage (civil or religious), while "living together" refers to informal unions. In subsequent tables, these two categories are combined and referred to collectively as "currently married" or "currently in union." Women who are widowed, divorced, and not living together (separated) make up the remainder of the "ever-married" or "ever in union" category. Table 6.1 Current marital status Percent distribution of women by current marital status, according to age, Uzbekistan 1996 Marital status Never Living Not living Age married Married together Widowed Divorced together Total Number 15-19 87.0 12.7 0.1 0.0 0.2 0.0 100.0 981 20-24 22.8 73.4 0.9 0.2 2.5 0.2 100.0 806 25-29 5.2 89.4 0.7 0.3 3.8 0.7 100.0 710 30-34 1.9 89.2 2.4 2.6 3.9 0.1 100.0 624 35-39 1.2 91.0 1.6 2.8 3.2 0.1 100.0 561 40-44 0.4 89.7 0.9 4.7 3.6 0.6 100.0 422 45-49 1.4 83.6 1.4 7.8 4.9 1.0 100.0 3 I0 Total 24.9 69.2 1.0 1.8 2.7 0.3 100.0 4,415 Note: Figures may not add to 100.0 due to rounding. Marriage is nearly universal in Uzbekistan. While the vast majority (87 percent) of women age 15-19 have not yet married, three-quarters of women age 20-24 years are married, and nine out of ten women age 25-44 are married. By age 45-49 the percentage of women married begins to decline, as the number of widows begins to increase. Only 3 percent of women are divorced or separated. Overall, 70 percent of women of reproductive age are currently married. In many societies, marriage is not a sufficiently exact measure of exposure to the risk of pregnancy; therefore, the UDHS asked women who are not currently in a union whether they have a regular sexual partner, an occasional sexual partner, or no sexual partner at all. Table 6.2 shows the distribution of women who are not currently in a union (whether never married or previously married) by current sexual relationship. The data 79 reveal that sex outside of marriage is highly unusual in Uzbekistan; barely 1 percent of the unmarried population report having a sexual relationship. Women in their thirties and those living in Tashkent City are somewhat more apt to report having a sexual relationship, but women who report such a relationship never exceed 5 percent, by any background characteristic. Figure 6.1 Marital Status of Women 15-49 Currently married 69% Widowed 9% Divorced/separated 3% amed 25% UDHS1996 6.2 Age at First Marriage Marriage generally marks the point in a woman's life when childbearing becomes welcome; it is therefore an important demographic and social indicator. Information on age at first marriage was obtained by asking all ever-married respondents the month and year they started living with their first spouse. As shown in Table 6.3, the median age at first marriage has been hovering around age 20 for several decades. Half the women in Uzbekistan marry before the age of 20. While the median is a convenient summary measure, not all changes in age at marriage are necessarily reflected in the median. Cohort trends in age at marriage can be more thoroughly examined by comparing the cumulative distributions for successive age groups, as shown in Table 6.3. ~ The distributions in fact reveal very little change in age at marriage in Uzbekistan over the past several decades. The graphing of the distributions in Figure 6.2 summarizes the marriage patterns, which have remained fairly constant over time. The age range of marriage is relatively narrow--60 percent of women marry between the ages of 18 and 22 years, 1 For each cohort, the accumulated percen/ages stop at the lower age boundary of the cohort to avoid censoring problems. For instance, for the cohort currently age 20-24, accumulation stops with the percentage married by exact age 20. 80 t ime. The age range o f marr iage is re lat ive ly narrow- - -60 percent o f women marry between the ages o f 18 and 22 years. Table 6.2 Sexual relationshins of nonmarried women Percent distribution of women currently not in a union by type of current sexual relationship, by selected background characteristics, Uzbekistan 1996 Widowed, divorced Never married not living together Occasional No Occasional No Number Background sexual sexual sexual sexual of characteristic partner partner partner partner Total women Age 15-19 0.0 99.8 0.0 0.2 100.0 856 20-24 0.2 88.7 0.2 10.6 100.0 207 25-29 0.0 52.6 2.6 44.1 100.0 70 30-34 0.0 22.0 4.4 73.6 I00.0 53 35-39 0.0 16.7 4.6 76.4 100.0 41 40-44 (0.0) (4.7) (3.7) (90.3) 100.0 39 45-49 0.0 9.0 0.0 91.0 IO0.O 47 Residence Urban 0.1 76.7 1.2 21.5 100.0 525 Rural 0.0 88.3 0.2 11.4 100.0 788 Region Region 1 0.0 84.0 0.6 15.4 I00.0 152 Region 2 0.0 88.0 0.0 12.0 100.0 356 Region 3 0.0 83.0 0.9 16.1 100.0 365 Region 4 0.0 85.4 0.0 14.6 100.0 314 TashkantCity 0.4 69.0 3.1 25.6 100.0 126 Education Primary/Secondary 0.0 89.3 0.0 10.7 100.0 911 Secondary-special 0.0 74.9 2.1 22.7 100.0 297 Higher 0.5 60.3 1.7 36.1 100.0 105 Ethnieity Uzbek 0.0 86.7 0.3 13.0 100.0 1,055 Other 0.2 71.5 1.7 25.7 100.0 258 Total 0.0 83.7 0.6 15.5 100.0 1,313 Note: Figures in parentheses are based on 25-49 unweighted women. Total includes five ever- married women who are not cor~'ont|y in union but have regular sexual partners. I Widowed, divorced, not living together includes five women who reported having regular sexual partners. 81 Tabl~ 6.3 Age at first marriage Percentage of women who were first married by specific exact age and median age at first marriage, according to current age, Uzbekistan 1996 Cu~entage 15 18 20 22 Percentage who were Percentage Median first married by exact age: who had Number age at never of first 25 married women marriage 15-19 0.5 NA NA NA NA 87.0 981 a 20-24 0.4 15.3 55.7 NA NA 22,8 806 19.8 25-29 1.3 15.8 51.0 80.5 91.8 5.2 710 19.9 30-34 0.5 12.7 42.7 73.5 90.1 1.9 624 20.4 35-39 1.2 16.3 51.4 76.9 92.4 1.2 561 19.9 40-44 0.2 18.0 56.2 77.2 91.3 0.4 422 19.7 45-49 1.7 19.5 45.1 67.6 89.7 1.4 310 20.4 25-49 1.0 15.9 49.3 76.0 91.2 2.3 2,628 20.1 NA = Not applicable a Oral ed because less than 50 percent of he women m the age group 15 to 19 were first married by age 15. Figure 6.2 Percentage of women Married by specific exact ages Percent married 100 6O 4O 2O 0 15 18 20 22 25 Age at Marriage ~t20:24 --25-29 .30-94 it35-39 ~-40-44 --45-491 I UDHS 1996 Table 6,4 presents the median ages at marriage for women age 25-49 by selected background characteristics, The most pronounced differential is one that is observed in many societies--age at marriage increases with increasing education. A differential of two or three years in the median from the least to the most educated occurs within every age group; women with higher education have a median age at marriage (21.9) which is 2.5 years later than women with a primary or secondary education (19.4). 82 Table 6.4 Median ane at first marriaee Median age at first marriage among women age 20-49 years, by current age and selected background characteristics, Uzbekistan 1996 Current age Women Background age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban -- 20.3 20.8 21.1 20.5 21.3 20.8 Rural 19.6 19.8 20.2 19.5 19.2 19.3 19.6 Region Region I 20.6 20.5 20.3 20.0 19.2 20.3 Region 2 -- 20.2 20.7 20.3 19.5 20.1 20.2 Region 3 19.9 20.l 20.3 19.9 20.0 21.4 20.2 Region 4 19.1 19.5 20.0 19.2 19. l 19.0 19.4 Tashkent City 19.8 20.2 21.5 21.2 21.6 21.0 21.1 Education Primary/Secondary 19+3 19.5 19.8 19.3 19.0 18.9 19.4 Secondary-special 20.5 20.7 20.9 20.9 21.5 20.8 Higher 21.2 22.3 22.0 21.8 22.8 21.9 Ethnicity Uzbek 19.7 19.8 20.2 19.8 19.4 20.0 19.9 Other 20.9 21.4 21.0 21.2 21.5 21.2 Total 19.8 19.9 20.4 19.9 19.7 20.4 20.1 Note: In all population subgroups and for the total population, the median age at marriage for women age 15-19 could not be determined because less than 50 percent of those women were first married by age 15, the lower boundary of the age group. In some population subgroups, the median age at marriage for women age 20-24 could not be determined for similar reasons. The other noticeable differential is that ethnic Uzbeks have a median age at marriage (19.9) that is one year earlier than women of other ethnic groups (21.2). Both the educational and ethnic differentials have been holding steady for over 20 years. Overall, while some differentials exist in age at marriage within the population, these data indicate that there has been no major change in age at marriage in Uzbekistan over the past 20 years. 6.3 Age at F i r s t Sexua l Intercourse Before using marriage as a proxy for exposure to intercourse, it is best to verify that the two events coincide, i.e., to verify whether or not some women engage in sexual relations prior to marriage. I f women do engage in sexual relations prior to marriage, then the proportion of married women would underestimate the percent of women who are sexually active. The UDHS asked women to state the age at which they first had sexual intercourse. The results, presented in Tables 6.5 and 6.6 mirror almost exactly the figures relating to age at marriage, indicating that in Uzbekistan, first exposure to sexual intercourse coincides with marriage. 83 Table 6.,5 Age at first sexual intercourse Percentage of women who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at first intercourse, according to current age, Uzbekistan 1996 Current age 15 Percentage who had Percentage Median first intercourse by exact age: who Number age at never bad of first 18 20 22 25 intercourse women intercourse 15-19 0.5 NA NA NA NA 87.0 981 a 20-24 0.4 15.8 55.8 NA NA 22.7 806 19.7 25-29 I.I 15.1 49.6 78.2 88.8 5.2 710 20.0 30-34 0.5 12.7 41.8 71.4 87.1 1.9 624 20.5 35-39 1.2 16.8 51.1 75.4 89.5 1.2 561 19.9 40-44 0.2 17.4 55.5 75.0 88.6 0.4 422 19.7 45-49 1.7 19.6 43.1 64.5 86.5 1.4 310 20.6 25-49 0.9 15.8 48.3 73.9 88.2 2.3 2,628 20.1 ~A = Not applicable Omitted because less than 50 percent in the age group 15-19 had had intercourse by age 15 Table 6.6 Median ace at first intercourse Median age at first sexual intercourse among women age 20-49 years, by current age and selected background characteristics, Uzbekistan 1996 Current age Women Background age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 20.0 20.4 20.8 21.2 20.5 21.4 20.8 Rural 19.6 19.9 20.2 19.4 19.3 19.7 19.7 Region Region 1 20.6 20.5 20.3 20.2 19.3 20.3 Region 2 - 20.3 20.8 20.4 19.6 20.4 20.3 Region 3 19.8 20. I 20.4 19.9 19.9 21.4 20.3 Region 4 19.1 19.6 20.0 19.2 19.1 19.2 19.5 Tashkent City 19.8 20.2 21.5 21.0 22.0 20.9 21.0 Education l:'rimary/Secondary 19.3 19.5 19.9 19.3 19.1 19. I 19.4 Secondary-special 20.6 20.7 20.9 21.1 21.5 20.8 I ligher 2 I3 22.3 22.1 21.7 23.0 22.0 Ethnicity Uzbek 19.7 19.9 20.3 19.8 19.5 20.2 19.9 Other 21.0 21.4 20.9 21.3 21.5 21.2 Total 19.7 20.0 20.5 19.9 19.7 20.6 20.1 Note: The median for women age 15-19 and some groups of women age 20-24 could not be determined because tess than 50 percent of the women had had intercourse for the first time by age 15 and 20, respectively. 84 6.4 Recent Sexual Activity In the absence of contraceptive use, frequency of sexual intercourse is a direct determinant of pregnancy; therefore, knowledge of frequency is a useful indicator of exposure to pregnancy. Table 6.7 shows the percent distribution of women by sexual activity in the four weeks prior to the survey and the duration of abstinence by whether or not the women have recently had a birth (i.e., whether they are postpartum). Women are considered to be sexually active if they have had sexual intercourse at least once in the four weeks prior to the survey. Overall, 65 percent of all women interviewed were sexually active in the four weeks preceding the survey. Less than 2 percent of women are postpartum abstaining, 9 percent of women are not sexually active for reasons unrelated to childbirth, and 25 percent of women have never had sexual intercourse. Most of the women who are not sexually active are women in their teens (and some women in their early twenties) who have never had intercourse. Approximately 85 percent of women age 25-44 reported being sexually active, Not surprisingly, women who are using a method of family planning are more likely to be sexually active than women who are not using a method (most of the difference is due to the fact that many of the women not using a method have not yet bad intercourse). 6.5 Postpartum Amenorrhea, Abstinence and Insusceptibility Postpartum amenorrhea refers to the interval between childbirth and the return of menstruation. During this period, the risk of pregnancy is reduced. The duration of reduced risk of conception largely depends on two factors: the length and intensity of breastfeeding, which tends to suppress the resumption of ovulation, and the length of time before the resumption of sexual intercourse. Women who are either amenorrheic or abstaining (or both), are considered insusceptible to the risk of pregnancy. The percentage of births during the last three years whose mothers are presently postpartum amenorrheic, abstaining or insusceptible is shown in Table 6.8 by the number of months since birth. These distributions are based on current status data, i.e., on the proportion of births occurring x months before the survey for which mothers are still amenorrheic, abstaining or insusceptible. The estimates of the median and mean durations shown in Tables 6.8 and 6.9 are calculated from the current status proportions at each time period. The prevalence/incidence mean is defined as the number of children whose mothers are amenorrheic (prevalence) divided by the average number of births per month (incidence). The data are grouped in two- month intervals to minimize fluctuations in the estimates. While both postpartum amenorrhea and postpartum abstinence are fairly short in duration, the former is longer than the latter and is, therefore, the principal determinant of the length of postpartum insusceptibility. Nearly all women (98 percent) are insusceptible to pregnancy in the first two months following a birth, but become susceptible to the risk of pregnancy quite steadily thereafter. Most women do not abstain for more than two or three months following a birth. The median duration of abstinence is 1.8 months. Fifty percent of women are again susceptible to the risk of pregnancy by 5.4 months, and those who are still insusceptible at six months steadily become susceptible with every passing month. Only about one-quarter of women remain insusceptible to the risk of pregnancy for more than 10 months following a birth. Table 6.9 presents the median durations of postpartum amenorrhea, abstinence, and insusceptibility by background characteristics. Postpartum abstinence is generally very short in duration, and does not vary much by background characteristics, nor does it greatly affect the duration of insusceptibility. Median durations ofamenorrhea do vary according to age, residence, and region. Older women (age 30 and above) 85 Table 6.7 Recent sexual activity Percent distribution of women by sexual activity in the four weeks preceding the survey, and among those not sexually active, the length of time they have been abstaining and whether postpartum or not postpartum, according to selected background characteristics and contraceptive method currently used, Uzbekistan 1996 Not sexually active in last 4 weeks Background Sexually Abstaining Abstaining characteristic/ active (postpartum) (not postpartum) Never Number contraceptive in last had of method 4 weeks 0-1 years 2+ years 0-1 years 2+ years sex Missing Total women Age 15-19 I 1,6 0.4 0.0 1.0 0.0 87.0 0.0 100.0 981 20-24 67.0 2.7 0.2 5.6 1.3 22.7 0.4 100.0 806 25-29 82.3 2.0 0,2 6.9 2.9 5.2 0.4 100.0 710 30-34 86.0 2.1 0,1 5.2 4.4 1.9 0.4 100.0 624 35-39 87.9 1.0 0.0 4.2 5.3 1.2 0.4 100.0 561 40-44 84.4 0.5 0.1 7. I 7.0 0.4 0.3 100.0 422 45-49 74.8 0.5 0.0 11.1 12.1 1.4 0.2 100,0 310 Duration of union (years) Never married 0.0 0.0 0.0 0.0 0.0 100.0 0.0 100.0 1,099 0-4 85.8 3.6 0.2 8.0 1.9 0.0 0.5 100.0 784 5-9 85.9 1.7 0.3 7.8 4.1 0.0 0.2 100.0 703 10-I4 91.0 2.2 0.1 3.0 3.2 0.0 0.5 100.0 616 15-19 87.4 1.2 0.0 5.3 5.6 0.0 0.5 100.0 507 20-24 86.7 0.4 0.0 6.0 6.8 0.0 0.1 100.0 415 25-29 73.1 0.7 0.0 13.0 12.7 0.0 0.4 100.0 240 30+ 82.2 0.0 0.0 9.5 8.3 0.0 0.0 100.0 51 Residence Urban 64.1 1.0 0A 5.5 5.2 23.8 0.4 100.0 1,693 Rural 65.1 1.7 0.1 4.8 2.5 25.6 0.2 100.0 2,722 Region Region 1 64.4 1.2 0.1 3.6 3.3 27.1 0.2 I00.0 471 Region 2 61.4 1.7 0.0 4.1 3.1 29.5 0.3 100.0 1,060 Region 3 64.1 1.8 0.0 5.8 3.9 24.3 0.0 100.0 1,249 Region 4 68.6 0.8 0.3 5.2 2.7 21.8 0.6 100.0 1,231 Tashkent City 63.8 1.4 0. I 6.9 6.0 21.5 0.2 100.0 404 Education Primary/Secondary 61.8 1.5 0.1 4.8 2.6 28.9 0.4 100.0 2,817 Secondary-special 68.8 1.2 0.0 5.7 4.6 19.7 0.0 100.0 1,127 Higher 72.5 1.3 0.4 5.4 6.4 13.4 0.5 100.0 471 Ethnicity Uzbek 65.4 1.5 0. I 4.8 2.9 25.1 0.3 100.0 3,647 Other 61.4 1.2 0. I 6.4 6.6 24.0 0.3 100.0 768 Contraceptive method No method 45.1 1.9 0.2 5.9 5.4 41.2 0.5 100.0 2,668 Pill 92.0 0.0 0.0 8.0 0.0 0.0 0.0 100.0 52 IUD 95.3 0.9 0.0 3.1 0.7 0.0 0.0 100.0 1,440 Condom 94.9 0.0 0.0 5. I 0.0 0.0 0.0 100.0 54 Periodic abstinence 90.1 0.0 0.0 9.9 0.0 0.0 0.0 100.0 35 Other 91.3 0.0 0.0 7.4 1.3 0.0 0.0 100.0 167 Total 64.7 1.4 0.1 5.1 3.5 24.9 0.3 100.0 4,415 86 remain amenorrheic for two months longer, on average, than do younger women. Rural women remain amenorrheic for about 1.5 months longer than do urban women, and women in Regions 2 and 4 have median durations that are about two months longer than among women in other regions. The practice of breastfeeding is virtually universal in Uzbekistan, although mothers begin supplementing with other foods or liquids very early. The data on breastfeeding show a slight rural/urban difference in intensity of feeding babies under six months of age, and that women in Regions 2 and 4 tend to breastfeed babies longer and more intensively (see Chapter 10 for a discussion of breastfeeding practices). 6.6 Termination of Exposure to Pregnancy Above age 30, the risk of pregnancy declines with age as increasing proportions o f women become infecund. Although the onset of infecundity is difficult to determine for an individual woman, it can be estimated for a population. Table 6.10 presents data on two indicators of decreasing exposure to the risk of pregnancy for women age 30 years and older: menopause and long-term abstinence. Table 6.8 postpBrtum amenorrhea, abstinence and insuscetaibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining and insusceptible, by number of months since birth, and median and mean durations, Uzbekistan 1996 Number Months Amenor- Insus- of since birth rheic Abstaining ceptible births < 2 (92.3) (79.5) (97.5) 41 2-3 58.1 24.1 61.3 58 4-5 62.1 3.5 62.1 67 6-7 43.4 2.5 43.4 74 8-9 30.2 1.1 30.2 92 10-11 24.8 6.3 27.5 99 12-13 13.2 2.8 15.4 83 14-15 15.0 2.1 17.2 86 16-17 20.9 6.2 24.9 84 18-19 12.4 3.9 14.6 82 20-21 7.3 0.0 7.3 75 22-23 4.7 5.1 7.7 77 24-25 1.0 1.9 2.9 82 26-27 2.8 0.5 3.3 94 28-29 0.0 0.0 0.0 72 30-31 0.0 0.6 0.6 70 32-33 2.6 2.6 5.1 80 34-35 2.4 0.0 2.4 64 Total 19.2 5.7 20.8 1,379 Median 5.3 1.8 5.4 Mean 8.2 3.2 8.7 Prevalence/ Incidence mean j 6.8 2.0 7.4 t The prevalence-incidence mean is borrowed from epidemiology and is defined as the number of children whose mothers are amenorrheic (prevalence) divided by the average number of births per month (incidence). The percentage of women who are in menopause refers to the proportion of currently married women who are neither pregnant nor postpartum amenorrheic and have not had a menstrual period in the six months preceding the survey, or who report themselves as being menopausal. Few women are menopausal before reaching their forties, after which time the proportion of menopausal women increases with age, from 8 percent among women age 44-45 to 40 percent among women age 48-49. The percentage of women practic- ing long-term abstinence refers to the proportion of currently married women who have not had sexual intercourse in the three years preceding the survey. It can be seen that long-term abstinence is not a factor in reducing the fertility of older women. A potentially more significant factor in reducing risk of exposure to pregnancy than terminal abstinence may be terminal divorce, widowhood and separa- tion among women in Uzbekistan. As was shown in Table 6.1,9 percent of women age 40-44 and 14 percent of women age 45-49 are currently widowed, divorced, or separated. I f these women do not remarry and are not sexually active, they represent a contributing factor to loss of exposure to pregnancy. 87 Table 6.9 Median duration of nostt~artum amenorrhea, abstinence, and insuscentibilitv bv background characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Uzbekistan 1996 Postpartum Number Background Postpartum Postpartum insuscep- of characteristic amenorrhea abstinence tibility births Age <30 5.1 1.7 5.1 1,019 30+ 7.1 2.0 7.3 361 Residence Urban 4.3 1.3 4.3 428 Rural 6.0 2.0 6.0 951 Region Region 1 5.0 1.6 5.0 156 Region 2 6.1 2.2 6. I 33 I Region 3 3.5 2.0 4.6 384 Region 4 6.5 1.0 6.5 425 Tashkent City 3.3 1.8 3.3 84 Education Primary/Secondary 4.8 1.9 5.1 879 Secondary-special 5.9 1.7 5.9 367 Higher 5.1 1.2 5.1 133 Ethnieity Uzbek 5.3 1.8 5.4 1,221 Other 5.3 1.4 5.3 159 Total 5.3 1.8 5.4 1,379 Note: Medians are based on current status. Table 6. I 0 Termination of ext, osure to the risk of Dre~nancv Indicators of menopause and long-term abstinence among currently married women age 30-49, by age, Uzbekistan 1996 Long-term Menopause ~ abstinence 2 Age Percent Number Percent Number 30-34 1. I 487 0.0 572 35-39 1.5 495 0.5 520 40-41 3.8 170 0.6 172 42-43 4.3 158 0.0 158 44-45 7.8 115 0.9 115 46-47 31.7 1 I0 1.2 110 48-49 39.9 90 0.0 92 Total 6.5 1,625 0.3 1,738 i Percentage of nonpregnant, nonamenorrheie currently married women whose last menstrual period occurred six or more months preceding the survey or who report that they are menopausal. 2 Percentage of currently married women who did not have intercourse in the three years preceding the survey. 88 CHAPTER 7 FERTILITY PREFERENCES Saidazym N. Soultanov, gia L Weinstein, Mila A. Li and Rano M. Usmanova Women interviewed in the 1996 UDHS were asked several questions in order to determine their fertility preferences: their desire to have a(another) child; the length of time they would prefer to wait before having a(another) child; and, i f they were to live their lives again, the number of children they would choose to have. These data make the quantification of fertility preferences possible and, in combination with the data on contraceptive use, allow estimation of the demand for family planning, according to the desire to space or limit births. 7.1 Desire for More Children Table 7.1 and Figure 7.1 show the percent distribution of currently married women by their fertility preferences. One-half of married women (5l percent) want no more children. An additional one-quarter of women want another child, but want to wait two or more years before having their next birth. Thus, three- quarters of married women in Uzbekistan are potentially in need of contraception, for the purpose of either limiting their family size or spacing births. Table 7.1 Fertilitv preferences bv number of livine children Percent distribution of currently married women by desire for more children, according to number of living children, Uzbekistan 1996 Desire for Number of living children I children 0 I 2 3 4 5 6+ Total Have another soon 2 69.6 24.9 12.4 8.0 3.5 2.1 1.7 12.9 Have another later 3 7.6 57.9 38.6 16.8 6.5 1.4 0.4 24.2 Have another, undecided when 3.6 1.3 I. 1 0.6 0.4 0.7 0.7 1.0 Undecided 3.8 3.1 9.5 14.1 9.3 I 1.3 4.4 8.8 Want no more 2.2 9.8 36.1 59.9 78.9 82.3 92.0 50.9 Sterilized 0.0 0.0 1.0 0.2 1.3 1.7 0.5 0.7 Declared infecund 13.1 3.0 1.4 0.5 0.1 0.6 0.4 1.7 Total 100.0 I00.0 100.0 100.0 100.0 I00.0 I00.0 100.0 Number of women 142 539 747 607 470 328 270 3,102 I Includes current pregnancy 2 Want next birth within 2 years 3 Want to delay next birth for 2 or more years The fertility preferences of married women are shown according to the number o f children they already have in Table 7.1 and Figure 7.2. The proportion of women wanting no more children increases sharply with the number they already have. In Uzbekistan, it is unusual for women with one child to want no more children--10 percent of women with one child report wanting no more. However, among women with three children, a clear majority (60 percent) want no more children. 89 Figure 7.1 Fertility Preferences among Currently Married Women 15-49 Want no more 51% . ondoo,do Wantchild soon 13 Want child Iater 24% 10% UDHS 1996 While most women with only one child want another child, the majority (58 percent) want to wait two or more years before having that child, and are thus in need of family planning for spacing purposes. The potential demand for family planning exists at every parity (other than zero, that is, since it is unusual for a married woman to report wanting to delay her first birth). Table 7.2 shows statistics on the fertility preferences of currently married women by age. The age pattern and pace at which women want no more children is particularly noteworthy. Among women age 15- 19 and 20-24, only a small percentage want no more children (2 and 12 percent, respectively). By age 25-29, one-third (32 percent) want no more children and by age 30-34, more than half (57 percent) want no more children. It should be noted that these women have 20 years of potentiaI childbearing ahead of them and, to the extent they remain exposed to the risk of pregnancy, will need contraceptive protection or abortion services if they are to achieve their stated preference for having no more children. Among women age 35 and above, 80 percent or more want no more children. In Uzbekistan, a majority of women have a preference for having no more children, and many women come to that preference at young ages when they have many fertile years ahead of them. For some of these women, the most appropriate method of contraception may be a long-term method such as female sterilization. However, only 27 percent of married women report knowledge of this method (Table 4.1). In the interest of providing a broad choice of safe and effective means of contraception, information about this method should be made available to women so that they can make informed choices about whether or not the method is appropriate for them. The family planning program should also consider increasing access to this method so that it is available to women who wish to use it. 90 Table 7.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, according to age, Uzbekistan 1996 Age of woman Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon I 32.0 19.5 20.0 14.5 5.2 1.1 1.1 12.9 Have another later 2 62.3 58.8 34.4 14.5 3.1 0.0 0.0 24.2 Have another, undecided when 0.8 1.6 1.6 0.7 0.5 0.0 0.7 1.0 Undecided 2.7 6.7 10.5 10.3 9.5 7.8 8.7 8.8 Want no more 2.2 11.8 31.7 58.7 79.5 87.9 82.1 50.9 Sterilized 0.0 0.2 0.4 0.3 1.0 1.3 2.1 0.7 Declared infeeund 0.0 1.3 1.5 1.0 1.3 1.9 5.3 1.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 125 599 640 572 520 383 264 3,102 Want next birth within 2 years 2 Want to delay next birth for 2 or more years 100 Figure 7.2 Fertility Preferences among Currently Married Women by Number of Living Children Percent 80 60 40 20 0 0 1 g 3 4 5 6+ Number of Living Children ImWant soon EgHave another later E~Undecided ~Want no more £JSterilized/lnfecund UDNS 1996 Table 7.3 presents the percentage of currently married women who want no more children by number of living children and selected background characteristics. While the overall proportion of women who want no more children does not vary greatly by background characteristics, there are strong differences in how quickly women with different background characteristics reach the point of wanting no more children. For example, one-half of urban women (52 percent) and one-half of rural women (51 percent) want no more children. However, one-half of urban women want no more children by the time they have two children; the same proportion is not reached among rural women until they have three children. 91 Table 7.3 Desire to limit childbearine Percentage of currently married women who want no more children, by number of living children and selected background characteristics, Uzbckistan 1996 Number of living childrenl Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 4.8 13.4 49.0 70.8 83.1 79.0 90.5 52.1 Rural 0.0 7.0 26.8 53.0 78.7 85.4 92.9 51.2 Region Region I (0.0) 6.2 3 I.I 60.4 89.2 94.6 93.4 54.7 Region 2 (2.1) 7.4 37.0 63.0 82.9 93.2 97.7 55.8 Region 3 * 8.6 34.9 62.4 84.7 90.3 (96.2) 53.9 Region 4 * 6.7 32.9 51.5 69.2 67.2 (76.3) 43.7 Tashkent City (4.3) 282 57.0 74.4 (89.6) * * 55.3 Education Primary/Secondary 0.0 67 32.3 58.7 79.3 83.0 91.8 52.3 Secondary-special (7.3) 11.9 40.6 56.4 80. I 90.1 (97.1) 49.3 Higher (5.3) 17.5 46.5 73.6 86.6 * * 52.5 Ethnicity Uzbck 1.2 5.1 30.9 58.4 79.5 83. I 92.4 50.1 Other 5.0 27.2 63.1 70.2 85.3 90.2 * 58.7 Total 2.2 9.8 37. I 60.0 80.2 84.0 92.5 51.5 Note: Women who have been sterilized are considered to want no more children. An asterisk indicates that a figure is based on fewer than 25 unweighted women and has been suppressed. Figures in parentheses are based on 25-49 unweighted women. i Includes current pregnancy The most notable regional variation in fertility preferences is in Tashkent City, where more than one- half of women (57 percent) with two children want no more. Women in Region 4 are the least likely to want no more children; only two out of three women with five children in Region 4 report wanting no more, compared to nine out of 10 women with five children in the other regions. While overall the proportions of women who want no more children are generally the same across educational levels, there is a general pattern of increasing proportions wanting no more children with increasing education at nearly every parity; i.e., women with more education have a lower threshold for wanting no more children. Similarly, non-Uzbek women are more likely than Uzbek women to want no more children at every parity. 7.2 Need for Family Planning Services Women who are potentially in need of family planning are those who either want to wait two or more years before their next birth (need for spacing), or want to stop childbearing altogether (need for l imiting). Women who want to space or limit their childbearing, but are not using contraception, are considered to have an unmet need for family planning. Women who are using family planning methods are said to have a met need for family planning. The sum of unmet need and met need constitutes the total demandfor family planning. Table 7.4 shows statistics on unmet need, met need and total demand for family 92 planning, according to whether the need is for spacing or limiting births. Findings are presented in terms of currently married women. Table 7.4 Need for familv olannine services Percentage &currently married women with unmet need for family planning, and met need for family planning, and the total demand for family planning services, by selected background characteristics, Uzbekistan 1996 Met need for Unmet need for family planning 2 Total demand tbr Percentage family planning I (currently using) family planning of demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fled women Age 15-19 15.7 0.0 15.7 14.7 1.1 15.8 30.4 1.1 31.5 50.0 125 20-24 15.9 2.2 18.0 29.7 5.8 35.5 45.5 8.0 53.5 66.3 599 25-29 9.7 5.0 14.7 33.2 21.9 55.1 43.0 26.9 69.9 78.9 640 30-34 3.4 8.2 I 1.5 24.9 44.0 68.9 28.3 52.2 80.5 85.7 572 35-39 1.0 8.8 9.8 9.9 64.8 74.7 10.9 73.6 84.5 88.4 520 40-44 0.7 13.0 13.7 3.8 60.4 64.2 4.5 73.4 77.9 82.4 383 45-49 0.6 11.7 12.3 3.8 38.5 42.3 4.3 50.2 54.5 77.5 264 Residence Urban 5.7 7.6 13.3 20.8 35.6 56.4 26.5 43.3 69.7 80.9 1,168 Rural 7.2 6.7 13.9 19.9 35.2 55.1 27.1 41.9 69.0 79.9 1,935 Region Region I 3.4 4.4 7.8 21.9 42.1 64.0 25.3 46.5 71.8 89.1 319 Region 2 6.1 6.7 12.8 13.1 39.8 52.9 19.2 46.5 65.7 80.5 705 Region 3 8.2 10.8 18.9 16.2 33.5 49.6 24.3 44.2 68.6 72.4 884 Region 4 7.7 4.9 12.6 28.3 29.5 57.8 36.0 34.4 70.4 82.1 917 Tashkent City 3.3 6.0 9.3 22.6 41.9 64.6 26.0 47.9 73.9 87.4 278 Education Primary/Secondary 7.7 6.8 14.5 17.7 35.2 52.9 25.4 41.9 67.4 78.5 1,906 Secondary-special 5.7 7.3 13.0 24.8 35.9 60.7 30.5 43.2 73.6 82.4 830 f~ligher 3.1 7.9 11.1 22.9 35.2 58.1 26.0 43.1 69.1 84.0 366 Ethnielty Uzbek 7.1 6.9 14.0 20.6 34.3 54.9 27.7 41.2 68.8 79.7 2,592 Other 4.3 7.7 11.9 18.3 41.1 59.4 22.6 48.7 71.3 83.3 511 Total 6.6 7.0 13.7 20.2 35.4 55.6 26.8 42.4 69.3 80.3 3,102 z Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrheic women whose last birth was mistimed, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning and say they want to wait two or more years for their next birth. Also included in unmet need lbr spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need lbr limiting refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted and women who are neither pregnant nor amenorrheic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are menopausal or infecund women. 2 Using fbr spacing is defined as women who are using some method of family planning and say they want to have another ehild or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here, Fourteen percent of married women in Uzbekistan have an unmet need for family planning services, 7 percent for spacing births and 7 percent for limiting births (Table 7.4). Combined with the 56 percent of married women who are currently using contraception, the total demand for family planning comprises 69 percent of married women. While contraceptive prevalence is quite high, if all married women who say they want to space or limit their births were to use methods, contraceptive prevalence would increase from 56 to 69 percent of married women. 93 Unmet need for spacing generally declines with increasing age, as unmet need for limiting increases with age; this pattern reflects the pattern of demand by age. Regional variations in unmet need generally reflect the variations observed in levels of prevalence. Region 1 and Tashkent City have the lowest levels ofunmet need (less than 10 percent), while Region 3 has the highest level (19 percent). There are no striking differentials in unmet need by urban/rural residence, education, or ethnicity (see Figure 7.3). Figure 7.3 . . Percentage of Currently Married Women with Unmet Need and Met Need for Family Planning Services by Background Characteristics UZBEKISTAN RESIDENCE Urban Ru~l EDUCATION Pdrnary/Secondary Secondary-special Higher ~~:~:~i i i ! ! i i ! i i~ i i~ 70 ~/~i i ! i~! i l i iiiiiiii~i~ii!i!iiii ~ 6 9 69 20 40 60 80 100 Percent I~ Unmet Need UDHS1996 7.3 Ideal Family Size Thus far, fertility desires have been examined relative to respondents' current family size. However, the UDHS also asked women how many children they would choose to have if they could go back to the time they had no children, i.e., the number of children they consider to be ideal. Overall, the number of children most commonly reported as ideal (the modal category) is four (Table 7.5 shows that 44 percent of women gave this response). Table 7.5 also shows the percent distribution of women by the number of children they would ideally like to have, according to the number of children they actually have. While the question regarding ideal family size is meant to be independent of the number of children the respondent already has, there is usually a correlation between ideal and actual number of children. This is because women who want larger families will tend to achieve larger families, and because women may adjust their ideal family size upwards as their actual family size increases. For example, nearly 60 percent of women with six or more children reported an ideal family size of six or more. It can be seen that mean ideal family size generally rises as the number of children a woman already has increases. However, an ideal family size of four children is not limited to those with four or more children; approximately 40 percent of women with fewer than three children report an ideal family size of four or more children. In general, the mean ideal number of children is approximately three among women with fewer than three children, and then increases from 3.6 to 5.7 with increasing parity. 94 Table 7.5 Ideal and actual number of children Percent distribution of all women by ideal number of children and mean ideal number of children for all women and for currently married women, according to number of living children, Uzbekistan 1996 Number of living children I Ideal number of children 0 1 2 3 4 5 6+ Total 0 0.2 1 l.l 2 32.2 3 16.1 4 36.3 5 4.9 2.8 6+ 3.1 3.2 Nonnumeric response 6.0 1.4 Total 100.0 100.0 Number of women 1,275 603 All women: Mean ideal number 2 3.2 3.1 Number of women 1,198 595 Currently married women: Mean ideal number 2 3.2 3.2 Number of women 141 535 0.0 0.0 0.1 0.0 0.0 0.0 0.1 4.2 0.4 0.1 0.1 0.1 0.0 1.0 34.2 34.6 10.9 3.0 5.5 1.2 22.6 18.0 15.3 30.7 1.5 1.1 1.2 14.6 36.2 44.0 48.3 78.7 40.5 29.4 43.9 4.0 5.1 7.7 33.5 3.7 6.9 1.0 1.9 6.7 14.2 58.5 7.4 0.8 2.9 2.3 5.0 6.0 3.5 100.0 100.0 100.0 100.0 100.0 100.0 792 633 485 343 285 4,415 3.2 3.6 4.2 4.6 5.7 3.6 785 615 474 326 268 4,260 3.2 3.6 4.2 4.6 5.7 3.8 740 590 459 311 255 3,030 Includes current pregnancy 2 The means exclude women who gave nonnumeric responses. Table 7.6 presents the mean ideal number of children for all women by age and selected background characteristics. The mean ideal number of children gradually increases with age of the respondent; the mean among younger women (3.3) is one child fewer than it is among the oldest women interviewed (4.4). The most significant finding regarding ideal family size is tbe fact that differentials which are apparent among older women are much less pronounced among younger women. For example, rural women age 45-49 report a mean ideal family size of f ive children, 1.3 children more than urban women of the same age; among women under the age of 30, the urban/rural ideals differ only by 0.3 children. The same narrowing o f differentials occurs at the regional level. Women age 45-49 in Region 2 report an ideal family size that is more than two children greater than women in Tashkent City; women in their twenties report ideal family sizes that are within 0.8 children across regions. Educational and ethnic differentials are also less pronounced among younger women. 7.4 Wanted and Unwanted Ferti l ity There are two ways of estimating levels of unwanted fertility from the UDHS data. One is based on reports of the wanted status of recent births. For each child born in the three years before the survey, and for each current pregnancy, women were asked whether the pregnancy was wanted at that t ime (planned), wanted at a later time (mistimed), or not wanted at all (unwanted). These data may lead to underestimates of unplanned childbearing, since women may retrospectively declare unwanted pregnancies as planned once the children are born. Another way of measuring unwanted fertility utilizes the data on ideal family size to calculate what the total fertility rate would be if all unwanted births were avoided. This measure may also suffer from underestimation to the extent that women are unwilling to report an ideal family size lower than their actual family size. Estimates using these two approaches indicate at least the minimum level of unwanted fertility. 95 Table 7.6 Mean ideal number of children bv background characteristics Mean ideal number of children for all women, by age and selected background characteristics, Uzbekistan 1996 Age of woman Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 3.0 3. I 3.2 3.3 3.4 3.5 3.7 3.3 Rural 3.4 3.4 3.6 4.0 4.2 4.8 5.0 3.9 Region Region I 2.9 3.2 3.5 3.8 4.1 4.6 4.7 3.6 Region 2 3.6 3.6 3.6 4.0 4.3 4.8 5.4 4.0 Region 3 3.6 3.6 3.6 3.8 4.2 4.5 4.4 3.8 Region 4 2.9 2.8 3.3 3.5 3.6 3.7 4.3 3.3 Tashkent City 2.7 3.0 2.9 2.8 3.0 3.2 3.2 3.0 Education Primary/Secondary 3.3 3.4 3.7 3.9 4.2 4.6 4.9 3.8 Secondary-special 3.2 3.1 3.3 3.5 3.6 3.8 3.7 3.4 Higher (2.9) 3.1 3.1 3.2 3.4 3.5 3.7 3.3 Ethnicity Uzbek 3.4 3.3 3.5 3.8 4. I 4.4 4.7 3.7 Other 2.9 3.0 3.3 3.2 3.2 3.8 3.6 3.2 Total 3.3 3.3 3.5 3.7 3.9 4.2 4.4 3.6 Note: Parentheses indicate a figure is based on 25 to 49 unweighted women. Tab le 7.7 shows the percent distr ibut ion o f births in the three years before the survey (and current p regnanc ies ) by whether the birth was wanted then, wanted later, or not wanted at all. Overa l l , only 4 percent o f births in the three-year period were reported to be unplanned. Whi le the proport ion o f unwanted births does rise with increasing birth order, the vast major i ty o f even the highest order births are reported as being wanted at the t ime (90 percent). Table 7.7 Fertility nlannin~ status Percent distribution of births in the three years preceding the survey and current pregnancies, by fertility planning status, according to birth order and mother's age, Uzbekistan 1996 Planning status of birth Birth order Number and mother's Wanted Wanted Not of age then later wanted Missing Total births Birth order 1 98.8 0.3 0.2 0.8 100.0 555 2 94.8 4.0 0.6 0.7 100.0 497 3 92.2 4.1 1.7 2.0 100.0 291 4+ 90.4 2.2 6.9 0.5 100.0 355 Age at birth <19 95.9 2.5 0.2 1.4 100.0 205 20-24 96.6 2.2 0.7 0.5 100.0 756 25-29 93.0 3.5 2.1 1.4 100.0 422 30-34 93.8 1.9 3.1 1.1 100.0 228 35-39 89.7 0.0 10.3 0.0 100.0 72 40-44 * * * * 100.0 10 Total 94.7 2.4 1.9 0.9 100.0 1,697 Note: Birth order includes current pregnancy. An asterisk indicates that a figure is based on fewer than 25 births (and current pregnancies) and has been suppressed. 96 Table 7.8 presents "wanted" fertility rates. Wanted fertility represents the level of fertility that would have prevailed in the three years before the survey i f all unwanted births had been prevented. Unwanted births are those which exceed the number considered ideal by the respondent. The wanted fertility rate is calculated in the same manner as the total fertility rate, but unwanted births are excluded from the numerator. The small proportion of women who gave a nonnumeric response to the question on ideal family size are assumed to have wanted all their births. A comparison of the total wanted fertility rate and the actual fertility rate suggests the potential demographic impact of avoiding unwanted births. As seen in Table 7.5, women who report an ideal family size which is smaller than what they actually have are in the minority; therefore, differences between wanted and actual fertility rates are extremely low in Uzbekistan. The wanted fertility rate is only 0.2 children lower than the actual rate, and there are no great differentials by background characteristics. Table 7.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Uzbekistan 1996 Total wanted Total Background fertility fertility characteristic rate rate Residence Urban 2.5 2.7 Rural 3.4 3.7 Region Region 1 3.2 3.4 Region 2 3.2 3.4 Region 3 3. I 3.3 Region 4 3.1 3.6 Tashkent City 2.2 2.3 Education Primary/Secondary 3.2 3.5 Secondary-special 2.9 3. I Higher 2.7 2.8 Ethnieity Uzbek 3.2 3.5 Other 2.2 2.5 Total 3.1 3.3 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey. The total fer- tility rates are the same as those presented in Table 3.2. 97 CHAPTER 8 INFANT AND CHILD MORTALITY Akhror B. Yarrulov and Jeremiah M. Sullivan 8.1 Background and Assessment of Data Quality This chapter presents information on mortality among children under five years of age. The rates shown provide information on levels and time trends in mortality as well as differentials between population subgroups. The information on mortality differentials should be of particular use to the agencies providing health services because the population subgroups at high risk of mortality are identified. The rates of mortality presented in this chapter are defined as follows: Neonatal mortality (NN): the probability of dying within the first month of life, Postneonatal mortality (PNN): the difference between infant and neonatal mortality, Infant mortality (~q0): the probability of dying between birth and the first birthday, Child mortality (4ql): the probability of dying between exact ages one and five, Under-five mortality (sq0): the probability of dying between birth and the fifth birthday. All rates are expressed as deaths per 1,000 live births, except child mortality which is expressed as deaths per 1,000 children surviving to age one. The mortality estimates were calculated from information in the reproductive section of the Women's Questionnaire. In the UDHS, survey respondents were asked to report reproductive events in terms of international definitions. The definition of a live birth is a birth, irrespective of the duration of pregnancy, which after separation from the mother breathes or shows any other signs of life such as beating of the heart or movement of voluntary muscles. Infant deaths are deaths of live-born infants under one year of age (United Nations, 1992). The reproductive section of the UDHS questionnaire includes a pregnancy history in which specific questions are asked about each pregnancy that a woman has had. For each live birth reported in the pregnancy history, questions are asked about the month and year of birth, sex of the child, survivorship status and current age (for surviving children) or age at death (for deceased children). The accuracy of mortality estimates calculated from pregnancy history data depends upon the sampling variability of the estimates and on nonsampling error (i.e., the completeness and accuracy with which births and deaths are reported and recorded). Sampling variability is discussed in the next section of this chapter. Typically, the most serious source of nonsampling error in mortality data collected by a retrospective survey is underreporting of the births and deaths of children who do not survive (United Nations, t982). Such underreporting results in underestimated mortality rates. When there is underreporting of deceased children in a survey, it is usually most severe for deaths which occur in early infancy, i.e., in the neonatal period, lfthere is underreporting of early neonatal deaths, this would result in an abnormally low ratio of neonatal mortality to infant mortality. In retrospective surveys, underreporting of early infant deaths is usually more common for births that occur further back in time than for births occurring close to the time of the survey. Hence, when considering the quality of 99 mortality data, it is useful to examine the ratios of neonatal to infant mortality for different retrospective time periods. Neonatal and infant mortality rates from the UDHS are shown in Table 8. l. For the periods 0-4, 5-9 and 10-14 years before the survey, the values of the ratio of the former to the latter are .46, .54 and .47, respectively. In countries known for having complete and accurate mortality data, at a level of infant mortality between 40 and 50 per 1,000 (a range which includes the infant mortality rates estimated by the UDHS), the value of this ratio is typically between .50 and .60) The ratios for Uzbekistan are somewhat lower than this but not greatly so. Accordingly, this inspection of the data does not suggest substantial underreportlng of" neonatal deaths. Iable 8 1 Intant and child mortality [nthnt mid child mortality rates by live-year periods preceding the survey. Uzbekistan 1996 Years Neonatal Postneonatal Infant Child Under-five prcceding mortality mortality mortality mortality mortality survey (NN) (PNN) {lqil) (4ql) (sq0) 0-4 22.8 26.3 49.1 10.7 59.3 5-9 20.6 17.2 37.8 13.9 51.1 1(I-14 21.7 24.5 463 20.0 65.3 8.2 Levels and Trends in Ear ly Ch i ldhood Mor ta l i ty Table 8.1 shows infant and childhood mortality estimates for 0-4, 5-9, and 10-14 years before the survey. For the period 0-4 years before the survey (i.e., approximately mid-1992 to mid-1996), infant mortality was estimated as 49 per 1,000 births. The estimates of neonatal and postneonatal mortality were 23 aM 26 per 1,000. The estimate of child mortality (age 1 to age 5) was much lower at 11 per 1,000. Overall, for the period mid-1992 to mid-1996, under-five mortality was 59 per 1,000. Between the periods 10- 14 and 0-4 years before the survey, the estimates of infant mortality were 46 and 49 per 1,000, respectively, indicating very little change in mortality during the period. The rate for the period 5-9 years before the survey was 38 per 1,000, a rate lower than the estimates for the adjacent time periods. However, given the sampling variability of the estimates (i.e., variability arising because the estimates are based on a sample of births rather than all births in Uzbekistan in a particular time period), one cannot be confident that the variability of the estimates reflects true cbauges in mortality levels rather than sampling wiriability. 2 This is particularly true when the observed fluctuations in the estimated rates have no obvious explanation; for example, a severe downturn in economic conditions accompanied by food shortages, and other statistical sources do not show a recent upturn in mortality. Under these circumstances, it is probably most appropriate to fbcus on the rates for the 10-year period preceding the survey. In this approach, the estimate of infant mortality for the period 1986-95, following definitions of live birth and infant death advocated by the United Nations, is 44 per 1,000. For example, see the neonatal and infant mortality rates for Austria (1959), Canada (1952), and Belgium (1956) in the U.N. Demographic Yearbook, 1961 and for Cuba (1968), Puerto Rico (1965), and Poland (1966) in the U.N. Demographic Yearbook, 1974. 2 The mortality estimates of the UDHS are based on data provided by a sample of 4,415 women and are subject to sampling variability. Of interest here is the 95-percent confidence interval for the estimated infant mortality rate for the period 0-4 years betbre the survey (49 per 1,000). The confidence interval is very broad and extends from 36 to 62 per 1.000 (see Appendix B). Thus, the point estimate of 49 per 1,000 cannot be considered exact and the true rate could be higher or lower. I00 8.3 Infant Mortality Rates from the Ministry of Health The Republic of Uzbekistan has a long history of demographic and health data collection primarily through the use of registration systems which are national in coverage and which collect information on all events throughout the country. In the case of births and infant deaths, the Ministry of Health (MOH) is responsible for data collection which is performed when reports of local level health officials are forwarded up the reporting hierarchy to the oblast level and to the Ministry. The data on live births and infant deaths are collected following protocols which were established during the period of the former Soviet Union. Those protocols define live births somewhat differently than the definitions of the United Nations which were used in the UDHS. According to the protocols, a pregnancy terminating at a gestation age of less than 28 weeks (i.e., weighing less than 1,000 grams or measuring less than 35 centimeters) is considered premature and is classified as a late miscarriage even if signs of life are present at the time of delivery. Only i fa premature birth survives for seven days is the child classified as a live birth. A pregnancy terminating at 28 or more weeks of gestation is considered a live birth if the child breathes and as a stillbirth if breathing is not evident at the time of delivery. Thus, some events classified as late miscarriages in the Uzbekistan statistical system would be classified as live births and infant deaths according to the definitions used in the UDHS. Official government statistics on infant mortality are published in tile annual statistical reports of the MOH and in the annual statistical reports of the State Committee on Statistics and Analysis (Goskomprognozstat). 3 Table 8.2 shows infant mortality rates based on MOH data for the years 1986 through 1995 as well as the average of the annual rates for that 10-year period. Overall there is a steady declining trend in tile annual rates from 46.3 to 26.0 per 1,000. The only deviations from the trend line are the modest increases in 1991 and 1992. Tile 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. Differences between the MOH and the UDHS in the definition of a live birth and an infant death no doubt contribute to the difference in infant mortality estimates for the period 1986-95. An assessment of the source of the difference in the estimates must also consider the sampling variability of the UDHS estimates. At this time, the precise contribution of definitional differences, sampling variability or other factors to differences between the estimates is not clear. Table 8.2 Trends in infant mortality rates lnlhnt mortality rates reported by the Ministry of I lealth. 1986-95 lnl~nt Year mortality 1986 46.3 1987 45.9 1988 43.3 1989 37.8 1990 34.6 1991 35.5 1992 37.0 1993 32.0 1994 28.2 1995 26.0 Mean 1986-95 36.6 Sources: 1986-93: Church and Koutanev, 1995; 1994: Ministry of Health, RepubLic of Uzbekistan, 1995; I995: Data tabulation obtaincd li'om Ministry of Ilcalth 3 It is worth noting that the rates published by the MOH and Goskomprognozstat are shown at the national level, for Tashkent City, for the 12 oblasts of Uzbekistan, and for the autonomous region of Karakalpakstan. I01 8.4 Socioeconomic Differentials in Childhood Mortality Differentials in infant and child mortality by urban-rural residence, mother's education and mother's ethnic group are shown in Table 8.3 and Figure 8.1. The estimated rates for subgroups of the population are for a 10-year period preceding the survey. Table 8,3 Infant and child mortality by background characteristics Infant and child mortality rates for the 10-year period preceding the survey, by selected background characteristics, Uzhekistan 1996 Neonatal Postneonatal Infant Child Under-five Background mortality mortality mortality mortality mortality characteristic (NN) (PNN) (lq0) (4ql) (sqo) Residence Urban 23.5 19.4 42.9 9.3 51.8 Rural 20.9 22.9 43.8 13.6 56.8 Education Primary/Secondary 21.9 23.5 45.4 14.0 58.8 Secondary-special 16.8 19.3 36.1 11.0 46.8 Higher 34.2 16.8 51.0 3.7 54.6 Ethnicity Uzbek 19.6 21.0 40.6 12.4 52.5 Other 35.8 26.7 62.5 11.5 73.3 Total 21.7 21.8 43.5 12.2 55.2 Figure 8.1 Under-five Mortality by Selected Characteristics RESIDENCE Urban Rural EDUCATION Primary/Secondary Secondary-special Higher ETHNICITY Uzbek Other SEX OF CHILD Male Female BIRTH INTERVAL < 2 years 2-3 years 4 years + 52 57 i i ~ ~ % ~ % ~ 53 ~ ~ ~ 73 46 65 ? ; ,L 2. <,'<.~ ,.,. =" :. ~ 66 57 0 20 40 60 80 Deaths per 1000 Live Births 100 UDHS1996 102 Under-five mortality is marginally higher in rural (57 per 1,000) than in urban areas (52 per 1,000). Most of this differential is the result of higher child mortality rates in rural areas. The mortality estimates for children by education of mother exhibit some unexpected differentials and suggest that early infant deaths (deaths to neonates) may have been underreported by some population groups in the survey. The problem is most evident in terms of the educational differentials in rates for the neonatal, postneonatal and child (age 1 to 5) age intervals. The postneonatal and child mortality rates behave as expected and exhibit a declining pattern when progressing from women with primary/secondary to secondary-special to higher education. On the other hand, the neonatal rates show the opposite pattern and are substantially greater for higher educated women (34 per 1,000) than for primary/secondary and secondary-special women (22 and 17 per 1,000 respectively). A full investigation of this problem is beyond the scope of this report. However, one plausible explanation is underreporting of events by less educated women. This explanation is based on the following rationale. The educational differential of the neonatal rates is not credible. Moreover, it is unlikely that neonatal mortality is mistakenly overreported by higher educated mothers. However, less educated women may have underreported events if they were less knowledgeable about live births who survived only a short time following birth and were classified as miscarriages, as would be the case in Uzbekistan for pregnancies terminating at less than 28 weeks of gestation. Striking mortality differentials are also evident by the ethnicity of a child's mother. Children born to women of Uzbek ethnicity have lower rates of infant mortality than children born to women of other ethnicity (41 and 63 per 1,000, respectively). The mortality advantage of Uzbek children is evident in both the neonatal and postneonatal rates. 8.5 Demographic Differentials in Childhood Mortality The relationship between early childhood mortality and selected demographic variables is shown in Table 8.4. In most populations, male children experience higher mortality than female children; this is the case in Uzbekistan. In terms of infant mortality, the rate for males (50 per 1,000) exceeds the rate for females (37 per 1,000) by 37 percent. The relationship between childhood mortality and birth order indicates that first births and, especially, births of order four and higher are at greater than average risk of mortality. A clear association is indicated between mortality risk and the length of the preceding birth interval. Births which occur after a short birth interval are at greater risk of mortality than births occurring after longer intervals. The risk of infant mortality for births following an interval of less than two years (51 per 1,000) is greater than the risk for births following an interval of 2-3 years (35 per 1,000) or four or more years (48 per 1,000). This relationship suggests that some mortality reduction would result if the proportion of births occurring after a short birth interval were reduced. 8.6 High-Risk Fertility Behavior Previous research has shown a strong relationship between fertility patterns and children's risk of mortality (United Nations, 1994). Typically, mortality risks are greater for children who are born to mothers who are too young or too old, who are born after a short birth interval, or who have a high birth order. In this analysis, a mother is classified as "too young" if she is less than 18 years of age, and "too old" if she is over 34 years of age. A "short birth interval" is defined as a birth occurring within 2 years of the previous birth, and a child is of"high order" if the mother had previously given birth to four or more children. 103 Table 8.4 Infant and child mortality bv demourat3hic characteristics Infant and child mortality rates lbr the 10-year period preceding the survey, by selected demographic characteristics, Uzbekistan 1996 Neonatal Posmeonatal Infant Child Under-five Demographic mona ty mortality mortality mortality mortality characteristic (NN) (PNN) (lq0) (4ql) (sq0) Sex of child Male 24.1 26. I 50.2 15.3 64.7 Female 19.3 17.4 36.7 9.2 45.6 Age of mother at birth < 20 28.2 16.8 45.0 14.8 59.2 20-29 17.6 24.3 41.9 13.7 55A 30-39 29.4 16.6 46.1 6.5 52.3 Birth order 1 20.8 21.1 41.9 14.8 56.0 2-3 18.5 21.2 39.7 13.5 52.7 4+ 27.6 23.4 51.0 8.3 58.9 Previous birth interval < 2 yrs 20.4 30.4 50.8 16.4 66.3 2-3 yrs 18.5 17.0 35.4 8.6 43.8 4+ yrs 27.8 19.7 47.5 9.4 56.5 Total 21.7 21.8 43.5 12.2 55.2 Table 8.5 shows the distribution of children born in the five years before the survey by risk category. While first births to women age 18 to 34 are shown separately in Table 8.5, they are not included in the analysis because they are not considered an avoidable risk. Column 1 of Table 8.5 shows that, in the five-year period before the survey, 28 percent of births were in a single high-risk category and 6 percent were in a multiple high-risk category. Column 2 of the table shows risk ratios for high-risk births relative to births not having any high-risk characteristics. Overall, the risk ratio for births in a single high-risk category is 1.3 (i.e., elevated by 30 percent over births in the no risk category). For births with multiple high-risk characteristics, the risk ratio is 2.1 (i.e., elevated by a factor of 2). Column 3 of Table 8.5 looks to the future and addresses the question: how many currently married women have the potential for having a high-risk birth? The results were obtained by simulating the risk category into which a birth to a currently married woman would fall if she were to become pregnant at the time of the survey. For example, a woman who was 37 years old at the time of the survey, and had four previous births the last of which occurred three years earlier would be classified into the multiple high-risk category of being too old (35 or older) and at risk of having a high order birth (greater than 4). Overall, 63 percent of currently married women had the potential to give birth to a child with an elevated risk o f mortality. Twenty-nine percent of women had the potential to give birth to a child with multiple high-risk factors. 104 Table 8.5 Hi,h-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality, and the percent distribution of currently married women at risk of conceiving a child with an elevated risk of mortality, by category of increased risk, Uzbekistan 1996 Births in 5 years preceding the survey Percentage of currently Risk Percentage Risk married a category of births ratio women Not in any high-risk category 36.8 1.0 Unavoidable risk category First birth between ages 18 and 34 29.0 I. 1 7.6 Single high-risk category Mother's age < 18 1.4 0,6 0.1 Mother's age > 34 1.3 0.9 12.5 Birth interval < 24 months 18.3 1.6 14.1 Birth order > 4 7.3 0.7 6.9 29.4 b Subtotal 28.3 1.3 33.6 Multiple high-risk category Age <18 & birth interval <24 c months 0.1 0.0 0.0 Age >34 & birth interval <24 months 0.3 0.0 0.1 Age >34 & birth order >4 3.8 2.4 25.6 Age >34 & birth interval <24 & birth order >4 0.5 0.0 0.9 Birth interval <24 & birth order >4 1.3 2.4 2.7 Subtotal 5.9 2.1 29.4 In any high-risk category 34.2 1.5 63.0 Total 100.0 100.0 Number of births 2,455 3,102 Note: Risk ratio is the ratio of the proportion dead of births in a specific high-risk ~ategory to the proportion dead of births not in any high-risk category. Women were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest Birth less than 15 months ago, and latest birth of order 4 or higher. Includes sterilized women e Includes the combined categories Age < 18 and birth order >4. 105 CHAPTER9 MATERNAL AND CHILD HEALTH Akhror B. Yarkuiov, Damin A. Asadov and Saidazym N. Souitanov This chapter presents findings conceming maternal and child health in Uzbekistan. Information is presented on maternal care during pregnancy and delivery, vaccinations of children and child illnesses (respiratory infection, fever and diarrhea) in the two weeks preceding the survey. Data on maternal care were obtained for all live births in the three years prior to the survey, while data on child vaccinations and illnesses were obtained for surviving children. 9.1 Antenatal Care Interviewers recorded in the UDHS questionnaires all medical personnel that a woman reported as having seen for antenatal care for each live birth in the three years preceding the survey. For the purpose of presenting results, antenatal care is classified in terms of the provider with the highest medical qualifications. Table 9.1 and Figure 9.1 show the percentage of births for which mothers received antenatal care. A very high proportion of mothers receive care from professional health providers (95 percent); the majority from a doctor (85 percent) and a significant proportion from a nurse or midwife (10 percent). Only 5 percent of women report no antenatal care. Differences in antenatal care between age groups of women are negligible. Births to older women are less likely to benefit from antenatal care from a doctor. Differences by birth order are more pronounced. Mothers are more apt to receive care by a doctor for first births (87 percent) than for births of order four and higher (78 percent). Significant differences in the source of antenatal care are found for mothers classified by urban/rural residence and by region. The percentage of mothers who receive care from a doctor is greater in urban (91 percent) than in rural areas (83 percent), and greater in Tashkent City (98 percent) and Regions 2 and 4 (95 and 99 percent, respectively) than in Regions 1 and 3 (73 and 64 percent, respectively). In Region 3, the percent of mothers who receive no antenatal care (14 percent) is several times higher than in any other region. Mother's education and ethnicity are also associated with antenatal care. All women, irrespective of education and ethnicity, receive antenatal care from a doctor equally. Antenatal care is most beneficial when it is sought early in pregnancy and is continued throughout a pregnancy. The first visit to the women's consulting center should occur in the first three months of pregnancy so that a timely assessment of each woman's health can be made and appropriate procedures can be employed for the management of the pregnancy. Table 9.2 shows information on the timing and number of visits made to health providers during pregnancy for live births in the three years preceding the survey. By the start of the third month of preg- nancy, 39 percent of women have made their first antenatal visit and by the start of the sixth month of pregnancy, 90 percent have made a visit. The median duration of pregnancy for the first antenatal visit is 3.2 months. 107 Table 9.2 also indicates that 79 percent of women make four or more antenatal care visits. The median number of antenatal care visits is 8. It is clear that in Uzbekistan antenatal care is received early in pregnancy and, for most women, is continued throughout pregnancy. Table 9.1 Antenatal care Percent distribution of births in the three years preceding the survey by source of antenatal care during pregnancy, according to selected background characteristics, Uzbekistan 1996 Antenatal care provider I Nurse/ Number Background Trained of characteristic Doctor midwife No one Total births Mother's age at birth < 20 86. I 7. I 6.8 100.0 169 20-34 85.9 9.6 4.5 100.0 1,150 35+ 75.1 16.1 8.8 100.0 72 Birth order 1 87.0 8.2 4.9 100.0 432 2-3 87.8 8.2 4.1 100.0 654 4+ 77.8 14.8 7.3 100.0 305 Residence Urban 90.7 5.9 3.3 100.0 428 Rural 82.9 11.3 5.8 100.0 963 Region Region 1 72.9 26.8 0.3 100.0 157 Region 2 94.8 0.9 4.3 100.0 334 Region 3 64.0 22.2 13.8 100.0 386 Region 4 99.3 0.7 0.0 100.0 431 Tashkent City 97.7 0.0 2.3 100.0 84 Mother's education Primary/Secondary 83.5 10.5 6.0 100.0 889 Secondary-special 88.7 8.2 3. I 100.0 368 Higher 88.3 7.9 3.8 100.0 135 Ethnicity Uzbek 85.4 9.4 5.2 100.0 L231 Other 85.0 11.3 3.7 I00.0 161 All births 85.3 9.6 5.0 100.0 1,392 Note: Figures are for births in the period 0-35 months preceding the survey. t If the respondent mentioned more than one provider, only the most qualified provider is considered. 9.2 Ass i s tance and Med ica l Care at De l ivery Hygienic conditions during delivery and supervision of delivery by trained medical staff reduce the risk of infections and ensure that complications of delivery are effectively handled. The UDHS collected information on the place of delivery for all children born in the three years preceding the survey and the type of medical staff assisting during delivery. 108 Table 9.3 indicates that virtually all births are delivered at health facilities (94 percent). The great majority of births occur in a delivery hospital (93.7 percent) and another 0.4 percent in either a general hospital or a FAP (doctor's assistant/midwife post). Only 6 percent of births are reported as occurring outside the setting of a health facility (i.e., primarily at the respondent's home). The high proportion of births delivered in delivery hospitals leaves little potential for differentials in place of delivery by age groups. Table 9.3 indicates that the percentage of births delivered in a hospital setting is 86 percent or higher for all population groups. Figure 9.1 Percent Distribution of Births by Antenatal Care and Delivery Characteristics ANTENATAL CARE Doctor Nurse/Midwife No one PLACE OF DELIVERY Obgyn Hospital Hospital Dr.Asst/Midwife post Respondenfs Home Other home ASSISTANCE DURING DELIVERY Doctor Trained Nurse Midwife Other ~~/ / / / / / / / / / / / / / / / / / / /~ 89.3 ,~,~',~ 9,6 5.0 93.7 0.3 0.1 5.1 0.8 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 93.9 3.7 2.5 20 40 60 80 100 Percent UDHS 1996 Table 9.4 indicates that almost all births are delivered under the supervision of persons with medical training--94 percent by a doctor and 4 percent by a nurse or trained midwife. While virtually all births are delivered by trained medical staff, there are differences in the percentage of deliveries assisted by a doctor and, alternatively, by a nurse or midwife by residence and region. Relatively more deliveries are attended by doctors in urban areas (99 percent) than in rural areas (92 percent), and more deliveries are attended by a doctor in Tashkent City (99 percent) and Regions 1 and 4 (98 percent) than in Regions 2 and 3 (88 and 9I percent, respectively). The likelihood of delivery under a doctor's supervision is greater for women of Uzbek ethnicity (95 percent) than for women of other ethnieity (88 percent). 9.3 Character ist ics of Del ivery Respondents were asked in the UDHS if their births were delivered by caesarean section. Respondents were also asked if their children were weighed at the time of birth, and if so, how much each baby weighed. In addition, mothers were asked for their subjective assessment of their baby's size at birth (very large, larger than average, average size, smaller than average, or very small). 109 Table 9.5 indicates that according to mothers' reports, 3 percent of births in the three years before the UDHS were delivered by caesarean section. This estimate is consistent with the reported statistic of 2.5 percent of deliveries by caesarean section (Ministry of Health, 1996). Delivery by caesarean section is more common among births to older women, women younger than 20, women residing in urban areas, more educated women, and women of non-Uzbek ethnicity. However, the most pronounced differential in the prevalence of caesarean section delivery is associated with region. The rate of caesarean section is several times higher among births in Tashkent City (9 percent) than among births in the other survey regions (2 to 4 percent). Mothers who report that their baby was weighed at birth were able to report the birth weight for 96 percent of all births in the last three years. As Table 9.5 indicates, 4 percent of births have a weight of less than 2.5 kilograms, which is classified as low birth weight and is considered to have a higher than average risk of early infant mortality. According to the mother's subjective evaluation of birth size, 1 percent of children are reported as very small at birth and another 11 percent are smaller than average. 9.4 Vaccinations According to guidelines developed by the World Health Organization, a child should have received a BCG vaccination to Table 9.2 Number of antenatal care visits and sta~e of vre~nancv Percent distribution of live births in the three years preceding the survey by number of antenatal care visits, and by the stage of pregnancy at the time of the t]rst visit, Uzbekistan 1996 Characteristic Percent Number of visits 0 5.0 1 1.9 2-3 7.8 4+ 78.5 Don't know/missing 6.8 Total 100.0 Median 7.8 Number of months pregnant at time of first visit No antenatal care 5.0 <3 months 39,2 3-5 months 50.9 6+ months 3.2 Don't know/missing 1.6 Total 100.0 Median 3.2 Number of births 1,392 Note: Figures are lbr births in the period 0-35 months preceding the survey. protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis and tetanus, three doses of the polio vaccine, and a measles vaccination by the age of 12 months. The child vaccination schedule in Uzbekistan requires that BCG and oral polio vaccines are first 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, 18 months and 6-7 years of a 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 Health, 1993 B). Vaccination coverage 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 times. After the two-year period, the vaccination schedule may still be under the control of the staff of the pediatric departments of polyclinics or the records can be transferred to a day care center if the child attends one. In tbe latter case, vaccination is coordinated by the day care nurse. Finally, when the child starts to attend primary school at age seven, the school nurse becomes responsible for the child's vaccinations. 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. Therefore, the decision was made to collect vaccination data in two 110 ways: first, from respondents while administering the Individual Woman's Questionnaire, and second, from the health cards maintained at the health facilities or day care centers. T~I~ 9,~ Place of delivery Percent distribution of births in the three years preceding the survey by place of delivery, according to selected background characteristics, Uzbekistan 1996 Place of delivery Doctor's assistant/ Respond- Number Background Delivery midwife ent's Other of characteristic hospital Hospital post home home Total births Mother's age at birth < 20 96.8 0.9 0.0 1.4 0.9 100.0 169 20-34 93.7 0,2 0.2 5.2 0.8 100.0 1,150 35+ 87.4 0.0 0.0 12.6 0.0 100.0 72 Birth order 1 97.0 0.5 0,4 1.4 0.7 100.0 432 2-3 94.4 0.0 0,0 5.0 0.5 100.0 654 4+ 87.6 0.5 0,0 10.5 1,5 100.0 305 Residence Urban 97.8 0.5 0,0 1.2 0.4 100.0 428 Rural 91.9 0,2 0,2 6.8 1.0 100.0 963 Region Region I 98.7 0.0 0,0 1.3 0.0 100.0 157 Region 2 89.7 0.2 0.0 9.6 0.4 100.0 334 Region 3 89.9 0.4 0.5 9.3 0.0 100.0 386 Region 4 97.3 0.4 0.0 0.2 2.1 100.0 431 Tashkent City 98.8 0.0 0.0 0.0 0.6 100.0 84 Mother's education Primary/Secondary 91.6 0.4 0.2 6.6 1.1 100.0 889 Secondary-special 97.5 0.0 0.0 2.3 0.1 100.0 368 Higher 97.3 0.0 0.0 2.7 0.0 100.0 135 Ethnicity Uzbek 94.4 0.3 0.1 4.2 0.9 100.0 1,231 Other 88.4 0.0 0.0 11.6 0.0 100.0 161 Antenatal care visits None 83.7 2.0 0.0 14.3 0.0 100.0 70 1-3 visits 91.4 0.0 0.0 8.6 0.0 100.0 134 4 or more visits 95.1 0.2 0.2 3.7 0.8 100.0 1,093 Don't know/Missing 88.7 0.0 0.0 9.7 1.6 100.0 95 All births 93.7 0.3 0.1 5.1 0.8 100.0 1,392 Note: Figures are for births in the period 0-35 months preceding the survey. The data collected in the Individual Woman's Questionnaire were almost entirely based on mother's recall, since health cards were unavailable in the homes for 98 percent of children. Data were collected on whether or not a child had received specific vaccines, such as BCG, polio, DPT or DT (against diphtheria and tetanus without the pertussis vaccine component), and measles. For children who were reported to have received polio and DPT/DT, mothers were asked the number of doses received for each. The vaccination data from the health cards were collected by the supervisors of the interviewing teams who visited the health care facilities or day care centers and, with the help of facility personnel (i.e., nurse or archive clerks), searched for the child health cards. Cards were found for 90 percent of children 111 reported as under three years of age in the woman's questionnaires. The team supervisors recorded the vaccination data for each child on forms designed for that purpose. Table 9.4 Assistance during delivery Percent distribution of births in the three years preceding the survey by reported provider during delivery, according to selected background characteristics, Uzbekistan 1996 Attendant assisting during delivery I Nurse/ Number Background Trained Relative/ of characteristic Doctor midwife Other No one Total births Mother's age at birth < 20 98.5 1.5 0.0 0.0 100.0 169 20-34 93.5 4.1 2.0 0.4 100.0 1,150 35+ 88.1 1.9 8.2 1.9 100.0 72 Birth order 1 97.1 2.3 0.6 0.0 100.0 432 2-3 94.2 2.8 2.5 0.4 100.0 654 4+ 88,4 7.4 3.3 0,9 100.0 305 Residence Urban 98.9 1.1 0.0 0.0 100.0 428 Rural 91.6 4.8 3.0 0.6 100.0 963 Region Region 1 98.1 1.6 0.3 0.0 100.0 157 Region 2 88.2 3.3 6.9 1.6 100.0 334 Region 3 91.2 7.4 1.4 0.0 100.0 386 Region 4 97.9 2. I 0.0 0.0 100.0 43 I Tashkent City 99.4 0.6 0.0 0.0 I00.0 84 Mother's education Primary/Secondary 92.6 4.4 2.7 0.3 100.0 889 Secondary-special 96.1 1.8 1.4 0.7 100.0 368 Higher 95.9 4.1 0.0 0.0 100.0 135 Ethnieity Uzbek 94.6 4.0 1.1 0.3 100.0 1,231 Other 88.3 1.6 9.3 0.8 100.0 16 I Antenatal care visits None 79.2 I-3 visits 90. I 4 or more visits 95.5 6.5 12.3 1.9 100.0 70 3.5 6.4 0.0 100.0 134 3.7 0.6 0.2 100.0 1,093 Total 93.8 3.7 2.1 0.4 100.0 1,392 Note: Figures are for births in the period 0-35 months preceding the survey. Total includes 95 births lbr which data on antenatal care are missing. 1 If the respondent mentioned more than one attendant, only the most qualified attendant is considered. Table 9.6 presents vaccination coverage rates for: 1) the data obtained on the Woman's Questionnaire (i.e., based on mother's recall), and 2) the data obtained from the cards at the health facilities. Vaccination coverage with BCG, first dose of polio, and measles vaccines was similarly high based on both the mother'sverbal reports and the records from the health facilities. However, mothers reported much lower coverage with the second and third doses of polio and with all doses of DPT/DT vaccines compared to what was recorded in the health cards. Because of the high dropout rate between the first and third vaccines of polio and DPT/DT according to the mother's report, the percentage of children who had received all WHO recommended vaccinations was only 28 percent, while according to the health cards, 85 percent of the children were fully immunized. 112 Table 9.5 Delivery characteristics: eae.~,arean section, birth weight and size Among births in the three years preceding the survey, the percentage of deliveries by caesarean section, and the percent distribution by birth weight and the mother's estimate of baby's size at birth, according to selected background characteristics, Uzbekistan 1996 Birth weight Size of child at birth Delivery Less 2.5 kg Smaller Average Number Background by than or Don't Very than or Don't of characteristic C-saction 2.5 kg more know Total small average larger know Total births A e ~<~0 5.1 5.7 93.4 0.9 100.0 1.8 11.0 87.3 0.0 100.0 169 20-34 2.4 4.1 92.2 3.7 100.0 0.9 11.5 86.5 1.1 100.0 1,150 35+ 6.1 2.2 87.2 10.7 100.0 0.0 8.3 87.9 3.8 100.0 72 Birth order 1 3.2 5.3 93.3 1.4 100.0 1.0 13.5 85.4 0.0 100.0 432 2-3 2.7 3.5 92.7 3.7 100.0 0.6 11.2 87.3 0.9 100.0 654 4+ 3.1 4.1 88.9 6.9 100.0 1.7 8.0 87.1 3.3 100.0 305 Residence Urban 4.7 2.8 96.4 0.8 100.0 1.I 8.7 89.9 0.3 100.0 428 Rural 2.2 4.8 90.1 5.0 100.0 0.9 12.4 85.2 1.5 100.0 963 Region Region I 1.8 4.7 94.0 1.3 100.0 2.2 6.7 91.1 0.0 100.0 157 Region 2 1.7 4.3 88.5 7.2 100.0 0.4 15.2 81.1 3.3 100.0 334 Region 3 4.3 2.4 92.0 5.6 100.0 0.0 12.6 86.1 1.3 100.0 386 Region 4 2.0 5.6 93.5 1.0 100.0 1.3 8.3 90.3 0.0 100.0 431 Tashkent City 8.7 4.7 95.3 0.0 100.0 3.5 12.8 83.7 0.0 100.0 84 Mother's education Primary/Secondary 2.2 5.0 90.2 4.8 100.0 0.9 12.6 84.8 1.6 100.0 889 Secondary-special 4.3 2.5 95.5 2.0 100.0 0.8 9.2 89.6 0.4 100.0 368 Higher 4.0 3.9 94.8 1.4 100.0 1.7 7.5 90.8 0.0 100.0 135 Ethnieity Uzbek 2.5 3.5 93.1 3.4 100.0 0.8 10.9 87.4 1.0 100.0 1,231 Other 6.5 9.4 84.4 6.2 100.0 2.3 14.1 81.0 2.5 100.0 161 Total 3.0 4.2 92.1 3.7 100.0 1.0 11.2 86.7 1.1 100.0 1,392 Note: Figures are for births in the period 0-35 months preceding the survey. Figures may not add to 100.0 due to rounding. Table 9.6 V~q~ipations bv source of information Percentage of all children age 12-23 months who have received specific vaccinations by the time of the survey, by whether the information was from a vaccination card or from the mother's report, Uzbekistan 1996 Percentage of children who received: Polio DPT Number Source of of information BeG 1 2 3 1 2 3 Measles All j children Mother's recall 96.2 95.2 90.3 62.4 86.6 68.0 39.3 89.3 28.4 466 Health cards 97.6 99.5 99.3 96.2 99.5 98.4 94.4 91.5 85.0 420 t All =BCG, polio I-3, DPT/DT I-3, and measles 113 Comparative analyses of 90 percent of children, for which data were available from both sources, show that mothers consistently report fewer vaccinations for the second and third doses of polio and DPT/DT. Among 1,330 individual cases analyzed, differences between the health card records and mother's verbal report were found in 880 and 712 cases for the polio and DPT/DT vaccinations, respectively. These data suggest that the mother's report of vaccination coverage is an unreliable source of information compared to the health card. For this reason, in the remainder of this report, vaccination data are presented based exclusively on health cards found in the health facilities. Table 9.7 and Figure 9.2 show rates of vaccination coverage for children 12-23 months of age (i.e., children who should be fully vaccinated). BCG vaccination is usually given in delivery hospitals soon after delivery and is found to be nearly universal (98 percent). Almost all children (100 percent) have received the first doses of polio and DPT/DT. Coverage for the second doses of polio and DPT/DT is also nearly universal (exceeded 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. Table 9.7 Vaccinations bv background characteristics Percentage of all children 12-23 months who have received specific vaccinations by the time of the survey (according to the health card maintained at the health facilities), by background characteristics. Uzbekistan 1996 Percentage of children who received: Polio DPT Number of children Background Un- characteristic BCG 1 2 3 1 2 3 Measles All L Weighted weighted Se/[ Male 99.0 100.0 99.8 97.4 100.0 98.5 94.3 91.1 85.5 217 207 Female 96.1 99.0 98.7 95.0 99.0 98.3 94.5 91.8 84.4 203 188 Residence Urban 97.1 98.3 98.0 92.0 98.4 96.1 88.9 83.9 74.8 125 162 Rural 97.8 100.0 99.8 98.0 100.0 99.4 96.8 94.7 89.3 294 233 Region Region 1 98.2 100.0 98.9 97.8 99.1 98.0 98.0 91.9 90.8 47 96 Region 2 98.7 100.0 100.0 97.3 100.0 98.7 95.5 92.3 86.6 109 91 Region 3 93.9 100.0 100.0 95.6 100.0 98.7 93.0 92.6 82.6 106 63 Region 4 98.8 98.5 98.5 95.0 99.2 98.5 94.6 90.8 83.9 136 100 Tashkent City 100.0 100.0 97.8 97.8 97.8 95.6 86.7 84.4 82.2 22 45 Mother's education Primary/Secondary 96.4 100.0 100.0 96.6 100.0 99.1 95.2 91.8 83.7 264 221 Secondary-special 99.6 99A 98.7 95.5 99.1 98.7 95.6 92.7 88.6 118 127 Higher 9g.9 97.3 96.0 96.0 97.6 92.8 85.2 85.2 82.5 38 47 Ethnicity Uzbek 97.5 99.4 99.2 95.8 99.6 98.3 94.6 91.2 84.3 374 330 Other 98.1 100.0 100.0 100.0 99.0 99.0 92.7 93.6 90.6 45 65 All children 97.6 99.5 99.3 96.2 99.5 98.4 94.4 91.5 85.0 420 395 ] All = BCG, polio 1-3, DPT/DT 1-3, and measles Because of the high coverage with BCG, measles and individual doses of polio and DPT/DT vaccinations, the percentage of children 12-23 months of age who have received all WHO recommended vaccinations is high at 85 percent. 114 100 80 60 40 20 Percent Figure 9.2 Vaccination Coverage Among Children Age 12-23 Months BCG Measles 1 2 3 1 2 3 Polio DPT All UDHS 1996 Table 9.7 also presents differentials in vaccination coverage according to selected background characteristics. The sex of the child makes little difference in coverage levels: the percentage of children fully immunized is only slightly greater for boys (86 percent) than girls (84 percent). Vaccination coverage is higher in rural areas than in urban: 89 percent of rural children have been fully immunized, compared with 75 percent of urban children. Among the regions, the lowest vaccination coverage is found in Tashkent City, where 82 percent of children have been fully immunized compared with 91, 87, 83 and 84 percent in Regions 1 to 4, respectively. Relatively low vaccination coverage in urban areas and in the capital city of Tashkent is mainly due to the more pronounced dropout between the first and third doses of DPT/DT vaccination and the relatively low measles vaccination coverage rate. For example, in Tashkent City and urban areas, the DPT/DT drop out rates are 11 and 10 percent, respectively, while in rural areas the rate is only 3 percent. Vaccination coverage is higher among children whose mothers have completed secondary-special education (89 percent) compared with children whose mothers have completed primary~secondary education (84 percent), or higher education (83 percent). Children ofUzbek ethnicity are less likely to be immunized (84 percent) than children of other ethnic groups (91 percent). 9.5 Acute Respiratory Infection Acute respiratory infection (ARI) is a primary cause of morbidity among children and a leading cause of infant mortality throughout the world. In Uzbekistan, approximately half of all infant deaths are attributed to ARI (Goskomprognozstat, 1994). 115 In the UDHS, mothers were asked if their children under three years of age had been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. These symptoms are compatible with ARI. It should be noted that the morbidity data collected in the UDHS are subjective in the sense that they are based on the mother's perception of illness without validation by medical personnel. Also, the data apply to the period from June to October, while the peak prevalence of ARl is in mid-winter. Table 9.8 and Figure 9.3 indicate that 1 percent of children under three years of age were ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. Figure 9.3 Prevalence of Respiratory Illness and Diarrhea in the Last Two Weeks by Age of the Child Percent 8 4 2 0 6 12 15 24 30 36 Age of Child (Months) !QRespirato~ illness i -~-Oiarrhea UDHS1996 Differentials in ARI also exist according to age and sex of child, birth order, area of residence, education, and ethnicity. Whether these differentials in illness prevalence reflect genuine differences in morbidity or are due to differences in perceptions of illness cannot be ascertained from these data. 9.6 Fever Table 9.8 also shows that 8 percent of children had an episode of fever during the two weeks prior to the survey. Differentials in the prevalence of fever are most pronounced by region with children living in Tashkent City and Region 2 being four times as likely to have had a fever than children living in Region 9.7 Diarrhea Dehydration caused by severe diarrhea is a major cause of morbidity among young children. In Uzbekistan, over 16 percent of all infant deaths are attributed to diarrhea (Goskomprognozstat, 1994). 116 Table 9.8 Prevalence of acute resoiratorv infection and fever Percentage of children under three years who were ill with a cough accompanied by short, rapid breathing (acute respiratory infection) during the two weeks preceding the survey, and the percentage of children with fever during the two weeks preceding the survey, by selected background characteristics, Uzbekistan 1996 Percentage of children Percentage Background with cough and of children Number of characteristic rapid breathing with a fever children Child's age < 6 months 0.3 7.8 162 6-11 months 1.9 7.8 254 12.23 months 1.6 9.0 466 24-35 months 0.6 7.7 444 Sex Male 1.5 7.8 676 Female 0.8 8.6 649 Birth order 1 2.0 9.7 408 2-3 0.9 8.2 624 4+ 0.5 6.0 293 Residence Urban 2.5 9.7 414 Rural 0.5 7.5 91 I Region Region 1 3.8 9.8 149 Region 2 0.0 13.1 315 Region 3 0.9 7.7 363 Region 4 0.2 3.1 419 Tashkent City 6.7 14.7 80 Education Primary/Secondary ! .0 7.6 842 Secondary-special 1.5 11.1 357 Higher 1.2 4.0 126 Ethnicity Uzbek 0.9 7.8 I, 177 Other 2.9 11.3 148 All children 1.2 8.2 1,325 Note: Figures are for children born in the period 0-35 months preceding the survey. A prompt increase in a child's fluid intake is a simple and effective procedure to prevent diarrhea from developing into a life-threatening illness. Increased fluid intake should be administered in the form of a sugar, salt, and water solution, i.e., oral rehydration therapy (ORT). A product called Rehydron is widely available throughout Uzbekistan for use in ORT. All women who had a birth in the last three years were asked some basic questions about the care which should be given to a child with diarrhea--namely, i f the intake of liquids and solid foods should be increased and i f they had ever heard of Rehydron as a treatment for diarrhea. Table 9.9 indicates that most women had heard of Rehydron (79 percent). However, a significant proportion of women indicated that it is appropriate to reduce the amount of liquid offered to a child with diarrhea (12 percent). 117 Table 9.9 Knowledee of diarrhea care Percentage of mothers with births in the last three years who know about Rehydron for treatment of diarrhea and the percent distribution by knowledge of appropriate feeding during diarrhea, according to background characteristics, Uzbekistan 1996 Quantities that should be given during diarrhea Liquids Solid foods Percent who Don't Don't Number Background know know/ know/ of characteristic Rehydron Less Same More Missing Total Less Same More Missing Total mothers Age 15-19 80.3 15.7 21.2 57.5 5.6 100.0 60.9 22.9 10.6 5.6 100.0 61 20-24 75.9 15.7 12.7 65.5 6.2 100.0 64.8 17.3 13.1 4.8 100.0 440 25-29 82.1 11.1 12.7 72.8 3.5 100.0 63.5 18.1 15.8 2.5 100.0 375 30-34 79.6 8.7 13.8 72.4 5.1 100.0 63.8 14.9 18.0 3.2 100.0 227 35+ 75.2 8.9 19.5 65.2 6.4 100.0 62.6 20.7 7.0 9.7 100.0 III Residence Urban 84.3 13.0 8.2 74.0 4.8 100.0 70.0 14.0 12.1 3.9 100.0 383 Rural 76.0 12.0 16.6 66.1 5.3 100.0 61.0 19.4 15.1 4.5 100.0 830 Region Region I 97.0 18.4 18.4 63.2 0.0 100.0 69.6 25.9 4.4 0.0 100.0 132 Region 2 82.7 8.1 8.1 81.0 2.7 100.0 83.9 8.9 5.0 2.2 100.0 280 Region 3 75.0 13.7 26.0 49.1 11.1 100.0 54.0 28.6 8.7 8.7 100.0 338 Region 4 70.3 12.1 7.1 76.6 4.2 100.0 52.6 12.2 31.3 3.9 100.0 387 Tashkent City 90.3 12.3 8.4 78.1 1.3 100.0 81.3 14.8 1.9 1.9 100.0 76 Mother's education Primary/Secondary 72.8 128 14.8 65.8 6.6 100.0 60.1 18.1 16.9 4.9 100.0 768 Secondary-special 88.1 13.6 12.0 72.0 2.5 100.0 68.9 19.1 9.6 2.4 100.0 328 Higher 90.5 5.9 13.8 77.2 3.1 100.0 74.1 II.0 9.3 5.6 100.0 117 Ethnieity Uzbek 77.8 12.0 14.3 68.6 5.1 100.0 62.8 17.9 15.1 4.2 100.0 1,070 Other 85.0 14.9 11.4 68.6 5.1 100.0 71.3 16.3 7.5 4.9 100.0 144 All mothers 78.6 12.3 13.9 68.6 5.1 I00.0 63.8 17.7 14.2 4.3 100.0 1,213 Mothers were also asked if their children had an episode of diarrhea in the last two weeks and, i f so, whether there was blood in the stools. The results of these questions are presented in Table 9.10. Table 9.10 and Figure 9.3 indicate that 5 percent of children under three had experienced diarrhea and that 0.3 percent had blood with the diarrhea. The age pattern of diarrhea shows a broad peak extending from late infancy (6-1 1 months) through age one (12-23 months). These are the ages when a child begins to crawl and walk, and therefore experiences more exposure to the environment. The prevalence of diarrhea among children under 6 months of age is 5 percent, increases to a peak among children ages 12-23 months (7 percent) and declines at 24-35 months of age (3 percent). Table 9.10 also indicates that region is associated with the most pronounced differentials in diarrhea. Children in Tashkent City and Region 1 are most likely to have diarrhea (9 and 8 percent, respectively), while children in Regions 2 and 4 are less likely to have diarrhea (4 and 3 percent, respectively). 118 Table 9.11 shows the treatment received by children who had diarrhea in the last two weeks. Thirty- four percent of children with diarrhea were taken to a health facility or health provider for treatment. In terms of other treatments, 31 percent of children received Rehydron and 9 percent received a homemade sugar-salt-water solution, so that 37 percent received some type of ORT. Overall, increased fluids were used to treat 77 percent of children with diarrhea. Table 9.12 summarizes the feeding practices which mothers followed when their children had diarrhea. Ninety-four percent of children were given fluids in either the same or increased amounts, and only 5 percent were given reduced amounts of fluids. Table 9.10 Prevalence of diarrhea Percentage of children under three years who had diarrhea and diarrhea with blood in the two weeks preceding the survey, by selected background characteristics, Uzbekistan 1996 Diarrhea in the preceding 2 weeks Number Background All Diarrhea of characteristic: diarrhea with blood children Child's age < 6 months 4.7 0.0 162 6-11 months 6.0 0.7 254 ! 2-23 months 7.3 0.1 466 24-35 months 2.7 0.4 444 Sex Male 4.7 0A 676 Female 5.7 0.6 649 Birth order 1 6.2 0.4 408 2-3 4.3 0.4 624 4+ 5.6 0.0 293 Residence Urban 8.5 0.6 414 Rural 3.7 0.2 911 Region Region I g.3 0.6 149 Region 2 4.0 0.4 315 Region 3 6.9 0.4 363 Region 4 2.7 0.0 419 Tashkent City 9.2 0.6 g0 Mother's education Primary/Secondary 4.6 0.3 g42 Secondary-special 6.0 0.3 357 Higher 6.4 0.3 126 Ethnieity Uzbek 5.3 0.3 1,177 Other 4.0 0.6 14g All children 5.2 0.3 1,325 Note: Figures are for children born in the period 0-35 months preceding the survey. l l9 Table 9.11 Treatment of diarrhea Among children under three years who had diarrhea in the two weeks preceding the survey, the percentage taken to a health facility or provider for treatment, the percentage who received oral rehydration therapy, the percentage who received increased fluids, and the percentage who received neither oral rehydration therapy nor increased fluids, Uzbekistan 1996 Treatments received Percentage Taken to a health fhcility or provider t 34.0 Received oralrehydration therapy Rehydron 31.3 Home sugar-salt-watersolution 8.5 Either 37.1 Received increased fluids Neither Rehydron, home sugar-salt-water solution nor increased fluids Number of children 77.1 13,2 699 i Includes health center, hospital, clinic and private doctor Table 9.12 Feedin~ oractices durin~ diarrhea Percent distribution of children under three who had diarrhea in the past two weeks by amount of solid foods given and amount of fluids given. Uzbekistan 1996 Feeding practices Total Amount ofsolld foods Same 19.6 Increase 9.1 Decrease 69.2 Don't know/missing 2.1 Amount of fluids Same 16.4 Increase 77.1 Decrease 5.0 Don't know/missing 1.5 Total 100.0 Number of children 69 Note: Figures are for children born in the period 0-35 months preceding the survey. 120 CHAPTER 10 NUTRITION OF WOMEN AND CHILDREN Akhror B. Yarkulov, Farida M. Ayupova and Parakhad R. Menlikulov This chapter covers two topics: infant feeding practices and the nutritional status of women and children. The former is described in terms of breastfeeding practices, supplementary feeding practices, and the use of bottles for supplementary feeding. Nutritional status is reported in terms of the height and weight of women and children. 10.1 Breastfeeding and Supplementation Infant feeding practices have important influences on both the child and the mother; for example, they determine a child's nutritional status and susceptibility to morbidity. Additionally, breastfeeding affects the health of a woman because of its influence on the return of ovulation following a birth and a woman's risk of another pregnancy. In the 1996 UDHS, for each child born in the last three years, mothers were asked if they had breastfed the child and, if so, how long after delivery breastfeeding was initiated. Women were also asked if their children were still breastfeeding and the age at which supplemental feeding began. Finally, for children not currently breastfeeding, the age at which they stopped breastfeeding was obtained. With these data, it is possible to look at several aspects of breastfeeding. For children born in the last three years, the length of time between delivery and initiation of breastfeeding can be investigated. From the data on current breastfeeding status (i.e., status at the time of the survey), the percentage of children breastfeeding by age can be calculated as well as median durations of breastfeeding. 10.1.1 Initiation of Breastfeeding Colostrum, which is contained in a mother's breast milk, has been proven to be highly nutritious and to contain the antibodies necessary to protect babies from infection before their immune system is fully mature. Table 10.1 indicates that breastfeeding is almost universal in Uzbekistan--96 percent of children born in the three years preceding the survey were breastfed; 19 percent within an hour of delivery and 40 percent within 24 hours of delivery. There was no significant variation between population groups in the percent of children breastfed. However, there were significant differences in the timing of initiation of breastfeeding. Initiation within an hour of delivery is more likely among women in Regions 1, 2, and 4 (33, 23 and 22 percent, respectively) than in Tashkent City (6 percent) and Region 3 (8 percent). Pronounced differentials in the initiation of breastfeeding exist by mother's ethnicity. Breastfeeding was more likely within an hour of delivery among non-Uzbek women (29 percent) than among Uzbek women (18 percent) and this differential was maintained at 24 hours of delivery (54 and 39 percent, respectively). It appears that more rapid initiation of breastfeeding following delivery would benefit many children in Uzbekistan and would be particularly beneficial to Uzbek children. 121 Table 10.1 Initial breastfeedin~ Percentage of children born in the three years preceding the survey who were ever hreastfed, and the percentage of last-born children who started breastfeeding within one hour of birth and within one day of birth, by selected background characteristics, Uzbekistan 1996 Among last-born children, percentage who started breastfeeding: Percentage Within Within Number Background ever 1 hour I day of characteristic breastfed of birth of birth I children Sex Male 96.1 18.3 40.8 717 Female 96.1 19.6 39.8 675 Residence Urban 96.6 16.6 36.7 428 Rural 95.9 20.0 41,9 963 Region Region 1 98.4 33.4 52.3 157 Region 2 97.3 22.7 42.3 334 Region 3 94.5 8.4 17.5 386 Region 4 95.9 22.3 58.2 431 Tashkent City 95,3 6.1 20.7 84 Mother's education Primary/Secondary 95.6 18.5 39.2 889 Secondary-special 96,6 20.4 43.9 368 ttigher 98.2 18.0 37.9 135 Ethnicity Uzbek 96.3 17.6 38.5 1,231 Other 94.7 29.3 54,4 161 Place of delivery Health facility 96.4 17.2 38.7 1,310 At home 91.7 48. I 68.6 82 All children 96, 1 18.9 40.3 1,392 i Includes children who started breastfeeding within I hour of birth. 10.1.2 Age Pattern of Breastfeeding Research has shown that breast milk contains all the nutrients needed by children in the first several months of life. Supplementation of breast milk before four months of age is not necessary and is discouraged since early supplementation increases the risk of a child having diarrhea. Early supplementation also reduces a woman's output of breast milk since milk production is influenced by the frequency and intensity of breastfeeding. Table 10.2 shows information on the breastfeeding status of children by age in months. As can be seen, a high proportion of children are breastfed in Uzbekistan. At 0-3 months of age, 98 percent of children are breastfed and at 8-11 months, 83 percent are still breastfed. This falls to 35 percent by 20-23 months and almost all children have stopped breastfeeding by their third birthday. 122 Table 10.2 Breastfeedine status Percent distribution of living children by current breastfeeding status, according to child's current age in months, Uzbekistan 1996 Percentage of living children who are: Breast feeding and: Number Not Exclusively Plain of breast- breast- water Supple- living Age in months feeding fed only ments Total children 0-3 2.4 4.1 28.7 64.8 100.0 96 4-7 10.3 0.0 4.5 85.2 100.0 138 8-I I 16.5 0.0 0.8 82.7 100.0 182 12-15 32.2 0.0 0.0 67.8 100.0 164 16-19 49.4 0.0 0.0 50.6 100.0 157 20-23 64.6 0.0 0.0 35.4 100.0 144 24-27 82.8 0.0 0.0 172 100.0 169 28-31 89.4 0.0 0.0 10.6 100.0 136 32-35 96.6 0.0 0.0 3.4 100.0 138 0-3 months 2.4 4. I 28.7 64.8 100.0 96 4-6 months 9.5 0.0 6.2 84.4 100.0 101 7-9 months 11.4 0.0 1.1 87.4 100.0 122 Note: Breastfeeding status refers to preceding 24 hours. Children classified as breastfeeding and plain water only receive no supplements. However, while breastfeeding is lengthy, supplementary feeding starts early in Uzbekistan. Exclusive breastfeeding during early infancy, as recommended by the World Health Organization, ~ is not common. At ages 0-3 months, only 4 percent of children were exclusively breastfed. During these early months of infancy, most breastfed children receive either plain water (29 percent) or other foods and liquids (65 percent). Table 10.3 shows information on the median duration of breastfeeding. For all of Uzbekistan, the median duration of any breastfeeding is lengthy (17 months) but the duration of exclusive and full breastfeeding (breastfeeding plus plain water) are short (0.4 and 0.7 months, respectively). The most pronounced differentials in breastfeeding are by region and ethnicity. The median duration of any breastfeeding is longer in Regions 1, 2, and 4 (19 months) than in Tashkent City and Region 3 (12 months). The median duration of any breastfeeding is almost equal for Uzbek and non-Uzbek women (17 and 18 months, respectively). Ninety-two percent of children under six months of age were reported to have been breastfed six or more times in the 24 hours preceding the survey. 10.1.3 Types of Supplemental Foods In the UDHS, mothers were asked about the types of foods that were given to children in the 24 hours preceding the survey. The foods given to a child are not mutually exclusive, and as a result, a child could be reported as receiving several types of food. Exclusive breastfeeding is the practice of feeding with breast milk only. Supplementation with water is discouraged (WHO/UNICEF, 1990). 123 Table 10.3 Median duration and frequency of breastfeedin~ Median duration of any breastfeeding, exclusive breastfeeding, and full breastfeeding among children under three years of age, and the percentage of children under 6 months of age who were hreastfed six or more times in the 24 hours precedLng the interview, according to background characteristics, Uzbekistan 1996 Children under 6 months Median duration in months j Number of Breastfed children 6+ times Any Exclusive Full under in Number Background breast- breast- breast- 3 years preceding of characteristic feeding teeding feeding 2 o1" age 24 hours children Sex Male 18.8 0.4 0.7 717 90.6 84 Female 15.6 0.4 11.9 675 92.8 78 Residence Urban 15.7 0.4 0.6 428 84.2 59 Rural 17.9 0.4 1.1 963 95.9 103 Region Region 1 19.3 0.6 1.7 157 * 20 Region 2 19.0 0.4 0.5 334 195.1) 43 Region 3 11.9 0.4 1.4 386 (87.4) 48 Region 4 19.2 0.4 1.6 431 (97.2) 37 Tashkent City 12.3 0.4 0.6 84 * 13 Education Primary/Secondary 18.0 0.4 0.8 889 90.0 98 Secondary-special 16.3 0.4 0.6 368 (94.6) 43 Higher 13.2 @4 1.2 135 * 20 Ethnicity Uzbek 17.2 0.4 0.7 1,231 91.6 143 Other 18.1 0.6 1.7 161 * 19 17.3 0.4 0.7 1,392 91.7 162 17.8 0.9 2.2 96.3 16.8 0.1 1.0 Total Mean Prevalence/Incidence 3 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Medians and means are based on current status Either exclusive breastfeeding or breastfeeding and plain water only 3 Prevalence-incidence mean Table 10.4 indicates the types of food given to children according to breastfeeding status. Among children 0-3 months of age who are breastfeeding, infant formula is commonly used to supplement breast milk (12 percent) as well as powdered and evaporated milk (23 percent). Tea is especially popular in Uzbekistan and was given in the last 24 hours to 49 percent of infants 0-3 months of age. Meat, poultry, fish, and eggs contain protein and other nutrients important for the physical and mental development of young children. Nineteen percent of breastfeeding infants age 4-7 months receive these foods. Fruits and vegetables are also commonly given to infants who are breastfeeding; 35 percent of infants 4-7 months of age were given these foods in the 24 hours before the survey interview. 124 Table 10.4 Tvoes of food received bv children in r~recedine 24 hours Percentage of children under 36 months of age by lype of food received in the 24 hours before the interview, and the percentage using a bottle with a nipple, according to breastfeeding status and child's age in months, Uzbekistan 1996 Powdered/ Fer- Poultry/ Using Breast evapo- mented fish/ Grain/ Fruit/ Sweets/ bottle Number Age milk Infant rated milk Plain Other eggs/ flour/ Tubers/ vege- ehoco- with a of (in months) only formula milk products I water Juice Tea liquids meat cereal potatoes tables late Other nipple children BREASTFEEDING CHILDREN 0-3 4.2 12.0 23.4 3.5 85.1 9.5 48.5 26.9 2.9 9.1 9.0 6.1 2.8 1.7 34.7 94 4-7 0.0 20.2 45.2 21.3 89.4 18.0 85.2 44.4 18.5 50.2 37.7 35.1 23.9 11.8 35.6 124 8-11 0.0 31.2 65.0 44.4 91.6 22.6 98.1 67.4 36.2 8t.9 78.8 75.1 53.9 21.9 27.6 152 0-11 1.1 22.6 47.8 26.2 89.2 17.7 81.2 49.4 21.8 52.8 47.3 44.2 30.9 13.3 32.1 369 12-23 0.0 31.1 58.4 56.6 97.0 30.3 94.9 75.4 58.0 89.2 76.7 85.2 68.7 28.5 17.1 242 Total 0.6 26.4 52.2 39.7 92.9 23.4 87.6 61.4 38.3 69.5 60.1 62.9 48.8 19.2 24.9 659 NON-BREASTFEEDING CHILDREN 0-11 NA 22.7 81.1 50.0 98.4 40.0 92.3 79.9 51.4 93.9 80.0 86.1 68.1 27.4 43.9 30 12-23 NA 31.1 60.9 58.8 93.4 38.3 97.8 82.2 71.4 92.1 88.9 95.3 82.6 32.7 20.3 224 24-29 NA 28.4 67.0 64.6 95.2 51.0 99.8 87.0 78.8 94.1 90.9 98.5 83.3 35.6 8.9 200 30-35 NA 24.8 61.2 61.3 97.4 41.6 99.2 83.0 79.6 93.8 89.2 97.9 81.2 36.3 9.7 195 Total NA 28.8 64.1 60.3 95.1 43.0 97.9 83.0 73.6 92.3 88.0 95.8 80.4 33.7 15.9 666 NA = Not applicable A relatively high percentage of children still being breastfed are also fed using a bottle with a nipple: 35 percent at age 0-3 months and 36 percent at 4-7 months of age. Among non-breastfeeding children, a high proportion at all ages receive powdered or evaporated milk (64 percent). Also, a high proportion receive high protein foods (poultry, fish, meat, or eggs) after the first birthday (71 percent of children). 10.2 Nutritional Status of Children under Age Three The data on height and weight of children in the UDHS permit the evaluation of nutritional status and the identification of subgroups of children that are at increased risk of faltered growth and morbidity. 10.2.1 Measures of Nutritional Status in Childhood The evaluation of nutritional status is based on the rationale that, in a well-nourished population, there is a statistically predictable distribution of children of a given age with respect to height and weight. The distribution of children in such a well-nourished population can be used as a reference for assessing the nutritional status of children in other populations. The reference population recommended by the World Health Organization, which is used in this report, is the NCHS (U.S. National Center for Health Statistics) standard. Three standard indices of physical growth that describe the nutritional status of children are presented: • height-for-age • weight-for-height • weight-for-age. Each of these indices gives different information about growth and body composition that can be used to assess nutritional status. Height-for-age is a measure of growth. A child who is below minus two standard deviations (-2SD) from the median of the NCHS reference population in terms of height-for-age is considered short for his/her age, or stunted, a condition reflecting chronic undernutrition. If a child is below minus three standard deviations (-3SD) from the reference median, the child is considered to be severely stunted. Weight-for-height describes current nutritional status. A child who is below minus two standard deviations (-2SD) from the reference median is considered too thin for his/her height, or wasted, a condition reflecting an acute or recent nutritional deficit, l fa child is below minus three standard deviations (-3SD) from the reference median, the child is considered severely wasted. The weight-for-age index does not distinguish between chronic undernutrition (stunting) and acute undernutrition (wasting). A child can be underweight for age because he is stunted, because he is wasted, or because he is both wasted and stunted. Weight-for-age is a good overall indicator of a population's nutritional health. In a healthy, well-nourished population of children, it is expected that 2.3 percent of children will fall below minus two standard deviations (-2SD) of the median of the reference population on these nutritional indices (i.e., will be classified as moderately or severely undernourished). 126 In the survey, all surviving children born since January 1993 were eligible for height and weight measurement. Of the 1,325 children under three years of age at the time of the survey, plausible values for height and weight were obtained for 989 children (75 percent). The most commonly reported reason for not measuring a child was that the child was not at home. The following analysis pertains to the 989 children, age 0-35 months, for whom complete and plausible anthropometric data were collected. 10.2.2 Levels of Child Undernutrition in Uzbekistan Table 10.5 shows the percentage of children under three years of age classified as undernourished according to demographic characteristics. For all of Uzbekistan, 31 percent of children are moderately or severely stunted, 12 percent are moderately or severely wasted, and 19 percent are moderately or severely underweight for age. Table 10.5 Nutritional status of children by demoarat~hic characteristics Percentage of children 0-35 months of age who are classified as undernourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by demographic characteristics, Uzbekistan 1996 Demographic characteristic Height-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD 1 -3 SD -2 SD L -3 SD - 2 SD t children Age <6 months 4.2 8.4 4.8 17.1 0.8 6.0 123 6-11 months 11.2 26.1 1.9 10.3 4.9 17.6 192 12-23 months 18.3 43.5 3.0 13.1 7.0 24.8 335 24-35 months 14.8 30.4 2.4 8.9 4.6 18.2 339 Sex Male 16.6 33.9 2.6 12.6 5.8 20.7 509 Female 11.3 28.5 3.1 10.6 4.2 16.8 480 Birth order I 11.6 27.4 2.6 9.0 3.3 I 1.8 313 2-3 14.5 30.7 3.0 11.6 4.4 20.0 465 4+ 16.4 38.3 2.8 15.6 9.0 26.5 211 Birth interval 2 First birth I 1.6 27.4 2.5 9.0 3.3 11.8 314 < 24 months 18.0 33.6 4.0 13.9 6.3 28.0 196 24-47 months 14.2 31.5 2.6 13.8 6.2 20.9 348 48+ months 13.3 36.7 2.2 8.7 4.3 16.4 131 Total 14.0 31.3 2.8 11.6 5.0 18.8 989 Note: Figures are for children born in the period 0-35 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as undernourished if their z-scores are below minus two or minus three standard deviations (-2 SD or-3 SD) from the median of the reference population. Includes children who are below -3 SD 2 Excludes first births In terms of demographic characteristics, the most pronounced differentials are found by age and birth interval. Children age 12-23 months and 24-35 months are less well-nourished than infants by almost all indices of undernutrition. Children born within a birth interval of less than 24 months are generally less well-nourished than children born after longer birth intervals. Figure 10.1 shows Jtutritional differentials by 127 selected demographic variables in terms of the stunting index. Moderate or severe stunting is found in a significant proportion of children 12-23 months of age (44 percent) and those born within a birth interval of less than 24 months and more than 48 months (34 and 37 percent, respectively). Figure 10.1 Prevalence of Stunting by Age of Child and Length of Birth Interval UZBEKSTAN AGE OF CHILD (MOS.) 1-5 6-11 12-23 24-35 BIRTH INTERVAL(MOS) <24 24-47 46÷ ~ ~ 31,3 8.4 ~;!;!ii~ii':i':i' ;~;~ 26.1 ~;~i~i~i~ i~ i~ i~:~ 30.4 ~i!i~i~i~i~i~i~iiiii':!':i':i!i] 33.6 ~ ~ 31.5 0,0 10.0 20.0 30.0 40.0 50.0 Percent of children stunted [~Severe ~aoderate I UDHS 1996 Table 10.6 shows nutritional indices by background characteristics. In terms of almost all indices, children in urban areas suffer undernutrition as much as children in rural areas. Children in Tashkent City suffer less undemutrition than children in the other regions. Figure 10.2 shows nutritional differentials in terms of the stunting index. Moderate or severe stunting is found in a significant proportion of children in urban and rural areas (33 and 31 percent, respectively), those in the Regions 2 and 4 (40 and 35 percent, respectively), and those born to women with a primary/secondary education (34 percent). Differentials by ethnicity are small. 10.3 Women's Anthropometrie Status In the UDHS, data were collected on the height and weight of all women 15-49 years of age. Measurements were obtained for 99 percent of surveyed women. Two indices of women's nutritional status are presented in this report: the height of women and the body mass index (BMI)--an indicator combining height and weight data. A woman's height is associated with past socioeconomic status and her access to nutritional foods during childhood and adolescence. Maternal height can be used to predict the risk of difficult delivery, since small stature is often associated with small pelvis size. The height below which a woman can be considered at risk is in the range of 140-150 centimeters. 128 Table 10.6 Nutritional status of children bv backeround characteristics Percentage of children 0-35 months of age who are classified as undernourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-lbr-age, by background characteristics, Uzbekistan 1996 Background characteristic Height-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD ~ -3 SD -2 SD 1 -3 SD - 2 SD 1 children Residence Urban 14.3 32.6 2.2 10.2 5.7 16.6 285 Rural 13.9 30.7 3.1 12.2 4.7 19.7 704 Region Region 1 9.9 26.7 1.9 6.8 2.6 14.5 128 Region 2 20.3 39.8 4.4 14.2 4.9 24.5 253 Region 3 13.0 24.1 3.5 17.9 8.0 16.3 290 Region 4 12.8 35.2 1.6 6.6 3.6 21.4 260 Tashkent City 5.9 22.7 0.0 2.5 2.5 4.2 58 Mother's education Primary/Secondary 16.3 33.8 3.5 13.9 6.3 24.7 620 Secondary-special I 1.0 29.4 1.7 9.5 3.6 10.3 269 Higher 7.6 20.8 1.4 3.3 0.8 5.2 100 Ethnieity Uzbek 14.4 31.4 2.6 12.0 5.3 19.3 869 Other 11.3 30.2 4.6 9.0 3. I 15.4 120 Total 14.0 31.3 2.8 I 1.6 5.0 18.8 989 Note: Figures are for children born in the period 0-35 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as undernourished if their z-scores are below minus two or minus three standard deviations (-2 SD or -3 SD) from the median of the reference I~opulation. Includes children who are below -3 SD Table 10.7 shows the percent distribution of women by height. The mean height of women is 159 cm. One percent of women are under 145 cm in height. 2 Indices of body mass are used to assess thinness and obesity. The most common is the body mass index (BMI), which is defined as weight (in kilograms) divided by squared height (in meters). A cutoff point of 18.5 kg/m 2 has been recommended for defining energy deficiency among nonpregnant women. Table 10.9 indicates that the mean BMI among nonpregnant, weighed and measured women 3 is 22.7, with 10 percent having a BMI below 18.5 kg/m 2. Table 10.8 shows mean values and the percent distribution of women for the BMI index by background characteristics. There are significant differentials in the percentage of women with a BMI less than 18.5 kg/m 2. Women in the 15-19 age group, those residing in the Regions 2 and 3, those with primary/secondary education, and those living in rural areas are more likely to have a low BMI value than other women. 2 If 150 em is used as the cutoff, 6 percent of women would be considered at risk. s Pregnant women were excluded from the BMI analyses because precise data on gestational age which are necessary for adjustments were nut available. 129 Figure 10.2 Prevalence of Stunting by Background Characteristics UZBEKISTAN RESIDENCE Urban Rural REGION Region 1 Region 2 Region 3 Re ion 4 Tashkent EDUCATION Primary/Secondary Sec~ndzr~-Speciat = Higher ETHNICITY Uzbek ; Other ' O.O :~i~!~i:.!~!~!!~!?:~i~!;!;;~i!!~i~i~!~!~i?:~ 31.3 " : " : : : : : : : : : : : : : ' :! 32.6 = ========================= 39.8 ~i~ ?!i~i~i . ' : : : : :: ~. . 314 ~ ~ ~ ~ ~ ~,: ~i!~.: ~ ~ ~::~ ~o.2 10,0 20.0 30.0 40.0 Percent of children stunted I~Severe ~Uoderate ] 50.0 UDHS 1996 130 Table 10.7 Anthrooometric indicator~ 9f f~:male nutritional status Percent distribution and mean and standard deviation for all women by height, weight, and body mass index (BMI), Uzbekistan 1996 Percent distribution including Indicator Percent missing Height (cm) 130.0-134.9 0.1 0.1 135.0-139.9 0.1 0.1 140.0-144.9 0.9 0.9 145.0-149.9 4.5 4.5 150.0-154.9 17.7 17.6 155.0-159.9 31.0 30.8 160.0-164.9 25.7 25.6 165.0-169.9 15.1 15.0 170,0-174.9 3.9 3.8 175,0-179.9 0.9 0.9 >180.0 0.1 0.1 ~lissing 0.6 Total 100.0 100.0 Mean 159.3 Standard deviation 6.3 Number of women 4,387 4,415 BMI (kg/m z) 12.0-15.9 0.8 0.8 16,0-16.9 1.7 1.7 17.0-18.4 7.8 7.8 18.5-20.4 20.1 19.9 20.5-22.9 31.7 31.4 23.0-24.9 16.2 16.1 25.0-26.9 9.8 9.7 27.0-28.9 4.9 4.9 29.0-29.9 1.5 1.5 30.0-31.9 2.1 2.0 32.0-33.9 1.4 1.4 34.0-35.9 0.9 0.9 36.0-37.9 0.5 0.5 38.0-39.9 0.4 0.4 >40.0 0.2 0.2 Missing 0.8 Total 100.0 100.0 Mean 22.7 Standard deviation 4.0 Number of women 4,037 4,069 Note: The BMI index excludes pregnant women and those who are less than 3 months postpartum. 131 Table IO.g Nutritional status of women by backeround characteristics Mean height and percentage of women shorter than 145 centimeters, mean body mass index (BMI), and percent distribution by BMI, for women age 15-49, by selected background characteristics, Uzbekistan 1996 Height Body Masslndex Percent distribution Background Percent 18.5- characteristic Mean <145 cm Number Mean <18.5 29.9 >31).0 Total Number Age 15-19 158.3 1.7 976 20.9 18.1 81.5 0.4 100.0 929 20-24 159.8 0.7 800 21.7 12.1 86.1 1.8 100.0 642 25-29 160.0 0.5 707 22.2 11,5 85.3 3.1 100.0 615 30-34 159.4 1.5 620 23.1 7.5 86.8 5.7 100.0 583 35-49 159.3 0.9 1,284 24.7 4.4 83.6 12.0 100.0 1,269 Residence Urban 160.4 1.0 1,669 23.1 9.3 83.2 7.5 I00.0 1,539 Rural 158.6 1.1 2,718 22.4 10,9 84.9 4.2 100.0 2,499 Region Region I 158.7 0.9 469 22.8 9.8 83.7 6.5 100.0 430 Region 2 159.3 0,5 1,051 21.9 12.3 85.4 2.3 1011.11 961 Region 3 160.1 I.I 1,241 22.5 11.5 84.9 3.7 100.0 1,134 Region 4 157.7 1.8 1,227 23.1 10.0 81.9 8.1 100.0 1,140 Tashkent City 162.5 0.4 398 24.1 3.3 87.0 9.7 100.0 372 Mother's education Primary/Secondary 158.8 1.4 2,803 22.5 11.1 84.3 4.6 100.0 2,591 Secondary-special 159.8 0.6 1,119 22.9 10.1 83.6 6.4 100.0 1,029 lligher 161.0 0.0 465 23.5 6.0 85.8 8.2 100.0 418 Ethnieity Uzbck 159.0 1.1 3,629 22.7 10.3 84.2 5.5 100.0 3,327 Other 160.9 1.0 757 22.6 10.5 84.4 5.1 1011.0 71I Total 159.3 1.1 4,387 22.7 10.3 84.2 5.4 100.0 4,038 Note: The BMI index excludes pregnant women and those who are less than 3 months postpartum. 132 CHAPTER 11 ANEMIA Saidazym N. Souitanov, Almaz 1". Sharmanov, and Nazima M. Abrarova 11.1 Introduction Anemia is a condition which is characterized by a reduction in the red blood cell volume and a decrease in the concentration of hemoglobin in the blood. Commonly, anemia is the final outcome of a nutritional deficiency of iron, folate, vitamin B~2 and some other nutrients. Although many other causes of anemia such as hemorrhage, infection, genetic disorders or chronic disease have been identified, nutritional deficiency, due primarily to a lack of bioavailable dietary iron, accounts for the majority of cases of anemia (INACG, 1979, 1989; DeMaeyer et al., 1989; Hercberg and Galan, 1992; Yip, 1994). Anemia is known to have detrimental health implications, particularly for mothers and young children. Compared to non-anemic mothers, unfavorable pregnancy outcomes have been reported to be more common in anemic mothers (1NACG, 1989). Women with severe anemia can experience difficulty meeting oxygen transport requirements near and at delivery, especially if significant hemorrhage occurs. This may be an underlying cause of maternal death, and prenatal and perinatal infant loss (Fleming, 1987; Omar et al., 1994; Thonneau et al., 1992). Iron-deficient anemia among children has been demonstrated in many studies to be associated with impaired cognitive performance, motor development, coordination, language development and scholastic achievement (Scrimshaw, 1984; Lozoff et al., 1991). Anemia increases morbidity from infectious diseases because several immune mechanisms are adversely affected. Anemia due to iron deficiency is recognized as a major public health problem throughout the world. According to the epidemiological data collected from multiple countries by the World Health Organization, some 35 percent of women and 43 percent of young children in the world are affected by anemia. In developing countries, about 50 percent of women and young children are anemic. In the U.S. and Europe, the prevalence of anemia is 7 to 12 percent among women and children. The highest overall rates of anemia are reported in southern Asia and certain regions of Africa (DeMaeyer et al., 1989). Anemia has been considered to be among the leading public health problems in Uzbekistan for decades. A study conducted in 1993 by the Crosslink Group in Muynak District of Karakalpak Republic of Uzbekistan found anemia levels of over 60 percent for women of reproductive age and approximately 80 percent for children under the age of three (Morse, 1994). Because of correspondingly low serum levels of iron and ferritin, iron deficiency was recognized as the major cause of anemia among women and young children in that area. Similarly high levels of anemia among women and children were found in the Southern and Westem Regions of neighboring Kazakstan during the anemia study conducted in conjunction with the 1995 Kazakstan Demographic and Health Survey (NIN and MI, 1996). 11.2 Anemia Measurement Procedures Testing of women and children for anemia was one of the major efforts of the 1996 UDHS. This was the first anemia study in Uzbekistan done on a nationally representative sample. The study involved hemoglobin testing for anemia to determine the prevalence and severity of anemia among women and 133 children, and to identify demographic, socioeconomic, nutritional and other risk factors for anemia by residence, region, education, and other subgroups of population in Uzbekistan. This chapter presents findings of the anemia study. Anemia testing was done on 3,658 women age 15-49 and 739 of their children age three and under. Prior to participating in the study, each respondent was asked to sign a consent form giving permission for the collection of a blood droplet from herself and her children. For hemoglobin measurement, capillary blood was taken from the finger using Tenderlett lancets (i.e., sterile disposable instruments that allow a relatively painless skin puncture). Hemoglobin was measured in the blood using the Hemocue system that allows the detection of the level of hemoglobin within a minute. This system consists of a battery-operated portable photometer and a disposable cuvette which serves as both a blood collection device and the site where reaction occurs. The procedure was performed by specially trained medical personnel and was determined to be suitable for the field conditions of the survey. Levels of anemia were classified as severe, moderate, and mild based on the hemoglobin concentration in the blood and according to criteria developed by the World Health Organization (DeMaeyer et al., 1989). Severe anemia was diagnosed when hemoglobin concentration was less than 7.0 g/dl, moderate anemia when the hemoglobin concentration was 7.0-9.9 g/dl, and mild anemia when the hemoglobin concentration was 10.0-11.9 g/dl (10-10.9 g/dl for pregnant women and children under age three). 11.3 Anemia Prevalence Among Women Table 11.1 shows the results of anemia testing of women age 15-49. Sixty percent of the women in the UDHS survey 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. Differences in anemia status of women by age, residence, ethnicity and education are minor. However, differences by region are more marked. High rates of moderate and severe anemia are found in Regions 1 and 4 (23 and 25 percent, respectively), while Tashkent City has the lowest rate of moderate anemia (7 percent). No cases of severe anemia are diagnosed in Tashkent City. When iron deficiency is the main etiologic factor of anemia, population groups with high iron requirements are disproportionately affected and develop anemia more frequently. Negative iron balance due to an imbalance of iron requirements versus iron intake often occurs during pregnancy and growth. For this reason, when iron deficiency is highly prevalent in a population, pregnant women, who provide the fetus with a considerable amount of iron, are at greater risk of developing anemia than nonpregnant women. Figure 11.1 shows the prevalence of moderate anemia among pregnant, breastfeeding, and nonpregnant, non-breastfeeding women. Among pregnant women in Uzbekistan, moderate anemia is twice as prevalent than among nonpregnant women (breastfeeding or non-breastfeeding). Figure 11.2 illustrates hemoglobin distributions of pregnant women, breastfeeding women, and nonpregnant, non-breastfeeding women. The entire hemoglobin distribution for pregnant women is shifted downward (to the left) as compared to the distribution for nonpregnant women. The hemoglobin distribution for breastfeeding women is also shifted downward compared to the distribution for nonpregnant and non- breastfeeding women, but to a lesser extent than the distribution for pregnant women. 134 There is sufficient evidence to suggest that the majority of cases of anemia among women in Uzbekistan are due to a nutritional deficiency of iron. Testing blood for hemoglobin, which is an iron- containing conjugated protein occurring in red blood cells, can be used as a screening procedure for iron deficiency. However, anemia represents only the severe end of iron deficiency, and the real magnitude of iron deficiency in a population is greater than that reflected by hemoglobin measurement alone. Iron deficiency results primarily from low consumption of food products containing bioavailable iron and promoters of iron absorption, such as animal protein and ascorbic acid. T~b[f 11.1 Anemia amon~, women Percentage of women age 15-49 classified as having anemia by background characteristics, Uzbekistan 1996 Percentage of women with: Background Severe Moderate Mild Women characteristic anemia I anemia 2 anemia 3 measured Age 15-19 0.6 10.4 45.3 964 20-24 0.9 16.6 45.0 792 25-29 0.6 t6.4 45.5 697 30-34 1.2 16.3 45.8 615 35-39 1.6 14.6 47.0 551 40-44 0.8 11.5 45.4 414 45-49 1.1 13.3 41.5 300 Residence Urban 0.9 12.8 45.5 1,625 Rural 0.9 15.1 45.2 2,709 Region Region I 2.1 21.3 48.1 461 Region 2 0.3 10.0 33.7 1,049 Region 3 0.4 8.5 44.7 1,243 Region 4 1.8 23.1 53.4 1,224 Tashkent City 0.0 6.7 50.2 357 Education Primary/Secondary 1.0 13.8 45.8 2,787 Secondary-Special 0.8 16.6 44.7 1,095 Higher 0.5 10.8 43.7 451 Ethaieity Uzbek 0.9 14.6 45.9 3,594 Other 0.8 12.1 42.3 739 Total 0.9 14.2 45.3 4,333 J Hemoglobin level less than 7g/dl 2 Hemoglobin level 7 - 9.9 g/dl 3 Hemoglobin level 10 - l 1.9 g/dl (10 - 10.9 g/dl for pregnant women) 135 It has been shown that the mean monthly menstrual blood loss increases from 30 ml for women who are not using contraception to 50 ml for those who rely on the IUD (INACG, 1989). The chronic use of the IUD can lead to iron depletion and iron defieiency anemia (Palomo et al., 1993). Based on the UDHS data, 46 percent of currently married women in Uzbekistan are using the IUD. The prevalence of anemia among women according to whether or not the respondent is currently using the IUD as a method of contraception is presented in Figure 11.3. The rates of both severe and moderate anemia among IUD users are higher than among nonusers. 11.4 Anemia Prevalence Among Chi ldren Table 11.2 presents anemia rates for 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. 30 25 20 15 10 5 0 Figure 11.1 Prevalence of Moderate Anemia Among Women by Pregnancy Status and Breastfeeding Status Percent Pregnant Lactating Non pregnant, non-lactating UDHS "1996 136 30 Percent Figure 11.2 Percent Distribution of Hemoglobin Levels among Women Age 15-49 20 15 10 5 O~ 4.5 5,5 6.5 7.5 8,5 9.5 10.5 11.5 12.5 13.6 14.5 15.5 16.5 Hemoglobin (g/d/} l~Nonpregnant and non-breasffeeding ~-Pregnant ~Breastfeeding I UDHS 1996 Figure 11.3 Percentage of Women with Moderate or Severe Anemia Among Those Who are Currently Using or Not Using the IUD Percent 20 16 16 14 12 10 6 6 4 2 O Severe anemia Moderate Anemia [[]Using IUD E2Not Using IUD] UDHS1996 137 Differences in overall rates of anemia by sex of the child, residence and education of the mother are relatively minor. However, as is the case with women, differences by region are substantial. More than half of the children (53 percent) living in Region I are diagnosed as having moderate or severe anemia. Prevalence of moderate and severe anemia is also high in Regions 3 and 4 (26 and 28 percent, respectively). In Tashkent City, the prevalence of moderate anemia among children is relatively low (7 percent), and no cases of severe anemia are diagnosed. Certain relationships are observed between the prevalence of anemia among mothers and their children. Table 11.3 shows the prevalence of anemia for children according to the anemia status of their mothers. Among children of mothers with moderate anemia, 3 percent have severe anemia and 38 percent have moderate anemia. The proportion of moderate anemia among these children is more than twice as high as among children of uon-anemic mothers. 11.5 Summary The high prevalence of anemia among the women and children of Uzbekistan is documented by the 1996 UDHS. The UDHS results are in accordance with data from the 1993 Crosslink study in Muynak District of Karakalpakstan (Morse, 1994) which showed high rates of anemia among women and children living in the area of environmental crisis around the Aral Sea. In the UDHS, the area of the Aral sea is covered by Survey Region 1 (Karakalpakstan and Khorezm Oblast), where the prevaleuce of anemia is among the highest. It is unlikely that hemoglobin- opathies contribute sub-stantially to the high prevalence of anemia in the UDHS Region 1. In tile study by the Crosslink group, only 0.14 percent of individuals residing in Muynak District of Karakalpakstan are diagnosed as having hemoglobinopathy (thalassem ia was not determined) (Morse, 1994). Negative iron balance is probably a major cause of anemia among both women and young children in this region. Table 11.2 Anemia amone children Percentage of children under three years classified as having anemia by background characteristics, Uzbekistan 1996 Percentage of children with: Background Severe Moderate Mild Children characteristic anemia t anemia 2 anemia 3 measured Sex of child Male 1.8 27.5 31.8 557 Female 0.6 23.7 36.2 549 Residence Urban 0.9 23.8 32.8 310 Rural 1.4 26.3 34.4 795 Region Region I 5.2 48.2 27.5 122 Region 2 0.5 17.6 29.6 294 Region 3 0.5 25.8 26.9 335 Region 4 1.4 26.9 50.2 307 Tashkent City 0.0 7.1 22.4 48 Education of mother Primary/Secondary 1.1 26.8 35. I 709 Secondary-Special 1.9 23.6 31.4 293 lligher 0.4 23.1 33.4 104 Ethnicity Uzbek 1.0 25.0 346 980 Other 3.2 30.2 29.3 126 Total 1.2 25.6 34.0 1,106 Hemoglobin level less than 7g/dl z llemoglobin level 7 - 9.9 g/dl I lcmoglobin level 111 - 10.9 g/dl 138 However, without focused studies of the prevalence of hemoglobinopathies and t~ and 13 thalassemias it is difficult to exclude their role as etiologic factors of anemia in certain regions of Uzbekistan, which is characterized by a highly ethnic admixture and a historically intensive migration process, in such areas as Fergana Valley (UDHS Region 4) and Samarkand Oblast (UDHS Region 3). The UDHS findings, as well as other geographically focused studies, provide an important information base for development of health intervention programs to prevent many severe complications of pregnancy and delivery related to iron-deficiency anemia among women of certain ethnic, educational, and residential groups in Uzbekistan. These data are important as a background for public health policy decisions that pertain to the iron fortification of food in Uzbekistan. Since anemia represents only the severe end of the iron deficiency spectrum, it is assumed that the total proportion of iron deficient individuals in the population is greater than that reflected by the prevalence of anemia detected by hemoglobin measurement alone. Therefore, in Uzbekistan, where the prevalence of anemia is 60 percent among women and almost 6l percent among children based on hemoglobin measurement, the real magnitude of iron deficiency is greater, and universal iron fortification or supplementation may be justified. Another solution would be selective supplementation of iron for certain population groups, such as pregnant women and young children. Table 11.3 Anemia amonu children born to anemic moChers Percent distribution of children under three years by anemia status according to mother's anemia status at the time of the survey, Uzbekistan 1996 Child's anemia status Severe Moderate Mild Not Children Mother's anemia status anemia ~ anemia s anemia 3 anemic Total measured Severe anemia I Moderate anemia 2 Mild anemia 3 Not anemic * * * * 100 .0 9 2.7 38.0 40.0 I9.4 IO0.O 174 1.4 29.1 32.7 36.8 100.0 524 0.1 15.4 32.7 51.8 100.0 397 Total 1.2 25.6 33.9 39.2 100.0 1,104 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. t Hemoglobin level less than 7g/dl 2 Hemoglobin level 7 - 9.9 g/dl 3 Hemoglobin level 10 - 11.9 g/dl (10 - 10.9 g/dl for pregnant women and children under age three) 139 REFERENCES Akhmedov. 1993. Uzbekistan. Tashkent, Uzbekistan. Church, Mary and Eugene Koutanev. 1995. Health sector indicators available through government institutions in the central Asian region of the former Soviet Union. Almaty, Kazakstan: Zdravreform, Abt Associates, Inc. DeMaeyer, E.M., P. Dallman, J.M. Gurney, L. Hallberg, S.K. Sood, and S.G. Srikantia. 1989. Preventing and controlling iron deficiency anemia through primary health care. A guide for health administrators and program managers. Geneva, Switzerland: World Health Organization. Fleming, A.F. 1987. Maternal anemia in northern Nigeria: Causes and solutions, g/'orldHealth Forum 8(3):339-343. Goskomprognozstat (State Committee on Statistics and Analyses of the Republic of Uzbekistan). 1990. Census 1989. Tashkent, Uzbekistan: Goskomprognozstat. Goskomprognozstat (State Committee on Statistics and Analyses of the Republic of Uzbekistan). 1995. Demographic yearbook of Uzbekistan. Tashkent, Uzbekistan: Goskomprognozstat. Hercberg, S., and P. Galan. 1992. Nutritional anemias. Bailli~ire's Clinical Haematology 5(1): 143. Institute for Mother and Child Health Care (IMCHC) and Centers for Disease Control and Prevention (CDC). 1995. Reproductive Health Survey of Romania 1993. Atlanta, Georgia: IMCHC and CDC. International Nutritional Anemia Consultative Group (INACG). 1979. lron deficiency in infancy and childhood. Geneva, Switzerland: INACG, World Health Organization. International Nutritional Anemia Consultative Group (INACG). 1989. lron deficiency in women. Geneva, Switzerland: INACG, World Health Organization. Lozoff, B., E. Jimenez, and A.W. Wolf. 1991. Long-term development outcome of infants with iron deficiency. New England dournal of Medicine 3 25( l O ):687-694. Ministry of Health. 1993. Prikaz No.518 (October 23, 1993): Procedures for immunoprofylaxis of infectious diseases in the Republic of Uzbekistan. Tashkent, Uzbekistan: Ministry of Health. Ministry of Health. 1995. Health of population and health protection in Republic of Uzbekistan in 1994. Tashkent, Uzbekistan: Statistics Department, Ministry of Health. Ministry of Health. 1996. Prikaz No.721 (October 29, 1996): Rules and procedures for pregnancy termination. Tashkent, Uzbekistan: Ministry of Health. Morse, C. 1994. A study of the prevalence and causes of anemia, Muynak district, Karakalpakistan, the Republic of Uzbekistan. Washington, D.C.: IMPACT Project, USAID. 141 National Institute of Nutrition (N1N) and Macro International (MI). 1996. Kazakstan Demographic and Health Survey 1995. Calverton, Maryland: NIN and MI. Omar, M.M., U. Hogberg, and B. Bergstrom. 1994. Maternal health and child survival in relation to socioeconomic factors. Gynecologic and Obstetric Investigation 38(2): 107-112. Palomo, I., G. Grebe, M. Ferrada, J.M. Carrasco, M. Maffioletti, and E. Felix. 1993. Effects of the prolonged use of intrauterine devices (IUDs) and oral contraceptives on iron nutrition. Revista Mddica de Chile 121(6):639-644. Research Institute of Obstetrics and Gynecology [Uzbekistan]. 1996. Special Tabulation. Unpublished. Russian Centre for Public Opinion and Market Research (RCPOMR) and Centers for Disease Control and Prevention(CDC). 1997. 1996Russian Women 's Reproductive Health Survey, Preliminary Report. Atlanta, Georgia: RCPOMR and CDC. Scrimshaw, N.S. 1984. Functional consequences of iron deficiency in buman populations. Journal of Nutritional Science and Vitaminolog9~ 30:47-63. Thonneau, P., B. Toure, P. Cantrelle, T.M, Barry, and E. Papiernik. 1992. Risk factors for maternal mortality: Results of a case-control study conducted in Conakry (Guinea), International Journal of Gynecology and Obstetrics 39(2):87-92. United Nations. 1982. Non-sampling errors in household surveys: Sources, assessment and control National Household Survey Capability Programme. New York: United Nations. United Nations. 1992. 1990 Demographic Yearbook. New York: United Nations. United Nations. 1995. Abortion policies: A global review. Vol 3: Oman to Zimbabwe. New York: United Nations. Yip, R. 1994. Iron deficiency: Contemporary scientific issues and international programmatic approaches. Symposium: Clinical nutrition in developing countries. Journal of Nutrition 124: 1479S- 1490S. 142 APPENDIX A SAMPLE DESIGN APPENDIX A SAMPLE DESIGN Thanh L~. A.1 Introduction The UDHS employed a probability sample of women age 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 Bukharskaya. The remainder of the country was divided into five survey regions. 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: Region 1: Region 2: Region 3: Region 4: Region 5: Karakalpakstan and Khoresmskaya. Navoiyiskaya, Bukharskaya, Kashkadarinskaya, and Surkhandarinskaya. Samarkandskaya, Dzhizakskaya, Syrdarinskaya, and Tashkentskaya. Namanganskaya, Ferganskaya, and Andizhanskaya. Tashkent City. A.2 Characteristics of the UDHS Sample The sample for the UDHS was selected in three stages. In the rural areas, the primary sampling units (PSUs) corresponded to the raions which were selected with probabilities proportional to size, the size being the 1994 population. At the second stage, one village was selected in each selected raion. A complete listing of the households residing in each selected village was carried out. The lists of households obtained were used as the frame for third-stage sampling, which is the selection of the households to be visited by the UDHS interviewing teams during the main survey fieldwork. In each selected household, women between the ages of 15 and 49 were identified and interviewed. In the urban areas, the PSUs were the cities and towns themselves. 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. The selected health blocks were segmented prior to the household listing operation which provided the household lists for the third-stage selection of households. A.3 Sample Allocation Tables A.I and A.2 show the distribution of the population in Uzbekistan to the different survey regions. The regions, stratified by urban and rural areas, were the sampling strata. There were thus nine strata with Tashkent City constituting an entire stratum. A proportional allocation of the target number of 4,000 women to the 9 strata would yield the sample distribution presented in Table A.3. 145 Table A.I Population distribution (1994) Region Urban Rural Total Region 1 923,000 1,504,200 2,427,200 Region 2 1,461,900 3,738,000 5,199,900 Region 3 2,122,400 3,990,000 6,112,400 Region 4 1,963,300 4,085.500 6,048,800 Tashkent City 2,113,000 0 2, I 13,000 Total 8,583,600 13,317.700 21,901,300 Table A.2 Percent distribution of population (1994) Region Urban Rural Total Region 1 38.0 62.0 11.1 Region 2 28.1 71.9 23.7 Region 3 34.7 65.3 27.9 Region 4 32.5 67.5 27.6 Tashkent City 100.0 0.0 9.6 Total 39.2 60.8 100.0 The proportional allocation would result in a completely self-weighting sample but would not allow for reliable estimates for at least two of the five survey regions, namely Region 1 and Tashkent City. Results of other demographic and health surveys show that a minimum sample of 1,000 women is required in order to obtain estimates of fertility and childhood mortality rates at an acceptable level of sampling errors. Given that the total sample size for the UDHS could not he increased so as to achieve the required level of sampling errors, it was decided that the sample would be divided equally among the five regions, and within each region, it would be distributed proportionally to the urban and the rural areas. With this type of allocation, demographic rates (fertility and mortality) could not be produced for regions separately. Table A.4 shows the proposed sample allocation. Table A.3 Proportional sample allocation Region Urban Rural Total Region I 168 275 443 Region 2 267 683 950 Region 3 387 729 I 116 Region 4 359 746 1105 Tashkent City 386 0 386 Total 1567 2433 4000 Table A.4 Proposed sample allocation Region Urban Rural Total Region 1 304 496 800 Regior~ 2 225 575 g00 Region 3 278 522 800 Region 4 260 540 800 Tashkent City 800 0 800 Total 1867 2133 4000 The number of sample points (or clusters) to be selected for each stratum was calculated by dividing the number of women in the stratum by the average "take" in the cluster. Analytical studies of surveys of the same nature suggest that the optimum number of women to be interviewed is around 20-25 in each urban cluster and 30-35 in each rural cluster. If, on average, 20 women in each urban cluster and 30 women in each rural cluster were to be interviewed, then the distribution of sample points would be shown in Table A.5 as follows: The number of clusters in Region 2 (Table A.5) would yield a slightly smaller number of women than expected because of rounding errors. Consequently, the number of clusters was rearranged in each stratum to be an even number, but in such a way that the expected regional sample size did not fall short of the required 800 minimum, as shown in Table A.6. The even number of clusters is recommended for the purpose of calculating sampling errors in which the first step is to form pairs of homogeneous clusters. 146 Table A.5 Number of sample points Region Urban Rural Total Region 1 15 17 32 Region 2 11 19 30 Region 3 14 17 31 Region 4 13 18 31 Tashkent City 40 0 40 Total 93 71 164 Table A.6 Proposed number of sample points Region Urban Rural Total Region 1 16 16 32 Region 2 16 16 32 Region 3 16 16 32 Region 4 16 16 32 Tashkent City 40 0 40 Total 104 64 168 The number of households to be selected for each stratum was calculated as follows: Number o f HHs = Number o f women Number o f women per HH x Overa l l response rate According to the 1989 census, the proportion of women age 15-49 in Uzbekistan was 25.0 percent in the urban areas and 22.3 percent in the rural areas. By applying this figure to the average household size of 4.7 and 6.2 for the urban and rural areas, respectively, obtained from the census, the number of women age 15-49 was estimated to be 1.2 per urban household and 1.4 per rural household. The overall response rate was assumed to be 80 percent (95 percent for households and 85 percent for women), which was the average overall response rate found in other surveys implemented in Uzbekistan. Using these two parameters in the above equation, approximately 3,900 households had to be selected in order to yield the target sample of women. This resulted in selecting on average 21 households in each urban cluster and 27 households in each rural cluster. A.4 Stratification and Systematic Selection of Clusters Stratification of the area sampling units was mostly geographic within each sampling stratum. A.4.1 Urban areas In the urban areas, the cities and towns were selected with probabilities proportional to size, the size being the 1994 population count. Large cities, or self-representing cities, that had to be selected with certainty (probability -- 1.0) were separated out before towns were selected. The limit above which a city became self-representing was calculated as follows: L = Popu la t ion in s t ra tum Number o f hea l th b locks to bese leoted Within each city, the required number of health blocks were selected with equal probability. The selection intervals for the towns were calculated as follows: ~M t 1 = t a 147 where ~M, is the size of the stratum (total population in the stratum according to the sampling frame) and a is the number of towns to be selected in the stratum. The selection procedure consisted of: (1) calculating the cumulated size of each town; (2) calculating the series of sampling numbers R, R+I, R+21, ., R+(a-1)l, where R is a random number between 1 and 1; and (3) comparing each sampling number with the cumulated sizes. The town to be selected was the first town whose cumulated size was greater or equal to the sampling number. Within each town, one health block was selected using a random number between 1 and the number of health blocks that exist in the town. A,4,2 Rural areas In the rural areas, the raions were selected with probabilities proportional to size. One village was then selected within each raion using a random number between 1 and the number of villages that exist in the raion. Selection ofraions followed the same procedure for town selection. Health blocks and villages that were very large in size were divided into segments of approximately 200-300 households and only one segment was retained for the UDHS. A.5 Sampling Probabilities of Selected Health Blocks and Villages The sampling probabilities were calculated separately for each sampling stage, and independently for each stratum. The following notations were used: P, is the first-stage sampling probability (towns, or raions) Pz is the second-stage sampling probability (health blocks, villages) P3 is the third-stage sampling probability (households) A.5.1 Urban areas First, towns will be discussed. Let a be the number of towns selected in a given stratum, M,. the size (population according to the sampling frame) of the ?h town in the stratum, and £'M~ the total size of the stratum (population according to the sampling frame). The probability of inclusion of the ?h town in the sample is calculated as follows: aMj Pli = y~M i i In the second stage, one health block was selected in each town. The probability of selection of the fh health block in the t ~ town is as follows: mH P:0 E,~- s) / where m!/is the size o f the f h health block. An intermediary sampling stage was introduced between the second and third sampling stages. This selection stage was not considered an effective stage but only a pseudo-stage in order to reduce the size of the health block. Let tuk be the estimated size (in proportion) of the/(h segment selected for the) t" health block. Note that Et,jk = I. Tile sampling probabilities are: 148 aMj mjitlj k Pl~'P2q = ~M i" ~m~j I j" In the third stage, a number, b~, of households was selected from the number M{ of households listed in the k ~ segment o f the j *h health block by the UDHS teams. It follows that: aM~ moZsj k b Pu'P2u'P3~Jk = Y~M 1 " Era~j " M~' i j In order for the sample to be self-weighting within the stratum, the overall probabilityf = PjrPz~P3,/k must be the same for each household within the stratum, where f is the sampling fraction calculated separately for each stratum: n f= - - N where n is the number of households selected in the stratum, and N is the number of households that exist in the stratum in 1996, at the time of fieldwork. The selection of the households was systematic with equal probability and the selection interval was calculated as follows: 1 Pl~ "P2q P 3 ijk f In the case of self-representing cities, P~ = 1. If more than one health block were selected then: / a mq Pz~ = ~mq J where a ' is the number of health blocks selected in the city. The other parameters were calculated as those for towns. A.5.2 Rural areas The calculations of the selection probabilities for the different stages of sampling were the same as for the towns, with raions equivalent to towns, and villages equivalent to health blocks. Because of the non-proportional distribution of the sample to the different strata, sampling weights were necessary to ensure the actual representation of the sample at the national level. 149 APPENDIX B ESTIMATES OF SAMPLING ERRORS APPENDIX B ESTIMATES OF SAMPLING ERRORS Thanh L~. The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the UDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the UDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the UDHS sample is the result of a multistage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the UDHS is the ISSA Sampling Error Module. This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: 2 Zh var(r ) 1 - f mh m, = ___ - - Z~ i - x 2 h=! mh-1 m h in which zht = yht-r .Xh~ , and z h = Yh- r 'Xh 153 where h mh Yhl Xhl f represents the stratum which varies from 1 to H, is the total number of clusters selected in the h" stratum, is the sum of the values of variabley in the :h cluster in the h ~ stratum, is the sum of the number of cases in the :h cluster in the h ~h stratum, and is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo-independent replications are thus created. In the UDHS, there were 168 non-empty clusters. Hence, 168 replications were created. The variance of a rate r is calculated as follows: SEZ(R) = var ( r ) - k 1 Z(r - r ) k(k -1 ) ,:1 in which r = k r - (k -1 ) r ( , ) where r rN k is the estimate computed from the full sample of 168 clusters, is the estimate computed from the reduced sample of 167 clusters (:~ cluster excluded), and is the total number &clusters. In addition to the standard error, ISSA computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result i fa simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. ISSA also computes the relative error and confidence limits for the estimates. Sampling errors for the UDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for five survey regions. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 to B.9 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE) for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). Estimates and sampling errors of total fertility and childhood mortality rates only apply to the national sample and the urban and rural samples. In the case of the total fertility rate, tbe number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to childbearing. The confidence interval (e.g., as calculated for Children ever born to women age 15-49) can be interpreted as follows: the overall average from the national sample is 2.26 and its standard error is .045. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 2.26±2x.045. There is a high probability (95 percent) that the true average number of children ever born to all women age 15 to 49 is between 2.17 and 2.35. 154 Sampling errors are analyzed for the national sample and for two separate groups of estimates: (1) means and proportions, and (2) complex demographic rates. The relative standard errors (SE/R) for the means and proportions range between 0 percent and 33.3 percent with an average of 6.7 percent; the highest relative standard errors are for estimates of very low values (e.g., Severe anemia among children under three who were tested). If estimates of very low values (less than 10 percent) were removed, than the average drops to 4.1 percent. So in general, the relative standard errors for most estimates for the country as a whole are small, except for estimates of very small proportions. The relative standard error for the total fertility rate is small at 3.9 percent. However, for the mortality rates, the average relative standard error is much higher at 15.7 percent. There are differentials in the relative standard error for the estimates of sub-populations. For example, for the variable secondary-special education, the relative standard errors as a percent of the estimated proportion for the whole country, for the rural areas, and for Region 2 are 4.3 percent, 7.8 percent, and 11.4 percent, respectively. For the total sample, the value of the design effect (DEFT), averaged over all variables, is 1.36 which means that, due to multistage clustering of the sample, variance is increased by a factor of 1.8 over that in an equivalent simple random sample. 155 Table B.I List of selected variables for samoline errors. Uzbekistan 1996 Variable name Estimate Base population Primary/secondary education Proportion Secondary-special education Proportion Higher education Proportion Never married (in union) Proportion Currently married (in union) Proportion Married before age 20 Proportion Had first sexual intercourse betbre 18 Proportion Children ever born Mean Children ever born to women over 40 Mean Children surviving Mean Knowing any contraceptive method Proportion Knowing any modern contraceptive method Proportion Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modem method Proportion Currently using pill Proportion Currently using IUD Proportion Currently using injectables Proportion Currently using condom Proportion Currently using periodic abstinence Proportion Currently using withdrawal Proportion Using public sector source Proportion Want no more children Proportion Want to delay at least 2 years Proportion Ideal number of children Mean Severe anemia Proportion Moderate anemia Proportion Mild anemia Proportion BMI < 18.5 Proportion BMI between 18.5 and 30.0 Proportion BMI > 30.0 Proportion Weight-for-height (< -2 SD) Proportion Mothers received medical care at birth Proportion llad diarrhea in the last 2 weeks Proportion Treated with ORS packets Proportion Consulted medical personnel Proportion llaving health card, seen Proportion Received BCG vaccination Proportion Received DPT vaccination (3 doses) Proportion Received polio vaccination (3 doses) Proportion Received measles vaccination Proportion Fully immunized Proportion Children with severe anemia Proportion Children with moderate anemia Proportion Children with mild anemia Proportion Weight-for-height (< -2 SD) Proportion Height-for-age (< -2 SD) Proportion Weight-for-age (< -2 SD) Proportion Total fertility rate (3 years) Rate bearing Rate Rate Rate Rate Rate Neonatal mortality rate Postneonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate All women 15-49 All women 15-49 All women 15-49 All women 15-49 All women 15-49 Women 25-49 Women 25-49 All women 15-49 Women aged 40-49 All women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Current users of modern method Currently married women 15-49 Currently married women 15-49 All women 15-49 Women 15-49 who were tested Women 15-49 who were tested Women 15-49 who were tested Women 15-49 who were measured Women 15-49 who were measured Women 15-49 who were measured Women 15-49 who were measured Births in last 3 years Children under 3 Children under 3 with diarrhea in last 2 weeks Children under 3 with diarrhea in last 2 weeks Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children under 3 who were tested Children under 3 who were tested Children under 3 who were tested Children under 3 who were measured Children under 3 who were measured Children under 3 who were measured Women-years of exposure to child- Number of births exposed to risk o f dying Number of births exposed to risk o f dying Number &bir ths exposed to risk o f dying Number of births exposed to risk o f dying Number of births exposed to risk o f dying 156 Table B,2 Samnling errors - National samt~le. Uzbekistan 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Primary/secondary education .637 .014 4415 4415 1.946 .022 .609 .665 Secondary-special education .255 .011 4415 4415 1.675 .043 .233 .277 Higher education .107 .006 4415 4415 1.335 .056 .095 .I19 Never married (in union) .249 ,010 4415 4415 1,540 ,040 ,229 .269 Currently man'ied (in union) .703 .010 4415 4415 1.515 .014 .683 .723 Married before age 20 .493 .014 2656 2628 1.484 .028 .465 ,521 Had first sexual intercourse before 18 .158 .010 2656 2628 1.445 .063 .138 .178 Chi|dran ever born 2.260 .045 4415 4415 1.364 .020 2.170 2.350 Children ever born to women over 40 4.606 .117 761 732 1.390 .025 4.372 4.840 Children surviving 2.124 .039 4415 4415 1.268 .018 2.046 2.202 Knowing any contraceptive method .957 .006 3067 3102 1.542 .006 .945 .969 Knowing any modem method .955 .006 3067 3102 1.532 .006 .943 .967 Ever used any contraceptive method .679 .015 3067 3102 1.750 ,022 .649 .709 Currently using any method .556 .014 3067 3102 1.596 .025 .528 .584 Currently using a modern method .513 .015 3067 3102 1.707 .029 .483 .543 Currantly using pill ,017 .003 3067 3102 1.271 .176 .011 .023 Currantly using IUD ,458 .015 3067 3102 1.716 .033 .428 .488 Currently using injectables .014 .002 3067 3102 1.097 .143 .010 .018 Currently using condom ,017 .003 3067 3102 1.123 .176 .011 .023 Currently using periodic abstinence ,011 .002 3067 3102 1.015 .182 .007 .015 Currently using withdrawal .028 .004 3067 3102 1.411 .143 .020 .036 Using public sector source .983 .003 1641 1614 1.016 .003 ,977 .989 Want no more childran .509 .012 3067 3102 1.315 .024 ,485 .533 Want to delay at least 2 years .242 ,010 3067 3102 1.247 .041 ,222 .262 Ideal number of childran 3.623 .041 4274 4260 1.999 .011 3,541 3.705 Severe anemia .009 .002 4274 4333 1.503 .222 .005 .013 Moderate anemia .142 .007 4274 4333 1.278 .049 .128 .156 Mild anemia .453 ,008 4274 4333 1.039 .018 .437 .469 BMI < 18.5 .103 .006 4035 4038 1.347 .058 .091 .115 BMI between 18.5 and 30.0 .842 .006 4035 4038 1.080 .007 .830 .854 BMI higher than 30.0 .054 .004 4035 4038 .995 .074 .046 .062 Weight-for-height .046 ,004 4031 4033 1.214 .087 .038 .054 Mothers received medical care at birth .975 .013 1324 1392 2.911 .013 .949 1.000 Had diarrhea in the last 2 weeks .052 .006 1261 1325 1.051 . I 15 .040 .064 Treated with ORS packets .313 .055 77 69 .986 .176 .203 .423 Consulted medical personnel .340 .072 77 69 1.258 .212 .196 .484 Having health card, seen 1.000 .000 395 420 Und .000 1.000 1.000 Received BCG vaccination .976 .011 395 420 1.399 .011 .954 .998 Received DPT vaccination (3 doses) .944 .012 395 420 1.091 .013 .920 .968 Received poilu vaccination (3 doses) .962 .011 395 420 I. 167 .011 .940 .984 Received measles vaccination .915 .017 395 420 1.278 .019 .881 .949 Fully immunized .850 .021 395 420 1.226 .025 .808 .892 Severe anemia .012 .004 1018 1106 1.001 .333 .004 .020 Modarate anemia .256 .017 1018 1106 1.263 .066 .222 .290 Mild anemia .340 .019 1018 1106 1.339 .056 .302 .378 Weight-for-height .I16 .016 954 989 1.545 .138 .084 .148 Height-for-age .313 .021 954 989 1.361 .067 .271 .355 Weight-for-age .188 .019 954 989 1.445 .101 .150 .226 Total fertility rate (3 years) 3.341 .129 NA 12291 1.587 .039 3.083 3.599 Neonatal mortality rate (0-4 years) 22.835 5.079 240I 2518 1.592 .222 12.677 32.993 Postneonatal mortality rate (0-4 years) 26.289 3.218 2407 2522 1.043 .122 19.853 32.725 Infant mortality rate (0-4 years) 49.124 6,634 2407 2522 1.462 .135 35.856 62.392 Child mortality rate (0-4 years) 10.719 1.979 2407 2523 1.002 .185 6.761 14.677 Under-five mortality rate (0-4 years) 59.316 7.042 2413 2527 1.432 .119 45.232 73.400 NA=Notappl icable Und = Undefined 157 Table B.~} Samoline errors - Urban sample, Uzbekistan 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Primary/secondary education .486 .021 2306 1693 2.022 .043 .444 .528 Secondary-special education .336 .014 2306 1693 1.433 .042 .308 .364 Higher education .178 .013 2306 1693 1.623 .073 .152 .204 Never married (in union) .238 .011 2306 1693 1.194 .046 .216 .260 Currently married (in union) .690 .011 2306 1693 1.145 .016 .668 .712 Married before age 20 .387 .015 1444 1060 1.204 .039 .357 .417 Had first sexual intercourse before 18 .124 .012 1444 1(160 1.331 .097 .100 .148 Children ever born 1.938 .046 2306 1693 1.179 .024 1.846 2.030 Children ever born to women over 40 3.600 .130 458 334 1.299 .036 3.340 3.860 Children surviving 1.836 .041 2306 1693 1,123 .022 1.754 1.91g Knowing any contraceptive method .972 .005 1575 1168 1.206 .005 .962 .982 Knowing any modern method .970 .005 1575 1168 1.202 .005 .960 .980 Ever used any contraceptive method .725 .015 1575 1168 1.363 .021 .695 .755 Currently using any method .564 .015 1575 1168 1.198 .027 .534 .594 Currently using a modern method .502 .017 1575 1168 1.333 .034 .468 .536 Currently using pill .020 .004 1575 1168 1.144 .200 .012 .028 Currently using IUD .420 .018 1575 1168 1.475 .043 .384 ,456 Currently using injectables .016 .003 1575 1168 .827 .188 .010 .022 Currently using condom .038 .006 1575 1168 1.340 .158 .026 .050 Currently using periodic abstinence .023 .004 1575 1168 1.149 .174 .015 .031 Currently using withdrawal .029 .007 1575 1168 1,567 .241 .015 ,043 Using public sector source .977 .005 818 603 1.004 .005 .967 .987 Want no more children .513 .015 1575 1168 h186 .029 .483 .543 Want to delay at least 2 years ,230 .012 1575 1168 1.140 .052 ,206 ,254 Ideal number of children 3.259 .046 2235 1638 1.801 .014 3,167 3.351 Severe anemia .009 .003 2181 1625 1.643 .333 .003 .015 Moderate anemia ,128 ,(109 2181 1625 1.321 .070 . J l0 .146 Mild anemia .455 .014 2181 1625 1.308 .031 .427 .483 BMI < 18.5 .093 .008 2099 1539 1.194 .086 .077 .109 BMI between 18.5 and 30.0 .832 .009 2099 1539 1.101 .011 .814 .850 BMI higher than 30.0 .075 .006 2099 1539 h052 .080 .063 .087 Weight-for-height ,044 .006 2097 1537 1.398 .136 .032 .056 Mothers received medical care at birth 1.000 .000 568 428 Und .000 1.000 1.000 Had diarrhea in the last 2 weeks .085 .011 548 414 .903 .129 .063 .107 Treated with ORS packets .395 .068 47 35 .958 .172 .259 .531 Consulted medical personnel ,433 ,093 47 35 1.301 .215 .247 .619 Having health card. seen 1.000 .000 162 125 Und .000 1.000 1.000 Received BCG vaccination ,971 .022 162 125 1.715 .023 .927 1.000 Received DPT vaccination (3 doses) ,889 .029 162 125 1.226 .033 .831 .947 Received polio vaccination (3 doses) .920 .029 162 125 1.384 .032 .862 .978 Received measles vaccination .839 .028 162 125 .999 .033 .783 .895 Fully immunized .748 .040 162 125 1.214 ,053 .668 .828 Severe anemia .009 .005 400 310 1.035 ,556 ,000 .019 Moderate anemia .238 .033 400 310 1.519 .139 .172 .304 Mild anemia .328 ,033 400 310 1.413 ,101 .262 .394 Weight-for-height .102 .018 391 285 1.137 .176 .066 .138 Height-for-age .326 ./127 391 285 1.113 .083 .272 .380 Weight-for-age .166 .026 391 285 1.375 .157 .114 .218 Total fertility rate (3 years) 2.712 .145 NA 4757 1.608 .053 2.422 3.002 Neonatal mortality rate (0-9 years) 23.484 4.045 2100 1575 1.031 .172 15.394 31.574 Postneonatalmortalityrate(O-9years) 19.389 3.341 2102 1577 1.005 .172 12.707 26.071 infant mortality rate (0-9 years) 42.873 4,718 2102 1577 .893 .110 33.437 52.309 Child mortality rate (0-9 years) 9.318 2.318 2105 1578 1.045 249 4.682 13.954 Under-five mortality rate (O.9 years) 51.792 5.556 2107 1579 .975 .•07 40.680 62.904 NA = Not applicable Und ~ Undefined 158 Table B.4 Samnlina errors - Rural samt~le. Uzbe~i~l~n 199~ Number of c~es Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R.2SE R+2SE Primary/secondary education .731 .019 2109 2722 1.943 .026 .693 .769 Secondary-special education .205 .016 2109 2722 1.777 .078 .173 .237 Higher education .062 .006 2109 2722 1. I 18 .097 .050 .074 Never married (in union) .256 .015 2109 2722 1.553 .059 .226 ,286 Currently married (in union) .711 .016 2109 2722 1.577 .023 .679 .743 Married before age 20 .564 .021 1212 1568 1.467 .037 .522 .606 Had first sexual intercourse before 18 .181 .016 1212 1568 1.408 .088 .149 .213 Children ever born 2.461 .069 2109 2722 1.344 ,028 2.323 2.599 Children ever born to women over 40 5.453 .162 303 398 1.333 .030 5.129 5.777 Children surviving 2.302 .060 2109 2722 1.254 .026 2.182 2.422 Knowing any contraceptive method .947 .009 1492 1935 1.471 .010 .929 .965 Knowing any modern method .945 .009 1492 1935 1.459 .010 .927 .963 Ever used any contraceptive method .651 .021 1492 1935 1.713 .032 .609 .693 Currently using any method .551 .021 I492 1935 1.629 .038 .509 .593 Currently using a modern method .520 ,023 1492 1935 1.753 .044 .474 .566 Currently using pill .014 .004 1492 1935 1.304 .286 .006 .022 Currently using IUD .482 .023 1492 1935 1.752 ,048 .436 .528 Currently using injectables .014 .003 1492 1935 1.148 .214 .008 ,020 Currently using condom .004 .002 1492 1935 1.033 .500 .000 .008 Currently using periodic abstinence .004 .002 1492 1935 .958 .500 .000 ,008 Currently using withdrawal .027 ,005 1492 1935 1.283 .185 .017 .037 Using public sector source .987 .I)04 823 1011 1.025 .004 .979 ,995 Want no more children .506 .017 1492 1935 1.293 .034 .472 .540 Want to delay at least 2 years .249 .014 1492 1935 1.214 .056 .221 ,277 Ideal number o f children 3.851 .058 2039 2621 1.878 .015 3.735 3.967 Severe anemia .009 .003 2093 2709 1.375 .333 .003 .015 Moderate anemia .151 .009 2093 2709 1.190 .060 .133 .169 Mild anemia .452 .009 2093 2709 .872 .020 .434 .470 BMI < 18.5 .109 .009 1936 2499 1.317 .083 .091 .127 BMI between 18.5 and 30.0 .849 .008 1936 2499 1.023 .009 .833 .865 BMI higher than 30.0 ,042 .004 1936 2499 .972 .095 .034 .050 Weight-for-height .047 .005 1934 2497 1.080 .106 .037 .057 Mothers received medical care at birth .964 .018 756 963 2.562 .019 .928 1.000 Had diarrhea in the last 2 weeks .037 .008 713 911 1.136 .216 .021 .053 Treated with ORS packets .227 .085 30 33 1.035 .374 .057 .397 Consulted medical personnel .242 .100 30 33 1.193 .413 .042 .442 Having health card, seen 1.000 .000 233 294 Und .000 1.000 1.000 Received BCG vaccination .978 .012 233 294 1.191 .012 .954 1.000 Received DPT vaccination (3 doses) .968 ,012 233 294 1.055 ,012 .944 .992 Received polio vaccination (3 doses) .980 .010 233 294 1.043 .010 ,960 1,000 Received measles vaccination .947 .022 233 294 1.449 .023 .903 .991 Fully immunized .893 .025 233 294 1.211 .028 .843 .943 Severe anemia .014 .004 618 795 .915 .286 .006 .022 Moderate anemia .263 .020 618 795 1.093 .076 .223 .303 Mild anemia .344 .023 618 795 1.216 .067 .298 .390 Weight-for-height .122 .021 563 704 1.485 .172 .080 .164 Height-for-age .307 .027 563 704 1.318 .088 .253 .361 Weight-for-age .197 ,024 563 704 1.319 .I22 .149 .245 Total fertility rate (3 years) 3.737 .181 NA 7534 1.382 .048 3.375 4.099 Neonatal mortality rate (0-9 years) 20.930 4.918 2677 3425 1.635 .235 11.094 30.766 3.059 2681 3429 .991 .134 16.755 28.991 6.009 2681 3429 1.400 .137 31.785 55.821 2.267 2682 3432 .972 .166 9.102 18.170 6.235 2686 3436 1.272 . I I0 44.372 69.312 Postneouatal mortality rate (0-9 years) 22.873 Infant mortality rate (0-9 years) 43.803 Child mortality rate (0-9 years) 13.636 Under-five mortality rate (0-9 years) 56.842 NA = Not applicable Und = Undefined 159 Table B.5 Samolin~ errors - Re~ion I. Uzbekistan 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted ef/kct error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Primary/secondary education .517 .022 982 471 1.368 .043 .473 .561 Secondary-special education .370 .017 982 471 1.114 .046 .336 .404 Higher education .113 .010 982 471 1.008 .088 .093 .133 Never married (in union) .271 .018 982 471 1.272 .066 .235 .307 Currently married (in union) .678 .016 982 471 1.060 .024 .646 .710 Married be/ore age 20 .452 .025 572 274 1.178 .055 .402 .502 Had first sexual intercourse before 18 .169 .024 572 274 1.548 .142 .121 .217 Children ever born 2.460 .102 982 471 1.282 .041 2.256 2.664 Childre~h ever born to women over 40 5.776 .258 146 69 1.223 .045 5,260 6.292 Children surviving 2.225 .078 982 471 1.100 .035 2.069 2.381 Knowing any contraceptive method .998 .002 663 319 1.033 .002 .994 1.000 Knowing any modern method .998 ,002 663 319 1.033 .002 .994 1.000 Ever used any contraceptive method .788 .015 663 319 .957 .019 .758 .818 Currently using any method .640 .022 663 319 1,160 .034 .596 .684 Currentlyusi1~gamodernmethod .617 .021 663 319 1.113 .034 .575 .659 Currently using pill .003 .002 663 319 .997 .667 .000 .007 Currently using IUD .593 ,021 663 319 1.098 .035 .551 .635 Currently using injectables .015 .007 663 319 1.462 .467 .001 ,029 Currently using condom .003 .002 663 319 .930 .667 .000 .007 Currently using periodic abstinence .018 .006 663 319 1.126 .333 .006 .030 Currently using withdrawal .004 .003 663 319 1.008 .750 .000 .010 Using public sector source .990 .006 412 200 1.235 .006 .978 1.000 Want no more children .544 ,024 663 319 1.219 .044 .496 .592 Want to delay at least 2 years ,247 .023 663 319 1.360 ,093 .201 ,293 1deal number of children 3.625 .051 947 454 1.209 .014 3.523 3.727 Severe anemia .021 .006 961 461 1.199 .286 .009 .033 Moderate anemia .213 .010 961 461 .738 .047 .193 .233 Mild anemia .481 .018 961 461 1.134 .037 .445 .517 BMI< 18.5 .098 .009 897 430 .918 .092 .080 .116 BMI between 18.5 and 30.0 .837 .013 897 430 1.018 .016 .gl I .863 BMI higher than 30.0 .065 .006 897 430 .788 .092 .053 .077 Weight-for-height .049 .010 896 430 1.367 .204 .029 .069 Mothers received medical care at birth .997 .003 323 157 1.015 .003 .991 1.000 Had diarrhea in the last 2 weeks .083 .015 306 149 .948 .181 .053 .113 Treated with ORS packets .455 .095 26 12 .964 .209 .265 .645 Const0ted medical personnel .462 .087 26 12 .889 .188 .288 .636 Having health card. seen 1.000 .000 96 47 Und .000 1.000 1.000 Received BCG vaccination .982 .002 96 47 .169 .002 .978 .986 Received DPT vaccination (3 doses) ,980 .013 96 47 .924 .013 .954 1.000 Received polio vaccination (3 doses) .978 .015 96 47 1.017 .015 .948 1.000 Received measles vaccination .919 .019 96 47 .693 .021 .881 .957 Fully immunized .908 ,024 96 47 .810 .026 .860 .956 Severe anemia .052 ,016 251 122 ,991 .308 .020 .084 Moderate anemia .482 ,033 251 122 1.015 .068 .416 .548 Mild anemia .275 ,030 251 122 1.093 .109 .215 .335 Weight-for-height ,068 ,010 262 128 .605 .147 .048 .088 Height-for-age .267 ,035 262 128 1.245 .131 .197 .337 Weight-for-age .145 ,023 262 128 1.102 .159 .099 .191 Und = Undefined 160 Table B.6 Samolina errors- Re~ion 2. Uzbekistan 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (~¢7q) (DEFT) (SE/R) R-2SE R+2SE Primary/secondary education .691 .031 936 1060 2.065 .045 .629 .753 Secondary-special education .229 .026 936 1060 1.906 .114 .177 .281 Higher education .079 .009 936 1060 .985 .114 .061 .097 Never married (in union) .295 .022 936 1060 1.483 ,075 .251 .339 Currently married (in union) .665 .023 936 1060 1.511 .035 .619 .711 Married before age 20 .468 .039 536 600 1.811 .083 .390 .546 Had first sexual intercourse before 18 .137 .020 536 600 1.367 .146 .097 . t77 Children ever born 2.278 .101 936 1060 1.302 .044 2.076 2.480 Children ever born to women over 40 5.248 .245 144 160 1.233 .047 4.758 5.738 Children surviving 2.153 .094 936 1060 1.275 .044 1.965 2.341 Knowing any contraceptive method .942 .012 621 705 1.249 .013 .918 .966 Knowing any modem method .936 .012 621 705 1.208 .013 .912 .960 Ever used any contraceptive method .609 .031 621 705 1.600 .051 .547 .671 Currently using any method .529 .032 621 705 1.576 .060 .465 .593 Currently using a modern method .496 .030 621 705 1.47l .060 .436 .556 Currently using pill .006 ,003 621 705 .937 .500 .000 .012 Currently using IUD .445 .030 621 705 1.519 .067 .385 ,505 Currently using injectables .021 .006 621 705 1.081 .286 .009 ,033 Currently using condom .016 .006 621 705 1.292 .375 .004 ,028 Currently using periodic abstinence .007 .003 621 705 .917 .429 .001 ,013 Currently using withdrawal .025 .008 621 705 1.255 .320 .009 ,041 Using public sector source .982 .007 311 352 .925 .007 .968 .996 Want no more children .550 .026 621 705 1.300 .047 .498 .602 Want to delay at least 2 years .254 .019 621 705 1.083 .075 .216 .292 Ideal number of children 3.974 .087 936 1060 1.807 .022 3.800 4.148 Severe anemia .003 .002 922 1049 .893 .667 ,000 .007 Moderate anemia .100 .012 922 1049 1.222 .120 .076 .124 Mild anemia .337 .014 922 1049 .885 .042 .309 .365 BM1 < 18.5 .123 .019 844 961 1.695 .154 .085 .161 BM[ between 18.5 and 30.0 .854 .018 844 961 1.456 .021 .818 .890 BMI higher than 30.0 .023 .004 844 961 .742 .174 .015 .031 Weight-for-height ,056 .010 844 961 1.315 .179 ,036 .076 Mothers received medical care at birth .914 .051 284 334 2.993 .056 .812 1.000 Had diarrhea in the last 2 weeks ,040 ,017 269 315 1,464 .425 ,006 ,074 Treated with ORS packets .169 .076 I 1 13 .680 .450 .017 .321 Consulted medical personnel .231 .107 I1 13 .851 .463 .017 .445 Having beaIth card, seen |.000 .000 91 109 Und .000 |.000 1.OO0 Received BCG vaccination ,987 .013 91 109 1.148 .013 .961 1.000 Received DPT vaccination (3 doses) .955 .023 91 109 1.072 .024 .909 1.000 Received polio vaccination (3 doses) .973 .017 91 109 1.009 .017 .939 1.000 Received measles vaccination .923 .046 91 109 1,686 .050 .831 1.000 Fully immunized .866 .049 91 109 1.396 .057 .768 .964 Severe anemia .005 .(105 249 294 1.106 1.000 .000 .015 Moderate anemia .176 .027 249 294 1.114 .153 .122 .230 Mild anemia .296 .026 249 294 .908 .088 .244 .348 Weight-for-height .142 .020 215 253 .841 .141 .102 .182 Height-for-age .398 .025 215 253 .727 .063 .348 .448 Weight,for-age ,245 .026 215 253 .889 .106 .193 .297 Und = Undefined 161 Table B.7 Samtdin, errors - Re~ion 3. Uzbekistan 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (51) (WN) (DEFT) (8E/R) R-2SE R+2SE Primary/secondary education .690 .028 755 1249 1.670 .041 .634 .746 Secondary-special education .218 .019 755 1249 1.262 .087 .180 .256 Higher education .092 .012 755 1249 1.179 .130 .068 .116 Never married (in union) .243 .022 755 1249 1.432 .091 .199 .287 Currently married (in union) .708 .024 755 1249 1.454 .034 .660 .756 Married before age 20 .463 .032 463 760 1.367 .069 .399 .527 Had first sexual intercourse before 18 .132 .020 463 760 1.250 .152 .092 .172 Children ever born 2.303 .115 755 1249 1.399 .050 2,073 2.533 Children ever born to women over 40 4.500 .238 132 211 1.168 .053 4.024 4.976 Children surviving 2.167 .095 755 1249 1.234 .044 1.977 2.357 Knowing any contraceptive method .966 .013 533 884 1.627 ,013 .940 .992 Knowing any modern method .964 .013 533 884 1.647 ,013 .938 .990 Ever used any contraceptive method .664 .036 533 884 1.764 .054 .592 .736 Currently using any method .496 .034 533 884 1.552 .069 .428 .564 Currently using a modern method .442 .037 533 884 1.720 ,084 .368 .516 Currently using pill .020 .006 533 884 1.001 .300 .008 .032 Currently using IUD .385 .033 533 884 1.573 .086 .319 .451 Currently using injeetables .015 ,005 533 884 1.052 .333 .005 .025 Currently using condom .018 .007 533 884 1.140 .389 .004 .032 Currently using periodic abstinence .007 .004 533 884 1.174 .571 .000 .015 Currently using withdrawal .047 .010 533 884 1.134 .213 .027 .067 Using public sector source .981 .007 243 400 .763 .007 .967 .995 Want no more children .534 .032 533 884 1.487 .060 .470 .598 Want to delay at least 2 years .255 .024 533 884 1.251 .094 .207 .303 Ideal number of children 3.840 .086 697 1149 1.607 ,022 3.668 4.012 Severeanemia .004 .003 751 1243 1.386 .750 .O00 .010 Moderate anemia .085 .014 751 1243 1.334 .165 .057 .113 Mild anemia .447 .016 751 1243 .907 .036 .415 .479 BMI<I8.5 .115 .012 685 1134 1.025 .104 .091 .139 BMI between 18.5 and 30.0 .849 .011 685 1134 .819 .013 .827 .871 BMI higher than 30.0 .037 .007 685 1134 1.022 .189 .023 .051 Weight-lbr-height .054 ,008 684 1133 .887 .148 .038 .070 Mothers received medical care at birth .986 .012 227 386 1.610 .012 .962 1.000 Had diarrhea in the last 2 weeks .069 .009 214 363 .509 .130 .051 .087 Treated with ORS packets .371 .I 14 16 25 .918 .307 .143 .599 Consulted medical personnel .371 .172 16 25 1.383 .464 .027 .715 Having health card, seen 1.000 .000 63 IO6 Und .0OO 1.000 1.000 Received BCG vaccination .939 .039 63 106 1.304 .042 .861 1.000 Received DPT vaccination (3 doses) .930 .028 63 106 .881 .030 .874 .986 Received polio vaccination (3 doses) .956 .032 63 106 1.243 ,033 .892 1.000 Received measles vaccination .926 .030 63 106 .909 .032 .866 .986 Fully immunized .826 .052 63 106 1.102 .063 .722 .930 Severe anemia .005 .006 197 335 1.098 1.200 .000 .017 Moderate anemia .258 .028 197 335 .932 .109 .202 .314 Mild anemia .269 .023 197 335 .756 .086 .223 .315 Weight-for-height .179 .042 170 290 1.432 .235 .095 .263 Height-for-age .241 .052 170 290 1.589 .216 .137 .345 Weight-for-age .163 .043 170 290 1.446 .264 ,077 .249 Und = Undefined 162 Table B.8 SamDlin~ errors - Re~ion 4, Uzbekistan 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Primary/secondary education .680 Secondary-special education .231 Higher education .087 Never married (in union) .218 Currently married (in union) .745 Married before age 20 .611 Had first sexual intercourse before 18 .215 Children ever born 2.314 .027 914 1231 1.749 .040 .626 .734 .024 914 1231 1.699 .104 .183 .279 .013 914 1231 1.364 .149 .061 .113 .014 914 1231 1.017 .064 .190 .246 .014 914 1231 .988 .019 .717 .773 .023 541 727 1,079 .038 .565 .657 .026 541 727 1.464 ,121 .163 .267 .055 914 1231 .839 .024 2.204 2.424 Children ever born to women over 40 4.645 .204 147 199 1.343 .044 4.237 5.053 Children surviving 2.182 .052 914 1231 .848 .024 2.078 2.286 Knowing any contracepti'~c method .932 .011 680 917 1,093 .012 .910 .954 Knowing any modem method .932 .011 680 917 1,093 .012 .910 .954 Ever used any contraceptive method .660 .024 680 917 1,305 .036 .612 .708 Currently using any method .578 .022 680 917 1.135 .038 .534 ,622 Currently using a modern method ,566 .025 680 917 1,306 .044 ,516 .616 Currently using pill .020 .007 680 917 1.304 .350 .006 ,034 Currently using IUD .529 .029 680 917 1.520 .055 .471 .587 Currently using injectables .008 .001 680 917 .305 .125 .006 .010 Currently using condom .002 .002 680 917 1.076 1.000 .000 .006 Currently using periodic abstinence .005 .002 680 917 .893 .400 .001 .009 Currently using withdrawal .007 .005 680 917 1.504 .714 .000 .017 Using public sector source .987 ,006 384 520 1.057 .006 .975 .999 Want no more children .430 .012 680 917 .624 .028 .406 .454 Want to delay at least 2 years .231 .014 680 917 .860 .061 .203 .259 ldcal number of children 3.316 .043 893 1205 1.186 .013 3,230 3.402 Se'~ere anemia .018 .006 909 1224 1.437 .333 ,006 .030 Moderate anemia .231 .012 909 1224 .858 .052 ,207 .255 Mild anemia .534 .017 909 1224 1.056 .032 .500 .568 BMI < 18.5 .100 .009 848 1140 .825 .090 .082 .118 BMI between 18.5 and 30.0 .819 .010 848 1140 .787 .012 .799 .839 BMI higher than 30.0 .081 .007 848 1140 .787 .086 .067 .095 Weight-for-height .040 .007 846 1138 .981 .175 .026 .054 Mothers received medical care at birth 1.000 .000 318 431 Und .000 1.000 1.000 Had diarrhea in the last 2 weeks .027 .011 309 419 1.225 .407 .005 .049 Treated with ORS packets .181 .134 9 11 1.012 .740 .000 .449 Consulted medical personnel .181 .122 9 I 1 .925 .674 .000 .425 Having health card, seen 1.000 .000 100 136 Und .000 1.000 1.000 Received BCG vaccination .988 .011 100 136 1.031 .011 .966 1.000 Received DPT vaccination (3 doses) .946 .024 100 136 1.053 .025 .g9g .994 Received polio vaccination (3 doses) .950 .017 I00 136 .798 .018 .916 .984 Received measles vaccination .908 .029 100 136 1.010 .032 .850 .966 Fully immunized .839 .034 100 136 .914 .041 .771 .907 Severe anemia .014 ,008 223 307 1.006 .571 .000 .030 Moderate anemia .269 .042 223 307 1.383 .156 .185 .353 Mild anemia .502 .048 223 307 1.445 .096 .406 .598 Weight-for-height .066 .021 188 260 1.202 .318 .024 .108 Height-for-age .352 .043 188 260 1.218 .122 .266 ,438 Weight-for-age .214 .043 188 260 1.424 .201 .128 .300 Und = Undefined 163 Table B.9 SamDlin~ errors- Tashkent City, Uzbekistan 1996 Number of cases Slandard Design Relative Confidence limits Value error Unweighted Weighte~ effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE Primary/secondary education .343 .032 828 404 Secondary-special education .380 .022 828 404 Higher education .277 .026 828 404 Never married (in union) .216 .014 828 404 Currently married (in union) .688 .014 828 404 Married before age 20 .349 ,022 544 266 Had first sexual intercourse before 18 .114 .014 544 266 Children ever born 1.687 .077 828 404 Children ever born to women over 40 2.802 .208 192 94 Children surviving 1.617 .075 828 404 Kno~ing any contraceptive method .998 .002 570 278 Knowing any modern method .998 .002 570 278 Ever used any contraceptive method .839 .022 570 278 Currently using any method .646 .025 570 278 Currently using a modern method .488 .022 570 278 Currently using pill .037 .011 570 278 Currently using IUD .342 .024 570 278 Currently using injectables .016 .005 570 278 Currently using condom .081 .011 570 278 Currently using periodic abstinence .049 .010 570 278 Currently using withdrawal .068 .012 570 278 Using public sector source .966 .012 291 142 Want no more children .542 .025 570 278 Want 1o delay at least 2 years .198 .022 570 278 Ideal number o f children 2.979 .088 801 391 Severe anemia .000 .000 731 357 Moderate anemia .067 .010 731 357 Mild anemia .502 .020 731 357 BMI < 18.5 .033 ,007 76] 372 BMI between 18.5 and 30.0 .870 ,010 761 372 BMI higher than 30,0 .097 .007 761 372 Weight-lbr-height ,008 .003 761 372 Mothers received medical care at birth 1.000 .000 172 84 Had diarrhea in the last 2 weeks .092 .015 163 80 Treated with ORS packets .333 .077 15 7 Consulted medical personnel .467 .117 15 7 Having health card, seen 1.000 .000 45 22 Received BCG vaccination 1.000 .000 45 22 Received DPT vaccination (3 doses) .867 .052 45 22 Received polio vaccination (3 doses) .978 .022 45 22 Received measles vaccination .844 .066 45 22 Fully immunized .822 .069 45 22 Severe anemia .000 .000 98 48 Moderate anemia .071 .033 98 48 Mild anemia .224 .050 98 48 Weight-for-height .025 .024 119 58 Height-for.age .227 .039 119 58 Weight-lbr-age ,042 .020 119 58 1.916 .093 .279 ,407 1.324 .058 .336 .424 1.664 .094 .225 ,329 .948 .065 .188 .244 .883 .020 .660 .716 1.056 .063 .305 .393 1.020 .123 ,086 .142 1.417 .046 1,533 1.841 1.670 .074 2,386 3.218 1.431 .046 1,467 1.767 1.006 .002 .994 1.000 1.006 .002 .994 1.000 1.431 .026 .795 .883 1.259 .039 .596 .696 1.041 .045 .444 .532 1.398 .297 .015 .059 1.231 .070 .294 .390 .872 .313 .006 .026 1.003 .136 .059 .103 1.128 .204 .029 .069 1.161 .176 .044 .092 1.166 .012 .942 .990 1.191 .046 .492 .592 1.328 A l l .154 .242 2.066 .030 2.803 3.155 Und Und .000 .000 1.123 .149 .047 .1187 1.089 ,040 .462 .542 1.036 .212 .019 .047 .821 .011 .850 .890 ,691 .072 .083 . I l l .815 .375 .002 .014 Und .000 l.O00 1.000 .676 .163 .062 .122 .632 ,231 .179 .487 .910 .251 .233 .701 Uod .000 1.000 1.000 Und .000 1.000 1.000 I.(116 .060 .763 ,971 1.002 .022 .934 1.000 1.218 .078 .712 .976 1.208 .084 .684 .960 Und Und .000 .000 1,251 .465 .005 .137 1.198 .223 .124 .324 1.272 .960 .000 .073 .974 .172 .149 .305 .949 .476 .002 .082 Und ~ Undefined 164 APPENDIX C DATA QUALITY TABLES Tobl* G.I Household a~e distribution Single-year age distribution of the de facto household population by sex (weighted), Uzbekistan 1996 Males Females Males Females Age Number Percent Number Percent Age Number Percent Number Percent 0 233 2.5 196 2.1 37 113 1.2 113 1.2 1 250 2.6 224 2.4 38 130 1.4 115 1.2 2 220 2.3 236 2.5 39 95 1.0 116 1.2 3 237 2.5 254 2.7 40 108 1.1 114 1.2 4 270 2.8 279 2.9 41 58 0.6 73 0.8 5 263 2.8 247 2.6 42 85 0.9 81 0.9 6 286 3,0 223 2.3 43 88 0,9 106 1.1 7 230 2.4 238 2.5 44 88 0.9 67 0.7 8 270 2.8 238 2.5 45 85 0.9 80 0.8 9 236 2.5 277 2.9 46 92 1.0 69 0.7 10 256 2.7 255 2.7 47 45 0.5 58 0.6 I1 229 2.4 240 2.5 48 68 0.7 40 0.4 12 199 2.1 244 2.6 49 70 0.7 76 0.8 13 223 2.3 245 2.6 50 66 0.7 50 0.5 14 229 2.4 241 2.5 51 27 0.3 44 0.5 15 233 2.4 205 2.2 52 39 0.4 54 0.6 16 230 2.4 211 2.2 53 49 0.5 46 0.5 17 229 2.4 203 2.1 54 47 0.5 50 0.5 18 205 2.2 182 1.9 55 54 0.6 74 0.8 19 160 1.7 189 2.0 56 78 0.8 80 0.8 20 214 2.2 184 1.9 57 38 0.4 43 0.5 21 135 1.4 165 1.7 58 67 0.7 58 0.6 22 163 1.7 157 1.7 59 35 0.4 41 0.4 23 169 1.8 169 1.8 60 79 0.8 89 0.9 24 169 1.8 158 1.7 61 37 0.4 38 0.4 25 193 2.0 180 1.9 62 32 0.3 31 0.3 26 152 1.6 155 1.6 63 43 0.5 65 0,7 27 171 1.8 133 1.4 64 47 0.5 45 0.5 28 160 1.7 138 1.4 65 48 0.5 62 0.7 29 115 1.2 116 1.2 66 42 0.4 41 0.4 30 167 1.7 164 1.7 67 33 0.4 47 0.5 31 131 1.4 104 1.1 68 27 0,3 31 0.3 32 149 1.6 154 1.6 69 32 0.3 30 0.3 ~33 112 1.2 110 1.2 70+ 239 2.5 324 3.4 34 126 1.3 102 1.1 Don't know/ missing 1 0.0 0 0.0 36 103 1.1 137 1.4 Total 9,527 100,0 9,502 100.0 Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. 167 Table C.2 Aee distribution of eligible and interviewed women Percent distribution of the de facto household population of women age 10-54 and of interviewed women age 15-49, and the percentage of eligible women who were interviewed (weighted) by five-year age groups, Uzbekistan 1996 Household popu- lation of women Interviewed women Age Number Percent Number Percent Percent interviewed (weighted) 10-14 1,225 - - - 15-19 989 21.9 976 22.1 98.6 20-24 833 18.4 811 18.4 97.4 25-29 722 16.0 703 16.0 97.3 30-34 634 14.0 622 14.1 98.1 35-39 578 12.8 564 12.8 97.6 40-44 441 9.8 423 9.6 96.0 45-49 322 7.1 307 7.0 95.5 50-54 244 15-49 4,519 4,405 97.5 Note: The de facto population incJudes aJl residents and nonresidents who slept in the household the night before interview. 168 Table C.3 ComDletenass ofra~ortin~ Percentage of observations missing information for selected demographic and health questions (weighted), Uzhekistan 1996 Percentage Number missing of Subject Reference group information cases Birth date Births in last 15 years Month only 0.4 7,131 Month and year 0.0 7,13 I Age at death Deaths to births in last 15 years 0.0 403 Age/date at first union ~ Ever-married women 0.6 3,316 Respondeut's education All women 0.0 4,415 Child's size at birth Births in last 35 months 0.5 1,346 Anthropometry 2 Living children age 0-35 months Height missing 12.6 !,325 Weight missing 12.0 1,325 Height or weight missing 12.8 1,325 Diarrhea in last 2 weeks Living children age 0-35 months 0.2 1,325 i Both year and age missing 2 Child not measured 169 Table C.4 Births bv calendar years Distr ibution of births by Western calendar years for l iving (L), dead (D), and all (T) children, according to reporting completeness, sex ratio at birth, and ratio o f births by calendar year, Uzbekistan 1996 Percentage with Sex ratio Number of births complete birth date t at birth 2 Calendar ratio 3 Male Female Year L D T L D T L D T L I.) T L D T L D T 95 503 26 529 100.0 100.0 100fl 120.1 17h2 122,1 NA NA NA 274 16 291 229 l0 238 94 446 25 472 100.0 100.0 100.0 96.8 216.4 1009 93.6 98.2 93.9 220 17 237 227 8 235 93 450 26 476 100.0 100.0 1000 84.1 219.7 88.5 91.4 84.0 91.0 206 18 223 244 8 253 92 538 36 575 99.9 100,0 999 89.7 103.5 90,5 115.4 142.2 116.8 254 18 273 284 18 302 91 482 25 508 99.8 1000 99.8 105,9 104.1 105.8 93.5 77,7 92.5 248 13 261 234 12 247 90 494 28 522 997 100.0 99.7 124.6 155.1 126.1 1062 142.6 1077 274 17 291 220 I1 231 89 448 15 463 100.0 1000 100.0 89,8 135.4 91.0 93.6 50.6 91.2 212 8 220 236 6 242 88 464 29 493 1000 92.9 99.6 131.2 176.0 1335 1001 138.1 101.8 263 19 282 201 I1 211 87 478 28 506 99.7 98,2 99.6 83.5 132.4 85.6 102.7 92.8 102.1 217 16 233 261 12 273 86 467 31 498 99.7 95.3 99.4 91.3 106.7 922 NA NA NA 223 16 239 244 15 259 91-95 2,420 139 2,559 99.9 100.0 99.9 98.7 148.3 1009 NA NA NA 1,202 83 1,285 1,218 56 1,274 86-90 2,351 131 2,482 99.8 96.9 99.7 102.5 1388 104.1 NA NA NA 1,190 76 1,266 1,161 55 1,216 81-85 1,964 135 2,099 99.7 89.1 99.0 93.6 14h7 96.1 NA NA NA 949 79 1,028 1,014 56 1,070 76-80 1,470 116 1.586 99,9 88.8 99.1 114,0 1638 1170 NA NA NA 783 72 855 687 44 731 <76 949 74 1,023 99.8 93.8 99.4 997 1528 1028 NA NA NA 474 44 518 475 29 504 All 9,153 595 9348 99.8 93.9 99.5 100.9 148.0 103.3 NA NA NA 4.598 355 4,953 4.556 240 4,795 NA = Not applicable i Both year and month of birth given 2 (BdBf) , 100, where B,,~ and Bf are the numbers of male and female births, respectively 3 [2B~/(Bx.I+B~+I)).I00, where B~ is the number of births in calendar year x 170 Table C.5 Renortin~ ofa~e at death irl 0~Y~ Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods preceding the survey, Uzbekistan 1996 Number of years preceding the survey Age at death Total (in days) 0-4 5-9 10-14 15-19 0-19 <1 4 3 1 1 I0 I II 13 16 9 50 2 3 10 6 3 22 3 6 9 8 9 31 4 7 0 3 2 12 5 8 2 2 8 20 6 5 0 1 0 6 7 0 0 l 0 I 8 1 l 1 0 3 9 3 3 2 0 7 10 0 2 0 2 5 13 0 0 2 0 2 14 1 0 0 0 1 15 1 0 2 0 3 16 I 0 0 0 1 17 I 0 1 0 2 18 3 0 2 0 5 20 2 0 4 0 6 23 0 0 0 I I 26 0 2 0 0 2 31+ 0 0 2 2 3 Total 0-30 57 46 53 35 190 Percent early neonatal a 78.0 81.2 72.5 90.4 79.5 1 (0-6 days/0-30 days) * 100 171 Table C.6 Renortinn ofa~e at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at ages under one month, for five-year periods preceding the survey, Uzbekistan 1996 Number of years preceding the survey Age at death Total (in manths) 0-4 5-9 10-14 15-19 0-19 <I a 57 46 53 35 190 I 10 4 5 6 24 2 7 7 3 4 22 3 5 6 11 10 32 4 5 2 8 2 17 5 8 7 I I 17 6 7 7 I 1 1 26 7 4 O 3 3 9 8 4 I 4 3 11 9 8 3 6 4 21 10 I I 3 2 6 I1 3 2 4 I l0 12 4 10 6 4 25 13 5 0 0 I 6 14 1 0 0 2 4 15 0 0 2 0 2 16 0 0 3 I 4 17 0 0 0 0 I 18 1 0 I 2 4 20 0 I 0 0 1 22 0 1 0 0 1 1 year 2 I 12 4 19 Total 0-11 I 18 85 I 12 72 386 Percent neonatal b 48. I 53.9 47.3 49.2 49.3 a b Includes deaths under 1 month reported in days (Under I month/under I year) * 100 172 APPENDIX D SAMPLE IMPLEMENTATION Table D.1 Sample implementation Percent distribution of households and eligible women in the DHS sample by results of the interviews and household, eligible women, and overall response rates, according to region and residence, Uzbekistan 1996 Region Residence Tashkent Result Region 1 Region 2 Region 3 Region 4 City Urban Rural Total Selected households Completed (C) 92.1 96.9 95.6 96.5 89.0 92.5 95.6 93.9 Household present but no competent respondent at home (HP) 0.3 0.I 0.1 0.0 1.2 0.5 0.2 0.4 Refused (R) 1.0 0.1 0.5 0.7 1.4 1.0 0.5 0.8 Dwelling not found (DNF) 0. I 0. I 1.4 0.0 0.2 0. I 0.7 0.4 Household absent (HA) 2.9 2.2 1.2 0.8 6.1 3.6 1.6 2.7 Dwelling vacant (DV) 3.5 0.5 0.9 1.7 1.9 2.0 1.3 1.7 Dwelling destroyed (DD) 0.0 0.0 0.3 0.4 0.1 0.2 0. I 0.2 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 I00.0 100.0 Number 763 765 767 767 883 2,228 1,717 3,945 Household response rate (HRR) z 98.5 99.6 97.9 99.3 96,9 98.2 98.6 98.4 Eligible women Completed (EWC) 96.4 98.6 98.7 96.6 95.7 96.6 97.8 97.2 Not at home (EWNH) 2.6 0.4 0.5 2.2 1.3 1.9 1.0 1.5 Refused (EWR) 0.6 0.3 0.4 0.3 2.0 1.0 0.3 0.7 Incapacitated (EWI) 0.5 0.6 0.4 0.8 1.0 0.5 0.9 0.7 Total percent 100.0 10O.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,019 949 765 946 865 2,388 2,156 4,544 Eligible woman response rate (EWRR) 2 96.4 9g.6 98.7 96.6 95.7 96.6 97.g 97.2 Overall resl~onse rate (ORR) s 94.9 98.2 96.6 96.0 92.8 94.9 96.5 95.6 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found. The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, incapacitated and "other." The overall response rate is the product of the household and woman response rates. t Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C C+HP+R+DNF z Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as; EWC EWC + EWNH + EWP + EWR + EWI The overall response rate (ORR) is calculated as: ORR = HRR * EWRR 175 APPENDIX E PERSONS INVOLVED IN THE 1996 UZBEKISTAN DEMOGRAPHIC AND HEALTH SURVEY APPENDIX E PERSONS INVOLVED 1N THE 1996 UZBEKISTAN DEMOGRAPHIC AND HEALTH SURVEY National Director Dr. Shavkat Karimov Executive Directors Dr. Damin Asadov Dr. Akhror Yarkulov Technical Directors Farida Aupova Feruza Faizieva Senior Field Staff Dr. Mila Li, Field Coordinator Dr. Rano Usmanova, Field Coordinator Macro International Staff Dr. Jeremiah M. Sullivan, Deputy Director for Survey Operations Dr. Almaz Sharmanov, Health Specialist Mr. Trevor Croft, Chief of Data Processing Ms. Thanh L~, Sampling Statistician Dr. Kia Weinstein, Consultant Ms. Annie Cross, Regional Coordinator Ms. Trina Yannicos, Editor Ms. Kaye Mitchell, Document Production Specialist Mr. Jonathan Dammons, Graphics Specialist Ms. Catherine Sansone, Graphics Specialist Ministry of Health, Republic of Uzbekistan S.I, Karimov, Minister A.B. Yarkulov, Deputy Minister Goskomprognozstat (State Committee on Statistics and Analysis) G.S. Kudratov, General Director R.S. Makhmudova, Deputy Director Chiefs of Oblast Health Departments M.A. Ziyaeva, Tashkent City T.B. Yeshganov, Karakalpakstanskaya Oblast B.O. Dustjanov, Khorezmskaya Oblast I.N. Norbaev, Navoyiskaya Oblast M.M. Abdurakhmanov, Bukharskaya Oblast H.M. Mustafaev, Kashkadaryinskaya Oblast H.H. Kurramov, Surkhandaryinskaya Oblast J.E. Eshkabulov, Samarkandskaya Oblast M.G. Sadykov, Jizzakskaya Oblast 179 B.R. Mirzaev, Syrdaryinskaya Oblast A.S. Sadykov, Tashkentskaya Oblast M.E. Turabekov, Namanganskaya Oblast H.H. Khojarahmetova, Ferganskaya Oblast A.A. Atakhanov, Andijanskaya Oblast Supervisor K.D. Mikirtichev Supervisor A.H. Shamirov Supervisor K. Abdurakhmanov Supervisor Norbaev T. Supervisor K.D. Mikirtichev Region 1 Supervisor A.D. Abdurakhmanov Field Editor G.N. Bekbaulieva Interviewers Z.U. Umirbekova Z.D. Jumaniyazov Z.Matkarimova D.Matkarimova R. Abdurakhimova Medical Technician B. Usupaliev Field Staff Region 1 Listers A.S. Logutov Region 2 Listers N.Aripov Region 3 Listers S. Tashmetov Region 4 Listers B. Usupaliev Region 5 Listers J.M. Arabyan Interviewing Staff Mappers B.J. Jumanov H.Safarov Mappers S. Razikov Mappers A. Jalilov Mappers Mappers N.F. Fuzailova Region 2 Supervisor B.K. Uskinbaev Field Editor A.M. Mamatkasimov Interviewers F. Sultanova B. Toshtemirova D. Zakirova U. Pulkanova G. Ganieva Medical Techician A.D. Jalilov 180 Region 3 Supervisor D. Kostsov Field Editor F. Nishanova Interviewers S+ Belennik N. Akilkhodjaeva N. Khismatulina S. Bakirova Z+ Kurabnova Medical Techniean S. Razikov Region 5 Supervisor H.A. Mansurova Field Editor S.U. lrgasheva Interviewers N.A. Abdusamatova Z. Akhatova E.N. Azimova N. Turdibaeva D. Abdullaeva Medical Technician Z. Nematova N.M. Abrarova N.F. Fuzailova B. lgamberdieva Region 4 Supervisor Musaeva G.M. Field Editor A.V. Popov Interviewers I. Kartseva J. Aziziova G. Nematjanova D. Kuzmatova E. Kazantseva Medical Technician T. Norbaev Data Processing Staff L.O. Samoilova D.B, Akbarova M.M. Faizirakhmanova tSt APPENDIX F QUESTIONNAIRES UZBEKISTAN DEMOGRAPHIC AND HEALTH SURVEY QUESTIONNAIRE HOUSEHOLD SCHEDULE REPUBLIC OF UZBEKISTAN INSTITUTE OF OBSTETRICS AND GYNECOLOGY MINISTRY OF HEALTH IDENTIFICATION CI~(/'rOWN/VILLAG E NAME NAME OF HOUSEHOLD HEAD REGION . OBLAST . . . . . . . . . . . . . . . . . . . . . . . . RAION . CLUSTER NUMBER . URBAN/RURAL (urban = 1; rural = 2) . LARGE CITY/SMALL CITY~_OWN/COUNTRYSIDE , . . (large cib/= 1, small ci~ = 2, town = 3, countryside = 4) HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . INTERVIEWER VISIT 1 2 3 FINAL VISIT DATE i h - II F]-- INTERVIEWER'S RESULT* NEXT VISIT: NAME DATE TIME ,-~:~.,:.:,,,. * RESULT CODES: 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD 4 POSTPONED 5 REFUSED 6 DWELLING VACANT OR ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 DWELLING NOT FOUND g OTHER (SPEC~PH) DAY MONTH YEAR NAME RESULT TOTAL NO. VISITS I } TOTAL IN HOUSEHOLD TOTAL ELIGIBLE WOMEN LINE NO, OF RESP, TO HOUSE-Ill HOLD SCHEDULE SUPERVISOR NAME ~ ] DATE FIELD EDITOR NAME DATE i OFFICE EDITOR KEYED BY 185 INFORMATION ABOUT HOUSEHOLD MEMBERS AND V!SITORS Now we would like some information about the people who usuafly live in your household or who are staying with you now, USUAL RELA= RESIDENCE SEX i AC~ i EDUCATION PENSION RESIDENTS TIONSI-tlp AND VISITORS TO HEAD i i DF HOUSE" i iF AGE 50 HOLD" IF AGE 7 Y~ARS OR OLDER yl:A[~S OR OLDE R I I , I l 1 I Please give me the What is Does Did Its iHow -~as LF ATTENt3ED SCHOOL names of the persons the re + NAME) tNAME) I :NAME) told iS NAMEj J who usually live in [ation- LISU- stay her~l m~Je NAME)? ,vet It Wh your household and ship ally live last Dr )een guests of the househol of here? night? IIe- o at is IF AGE LESS who stayed here (~AMEI male? ;chool? last night, starting to the I I with the head of head ot the household, house-the i hold? I pARENTAL SUFIVIVORSHIp AND RESIDENCE: FOR PERSONS LES~ THAN 15 YEARS OLD O Z I the i ~,~AJ~ as highest i revel YEARS of school i I (NAM E ) I attended? I i What is =is {N~M~) sti I the I'o highest I grade , (t~AME) I completed , at that I level?** IS (NAME} J~ pensioner (NAMES) natural mother alive? IF ALIVE Is (NAMES) , natura~ Does (NAME's) ~t~er ' na tura l mother a~e? live in this household? IF YES: What is her name? LINE IF &LIVE CLRCLE LINE • NUMBER Does (NAME'S) OF WOME N naturalfather live in this EL~G+eL¢ househo ld? FOR IF yES: INDIVIDUAL What is INTERVIEW his name? FATHER'S LINE ( t ) 01 02 03 04 05 (2) (3) (4) (5) ! (6) (7) (8) (9) I (10) (ft) (~2) ' i I ' ' ] I ' ' ' ~t1~ NO YtS NO M F N~RS ~t~S NO L~VEL GH~E YES N{~ Y~SNODK Y~SNODK I 1. 2 .' 1 2 I 2 ." . I 2 .' . 1 2 t 1 2 8 i l 2 8 i L 1 2 1 2 12 2 1 2 1 28 t 2 ; .1 ; . : . '. : , , 8 ! ;I-1 I-FI 1 2 : 1 2 L 1 2 .t 2 f 2 1 28 1 2 8, I - I -1 f2 t2 ; i : : .'1 '. '. f 2 a t 2 8a 1 2 B ~{'~ 1 2 _ 1 2 1 2 r ~ . 1 2 [~ I ~ . . . f 2 . f 2 8 1 2 B . (13) (14 (15) (16) I I I YES NO DK m ot 1 2 8 I I I 1 2 8 I I | M M 1 2 8 I I | 1 2 8 I I | ,oo, 1 2 8, HOUSEHOLD SCHEDULE CONTINUED (1) (2) (3) (4) (5) (6) (7) (8) I (9) (10) ( l t I (12) ( t3) (14) (tS) ' i t6) I I I y~r~S NO OK M I-FI °° 1 2 8 ! I ; m m o, l 2 8 : : 1 ~ 08 I I I m ~ og 1 2 8 M m '° 1 2 8 I I I 1 2 8 12 YES NO YES NO ~ F IN~A~:I ~.~ ~ ~ ~ , o° M I-]3 I--1 Fi-I I 112 12 2 1 2 I " ; ! ." -I ; I ; 0, m I~ Dm i 2 t 2 2 .1 2 l " ; ! £ ~ . ! : f °', ,m, ,,~ , ~,M, ,Sm; 0, ~ I-lq., Dr-FI 2 1 2 2 2 • -" I I I = ; : 1( 1 2 12 12 1 2 • ~m, , , ,I-T1, :DM; ' !FR i FI-I DI-I-1 2 12 2 . 2 j I I I I : . , I [ ] 2 1 2 2 2 I I I L i I ' Jus t to make sure that I have a complete l i s t ing : 1) Are there any o ther persons such as smal l ch i ld ren or I in fants that we have not l i s ted? ~Es I ~ES NO YESNODK rIESNODK 2 2 f 1 28 i I 2 2 ~ 1 28 2 2 ~ 1 28 i 1 28L1 28 281 28 281 28 2 281 2 B ) ENTER EAC 2) In add i t ion , are there any other people who may not be members of your family (lodgers or friends) who usually live here? YI~S I I ) ENTE TABLE 3) Are there any guests or temporary visitors staying here, or anyone else who slept here last n ight that have not been l i s ted? • CODE S FOR Q.3 RELATIONASHIp TO HEAD OF HOUSEHOLD: YES I I ENTER EACH iN TABLE -- CODE S FOR Q 9 LEVEL OF EDUCATION; 01 . HEAD 09 . CO-WIFE 02 . WIFE OR HUSBAND 05 . GRANDCHILD 10 . OTHER RELATIVE 03 . SON OR DAUGHTER 06 , pARENT 11 = ADOPTEO/FOSTER/STE.P CP~it.~ 04 SON-IN=LAW OR 07 . PARENT-IN-LAW 12 + NOT RELATED DAUGHTER-IN*L&W O8 . BROTHER OR SISTER 98 . DK 1 PRIMARY AND SECONDARY 2 .SECONDARY SPECIAL 3 HIGHER 8+DK -** THES E QUESTIONS REFER TO THE BIOLOGICAL pARENTS OF THE CHILD. RECORD OO IF PARENT t~IOT ~EMB~R OF ~CfUSE~IDLD, NOI I NOI I NOII GRADE 00. LESS THAN 1 YEAR COMPLETED 9~. DK NO 17 18 19 20 21 22 23 24 C4JESTIO~ S AND R LTE~IS What is the main source of dnnking water for members of your household? How long does it take to go there, get water, and come back? What kind of toilet facility does your household have? Does your household have: Electricity? A radio? A television? A telephone? A refrigerator How many rooms in your household are used for sleeping? RECORO OBSERVATION Does any member of your household own A bicycle? A motorcycle? A car? What type of salt is usually used for cooking in your household? {A~K TO ~;~JE SALT PAC KAGEI. CO[~ NG CATEGOF(IF~ pIpED WATF~ PIPED INTO RESIDENCE/YARD/PLOT . 11 PUBLIC TAP . 1 V~]J_ WAllER WELL IN R ESIDEN C E,P(ARD/pLOT . 21 PUBUC WELL . . . . . . . . . . . . . . . . . . . . 2 2 ~pRINCI WATER . 31 RJVER/STF IEAM . 3 ;~ ~ND/LAKE . . . . . . . . . . . . . . . . . . . . . . . 33 DAM . 34 R~i~P~ATER . . . . . . . . . . . . . . . . . . . . . . . . . 41 TANKER TRUCK . 51 | BO3~]~D WATER . . . . . . . . . . . . . . . . . . . . 61 (SPECIFY) ,11] . . . . . . . . . . 996 ON PREMISES . FIJJ~H TC4 LET OWN FLUSH TOILEr . 11 SHARED FLUSH TOILET . 12 piT TO]LET/LATRI NE~ TRADITIONAL TYPE . . . . . . . . . . . . . . . . . . . 21 iMPROVeD . VENTILATED . 2 2 NO FACILITY (BUSH/FIELD) . 31 OTME~ 96 (SPECIFy) YES NO ELECTRICITY . 1 2 RAOIO . 1 2 TELEVISION . 1 2 TELEPHONE . I 2 REFRIGERATOR . 1 2 ROOMS NATUR/iL FLOOR I EARTH/SAND . tl TEZEK . I 2 RUDIMENTARY FLOOR ~4iC~ O pLANKS . ~ 1 STRAW/SAWDUST . ~ 2 nNISH~ F~OOR pARQUeT OR POLISHED WOOD . 31 UNOtI~UM OR ASPHALT . 3 2 CERAMIC TILES . 33 CEMENT . 34 CARpEr . 35 O~D~ 96 (SPECIFY} I YIES NO BICYCLE . . . . . . . . . . . . . . . . 1 2 MOTORCYCLE . 1 2 CAR . 1 2 LOCAL SALT . . . . . . . . . . . . . . . . . . . . . . . . O~ PACKAGED ,~.ALT (IODIZED) . 02 PAC KAC-4ED SALT (NOT IODIZED} . 03 OT~ER g6 (SPECIFY) J I SKiP I ) ,19 • 19 • 19 • 19 188 INDIVIDUAL WOMAN'S QUESTIONNAIRE REPUBLIC OF UZBEKISTAN INSTITUTE OF OBSTETRICS AND GYNECOLOGY MINISTRY OF HEALTH IDENTIFICATION CITY/TOWN/VILLAGE NAME NAME OF HOUSEHOLD HEAD REGION . OBLAST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RAION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL {urban = 1; rural = 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE . (large city = 1, small city = 2, town = 3, countz~side = 4) HOUSEHOLD NUMBER . NAME AND LINE NUMBER OF WOMAN INTERVIEWER VISIT 1 2 3 FINAL VISIT DATE INTERVIEWER'S NAME RESULT* NEXT VISIT: DATE TIME DAY MONTH YEAR NAME RESULT TOTAL NO. VISITS r-1 F~ES U LT CODES: 7 OTHER COMPLETED 4 REFUSED NOT AT HOME 5 PARTLY COMPLETED POSTPONED 6 INCAPACITATED (SpEcIFY} 1. LANGUAGE OF INTERVIEW 2. NATIVE LANGUAGE OF RESPONDENT 3. WHETHER TRANSLATOR USED UZBEK RUSSIAN 1 2 1 2 YES NO 1 2 SUPERVISOR NAME DATE FIELD EDITOR NAME DATE OFFICE EDITOR KEYED BY 189 NO. 101 102 103 104 105 ~ect ion 1 . RESPONDEN " A R QUEST IONS AND F ILTERS CODING CATEGORIES HOUR • MINUTES First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a countryside? How long have you been living continuously in (NAME Q¢ CURRENT pLACE OF RESIDENCE)? Just before you moved here, did you live in a city, in a town, or in the Countryside? In wffat month and year were you born? CITY TOWN. COUNTR ClqW TOWN • MONTH¸ SIDE. . 1 . 2 . 3 95 . . . . . 98 FT1 YE~.R . . . . . . . . . . . . . . . . . . . . DON'T KNOW YEAR . . . . . . . . . . . . . . . . . . . . 98 106 How old wore you at your last birthday? AGE IN COMPLETED yFJ~RS . . . . . . . . . . 107 YES . 1 Have you ever attended school? NO . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . 2 ~KIP • t05 >-11, What is the highest level of school you attended: primary, secondary, secondary-special, or high What did you study? How many years/classes~courses did you completed at that level? HIGHER PRIMARY/SECONDARY 1 SECONOARY SPECIAL 2 3 (NAME OF SPECIALJ3~f )) CHECK 106 34ORBELOW ~-~ 3S OR ABOVE I • 10! lt4 Are you currently attending school? What was the main reason you stopped attending school? Can you read or understand a letter or newspaper easily, with dificulty, or not at all? YES 1 NO . . . . . 2 | GOT PREGNANT GOT MARRIED : . . . . . . TO CARE FOR YOUNG~ CHILDREN FAMILY N EEDEO HE~P AT WORK NEEDED TO EARN MONEY . . . . HAD I~NOUGH SCHOOLING DID NOT PASS ENTRANCE E~OLMS DID NOT IJKE SCHOOL SCHOOL IS TOO FAR OTH[~:~ (SPECIFY) DON'T KNOW 01 02 03 04 05 06 07 08 09 96 98 EASILY 1 Wt~ Dim CULPt 2 NOT AT ALL 3 -~114 ~11( NO. 115 116 117 118 119 119A QUESTIONS AND FILTERS Do you usually read a newspaper or magazine at least once a week? CODING CATEGORIES ~ES . NO Do you usualty listen to the radio every day? '~ES . 1 NO . 2 I Do you usually watch television at least once a week? ~r~s . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I MUSLIM . . . . . . . . . . . . . . . . . . . . . . | What is your religion: Are you Muslim, Christian, another religion or do you not practice any religion? CHRISTIAN . . . . . . . . . . . . . . . . . . . . . . . 2 OTHER 6 (SPECIFy) NOT RELIGIOUS . . . . . . . . . . . . . . . . • What is your nationality? Are you Uzbek? Russian? Kazakh? Tadzhik? Korean? Other? U~EK . . . . . . . . . . . . . . . . . . . . . . . . 1 RtJ~StAN . . . . . . . . . . . . . . . . . . . . . . 2 KOREAN (SPECtF~3 ONLy M~IBEK . 1 MOR~ L/ZBEK THAN ,¢IIJ~S ,MiN . 2 SAME UZBEK AND RUSSIAN . 3 MORE RUSSIAN THAN UZBEK . 4 ONLY RUSS IAN . . . . . . . . . . . . . . . . . . . 5 O~I~ET~ 6 (SPECIFY) What language is easiest for you to read: Only Uzbek? Uzbek more than Russian? Both equally? Russian more than Uzbek? Only Russian? Other language? ISKIP 2 I 119~ 11gC 1190 119E 121 What language do you usually speak at home: Only Uzbek? Uzbek more than Russian? Both equally? Russian more than Uzbek? Only Russian? Other language? Do you own dacha, or do you have access to a garden from whichyou obtain fruits and vegetables during the growing seasons? Do you have any chronic diseases? What kind of disease do you have? ONLY LJZ BEK . . . . . 1 MORE L~BEK THAN RUS~AN 2 SAME L~BEK AND RUSSIAN . 3 MORE RUSSIAN THAN UZBEX 4 ONLY RUSSIAN . . . . 5 OTHER 6 (SPECIFY) YES 1 NO 2 OTHER 6 (SPECIF~ YES 1 NO 2 {NAME OF D~SEASE) CHECK IN TERMI EWE~'S ASSIGNMENT SHEET THE ~M3MAN INTE, RVLE~tO IS NOT A USUAL RESIDENT ? Now I would like to ask about the place in which you usually live. What is the name of the place in which you usually live? INAME OF PLACEI Is that a city. town, or the countryside? ~HE WGMAN ~NTEF~B/~O ~5 A USUAL RESIOENT I I CAPITAL C~TY, LARGE CITY 1 SMALL CITY . 2 TOWN 3 COUNTRYSIDE . 4 • 120 No, t22 123 QUEST IONS AND F ILTERS In which oblast is that located? Now I would like to ask about the household in which you usuaily live. What is the main source of drinking water for members of your household? CODING CATEGORIES ~BLAST: K~EZ~4SKAyA . NAVC~YISKAy~ . B I, JKHAR SKAyA. . KASHI<Jd~4~INS KAyA~ . SURKHAN~NSKAyA . SkMARKANOSKAYA . DZHJZA~SJ~,Ay~, . SYR DARLN~,KAyA . . . . . . . . . . . . . . . . . . TASHKENTSKAyA . NAI~t AN~SKAyA . F ~ R GANSK.AyA . . . . . . . . . . . O~B~ ~h~y PUBLIC TAP . . . . . L~ WA~ PUBUC K:~:~E/Y'~D/I:'LOT . R IVER/~TREAM F~)ND/~AKE , . 3K . . . . . . . 0t 02 03 04 • 05 . 06 . 07 • 08 o9 . 10 11 12 13 96 ~3E/YARD/ f! 21 22 31 32 33 34 41 51 6~ SKIP J ,25 ;25 OTHER [SPECII~r) 124 How Io¢~g does tt take to go there, get waler, and come back? M=NUTES . . . . . . . . . I ] I ] ON PREMtSES . . . . . . . . 125 What kind of toilet facility does your household have? 126 127 128 Does your household have: Electricity? A radio? A television? A telephone? A refrigerator Could you describe the main material of the floor of your home? Does any member of your household own A btcyole? A motorcycle? A car? FLUSH TOILET OWN FLL~H TC~LET . . . . ~1 SHARi3D FLLiSH TO4 LET . . . . . . . 12 PiT TI~LET/LATRIN E ~DmONAL TyPE . . . . . . 2 1 ~M PROVED - VENTiLATIED 2 2 NO FACItJ~f ( BLiSH/R EtD) . . . . . 31 OTHER 96 (SPECIFY) YES NO E~ECI~F~C~Ip~ . . . . t 2 RADIO . ~ 2 T~SiON 1 2 TELEPHONE t 2 REF~GERATOR . 1 2 NATURAL FLOOR EARTH/*~LAN D . 1 1 TEZEK 1 2 RUI~ MENTARY FLOOR WOOD PLANKS 2 1 STRAW/SAWDUST . . . . . 2 2 RNISHED FLOOR PARC4JET OR POUSHED WOOD 31 UNOLEUM OR A,~PHALT . . . . 32 C~AMJC TILES . . . . . 33 CEMF3NT . . . . . . . 34 CARPE~ . . . . . 35 OTHE~ 96 (SPECIFY) YES NO B)£,~tCLE . 1 2 MOTORCYCLE I 2 CAR . . . . . 1 2 O~ No 201 202 203 204 205 206 SeDtion 2. PREGNANCY H ISTORY QUESTIONS AND FILTERS Now I would like to ask you about all the births you have had during your life Have you ever given birth? Do you have any sons or daughters to whom you have given birth who are now tiving wfth you? HOW many sons live with you? And how many daughters ~ive with you? IFNONERECORD00" Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE RECORD 00' Have you ever given birth to a boy or a girl who was born alive but later died? ~F NO, PROBE Any baby who or days? CODING CATEGORIES YES NO YES NO f 2 Fqq SONS AT HOME ~ 1 ~ LU DALK~HTERS AT HOME YES NO cried or showed signs of l ife but survived only a few hours SONS ELSEWHERE D~UGHTERS ELSEWHERE YES . . . . . 1 NO . . . . . 2 1 I SKIP 2 ~206 I L 204 ~201 2O8 I 207 How many boys have died? How many girls have died? BOYS DEAD . . . . . . I GIRLS DEAD 208 SUM ANSWERS TO 203, 205 207, AN D ENTER TOTAL IF NONE, RECORD '00' TOTAL BIRTHS I-R ~o 20g Women sometime have pregnancies which do not result in a live born child, That is, a pregnancy can ended very early by a mini abortion or by an induced abortion, a miscarriage or a stillbirth. In total how many mini abortions, and induced abortions have you had? 210 How many miscarriages? I 211 How many stillbirths? 212 SUM ANSWERS TO 208 209 210 211 AN D ENTER TOTAL IF NO PREGNANCIES. RECORD '00" CHECK 212 ONE OR MORE 0REONANC¥ T~T~ A~T~S I-R TOTAL MISCARRIAGES TOTAL STILLRIRTHS . . . . . TOTAL PREGNANCIES ~ ' ] NO PREGNANCIES~'~ ) 227 ! 214 Now I wa~t to talk to you about each of your pregnac0es, including those which ended in a live birth, an induced abortion, a miscarriage, and a stillbirth. Starting with your last pregnancy, please tell me the following information o-q MON I]d yEAR MON ~c~ YEAR 215 ~/hen did your :last/next to-last~ ~tc) pregnancy ~nd? In what 3~onth and year? MON~r~ o-q MONTH YEAR 216 Did this pregnancy end in a live birth, an induced abortion, a m~scarnage, or a s t i l l b i r th? UVEBiRTH 1 LNDUCEDABORTION 2 M;SCARRIAGE 3 STILLBIRTH 4 LIVE B~RTH 1 INDUCED ABQRTION 2 MISCARRLAGE 3 ST~LLBIRTH 4 LIVE SIRTH 1 INDUCED ABORTION 2 MISCARRIAGE 3 STILLBII~rH 4 UVE BIRTH 1 INDUCED ABOF~ION 2 MISCARRIAGE 3 StqLLBIRTH 4 217 FROM YEAR OF LAST/NEXT TO THE LAST, ETC PREGNANCY SUBTRACT YEAR OF PREVtOUS PREGNANCy IS THE DIFFE- RENCE 4 QR MORE? TRY TO DETER MINE IF THERE WAS ANOTHER PREGNANC~ BETWEEN THIS AND PRE- VIOUS PREG NANCY YES 1 I NO 2 YES 1 I NO 2 YES 1 NO ! i NO 218 CHECK 2~6 RECORD SAME RESPONSE IVEBiRTH 1 INDUCED ABORTION4~ IMISCARRIAGE 3 STILLBIRTH 4 ~[xz V~[G~A~Cy UVE BIRTH 1 ~NDUCED AeQRISON 2q MtSCARRIAGE 3 STILLBIRTH 4 Ntxl p~EG~A~C~ • 219 Was this a single or a multiple blrtt~? SING 1 MULT 2 SING 1 MULT 2 SING 1 MULT 2 220 What name was g iven to this child? NAME NAME IS (NAME) a boy or girl? E~Qy 1 GIRL 2 8Oy f GIRL 2 BOY 1 GIRL 2 22 is (NAME} still alive? YES 1 NO 2 L224 YES 1 NO 2 L224 223 How old W~S (NAME) on his/ her last b i r thday? RECORD AGE IN COMPLETED YEARS AGE IN YEARS LIVE BI F(I H 1 IN DUCED ABORTION 2 4 MLSCARRIAGE 3 STILLBIRTH 4 UVE BIRTH 1 INDUCED ABORT]ON~ MISCARRIAGE 3 STILLBIRTH 4 N~XT pREGNANCy SiNG 1 MULT 2 NAME NAME BOy 1 G~RL 2 I YES 1 NO 2 L224 YES 1 NO 2 L224 AGE iN YEAR,S AGE ~N YEARS AGE IN YEARS 224 How old ~as (NAME) when he /she d ied? IF "1 YR ', PROBE How many month5 o )d was INAME}? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS. OR YEARS MONTHS yEARS DAYS 1 ~ MONTHS 2 YEARS 3 DAYS 1 ~ MONTHS 2 yEARS 3 DAYS . 1 J J J MONTHS 2 YEARS . YEAR yF~R ~ LIVE BIRTH . 1 INOUCE~ ABOR~GN 2 M~SCARRIAGE 3 STILLBIRTH 4 LIVE B~RTH . 1 iNDUCED/iBO~RlrlC~d 2 MtSCARRtAGE 3 SllLL~RTH . 4 NO 2 YES I i NO 2 J UVIE ~RIH I I tNDLICED~BO~tOht 2~ MISCAF~ZAGE 3 S~LLB&RTH . 4 hEXT ~'REaNAIdC~' • ! UVE BIRTH 1 INOUCED AIBOR~ON 2-- MISCARRIAGE 3 STI/U31RTH 4-- mxr P~EONANCV • SING . 1 MULT . 2 ~NG 1 MULT . 2 NAME NAME MONTH INDUCED ABORT3ON 2 MISCARRIAGE 3 STILLI~RI~ 4 UVE BIRTH 1 MONTH J J J iNDUCED ABOFTTION 2 MISC.ARRIAGE 3 STILL~RTH 4 YEAR YES 1 NO 2 yES 1 NO 2 UVE ~qR~r t . *~ INDUCE~O AEIO~TtON 2~ MISCARRIAGE 3 S~LLBIRTH . 4 NEX] PREGN~*NCV • LIVE BIRIH 1 tNOUC, EI3 ~BORT~ON 2~ MISCARRtAGE 3 STtLLB~RTH 4 NEX~ PAEONANCV • SING 1 MLILT 2 SING 1 MULT 2 NAME NAME BOy . ~lRt. . ~oy. ~IRL ~Oy ~IRL 1 YES . 1 2 NO 2 ~224 YES 1 2 'NO 2 ~Z24 IYES NO 2 I ~224 1 YES t 2 NO 2 ~224 AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS DAYS . 1 I l I MONTHS 2 YEARS . 3 I-"1--I DAYS 1 MONTHs 2 YEARS 3 DAYS 1 ~ ~ ~ MQN' (~S 2 YEARS 3 MONTHS¸ 2 YEARS 3 MONT~ MONI~ yF~.R MON/~ MON~Pr] yEAR LIVE BIRTH 1 INDUCED ABORTIQN - - MISCARRIAGE 3 STILLBIRTH 4 - - LIVE BtRTH t INDUCED ABORTION 2 MISCARRIAGE 3 STILLBIRTH 4 - - UVE BIRTH 1 INDUCED ABORTION 2 MISCARRIAGE 3 STILLBIRTH 4 - - LIV~E. BI F~H 1 INDUCE]O ABORTION 2 MISCARRIAGE 3 S~ILLBIRTH 4 YES NO YES NO YES NO YES NO LIVE BIRTH 1 INOUCED ABORTION 2~ MI,SC.A ~IAG E 3 STILLBIRTH 4 ~xT P~E~N~NC, • L/VE BIRTH 1 INDUCED ABORTION 2~ MLSCARRIAGE 3 S~LLBIRTH 4 ~LXl r~EGNANC~ < LIVE BIRTH 1 IN DUCE]3 ABORTION 2~ MISCARRIAGE 3 STILLBIRTH 4 h[x l PnEGNANC~ • LIVE BIRTH 1 INDUCED ABORTION~ MISCARRIAGE 3 SI'ILLBIRTH 4 NEXT PREGNANCY SING MULT SiNG MULT SING 1 MULT 2 SING 1 MULT 2 1 NAME 2 1 NAME 2 NAME NAME BOY 1 GIRL 2 BOY 1 GiRL 2 80y 1 GiRL 2 BOy 1 GiRL 2 YES 1 NO 2 L224 YES 1 NO 2 L224 YES 1 NO 2 L224 YES 1 NO 2 L224 AGE IN yEARS AGE iN yEARS AGE tN YEARS AGE iN YEARS MONTHS YEARS MONTHS YEARS MONTHS 2 YEARS 3 DAYS 1 ~ ~ ~ FH MONTHS 2 YEARS 3 LIVE B~RTH . 1 YES . I NDUCED/~B(~CITK~N .2 NO . MISCARRIAGE . 3 ~;TLLB fRI~t . 4 ,,--r LP,'IE BIRTH . 1 INDUCED ,~BORTION.2 MISCJ~RRIAGE . 3 STNIBIR]11 . . . . . . . . 4 LIVE BIRTH . I IfdCHJCED ABORTION . .2 MISCARRIAC~E . 3 LIVE BIRTH . 1 INDUCED/~BORTION . .2 MISCARRIAGE . 3 STILLIB JR~I . 4 YES . NO . YES . I NO . YES . I NO . t3VF- BtRT~t . 1 INDUCED ABORTION , 2 ~ MISCAFrRIAGE . 3 STJU~B IFITH . 4 NEXt PRer=N;,~C,~ • LIVE BIRTH . 1 tt,~UCED AB(~T~I 2 - MISCARRL&GE . 3 STILLBIRTH . 4~ BIRTH . 1 INDUCED ABORTION 2 ~ MISCARRIAGE . 3 STNJJE~I R~-I . 4~ N~XI PREBNANC~ K LIVE BIRTH . ,t INDUCED AB~TION 2 MISCARRIAGE . 3 STILLBIRTH . 4-- NEXT PREGN=NC~ • SING . I MULT . 2 S IN ~G . . . . . . . . 1 Mt~.T . . . . . . . . . . 2 SING . I MUI-T . 2 ~tNG . . . . . . . . . 1 MULT . 2 NAME NNME N'~ME 5OY . ~ YES . 1 31RL . NO . L 2224 3OY . t ~RL . |OY . 1 ;4RL . IBOY . GIRL . W E YE~ . NO . L224 YES . NO . ~22~ 1 YES . I 2 NO . 2 L224 AGE IN YEARS 218 • AGE IN YEARS AGE IN YEARS AGE IN YEARS DAYS . 1 ~ MONTH6 . 2 YEARS . 3 MONTfi~ . . 2 ~¢ARS . 3 225 CAMpARE 212 WITH TOTAL PREGNANCIES IN pREGNANC Y HISTORY IN QUESTION 215: t4'dMBERS AIRE THE SAME ~ NUMBERS ARE DIFFERENT i I r (PROBE AND RECONCILE) CHECK; Q215 FOR EACH pREGNANCy: YEAR OF PREGNANCy ENDED IS RECORDED. 0223 FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED Q224 FOR AGE AT DEATH I 2 MONTHS OR 1 YEARL PROBE TO DETERMINE EXACT NUMBER OF MONTHS. 226 CREEK 215 AND ENTER THE NUMBER OF PREGNANCIES ENDED SINCE JANUARY 1993 J I I I iF NONE. RECORD '0' K) No 227 228 229 229A 230 QUEST IONS AND FILTERS Are you p~egnant now? How many months pregnant are you? AECORD NUMBER OF COMPLETED MONTHS At the time you bec.ame pregnant, did you went to become pregnant then. d~ you ~,~nt to wait until Ij~t~, or did you not w~nJ to become pregnant at all? At w~at age d~ you have your first menstrual period? When did your last menstrual period start? (DATE, ]F GIVEN) COD{NG CATEGORIES N~Ct . . 2 q MONTI~ . SKIP • 22~ 230 A For how many days your menstrual cycle lasts? DAYS . I ~ | | | 230B Is the time between your menstrual cycle regularor irregular? REGULAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 IRREGULAR . 2 I , J DAYS AGO . . . . . . . . . . . . . t . . . WEEKS AGO . . . . . . . . . . . . . . 2 MONTHS AGO . 3 . YEARS AGO . 4 iN MENOPAUSE . . . . . . . . . . . . . . . 994 BEFORE LAST B IRTH . . . . . . . . . . . . 995 NEVER MENSTRUATED . 996 THEN . . . . . . . . . . . . . . . . . . . . . . . . 1 I LATER . 2 I I "°T AT ALL . . . . . . . . . . . . . . . . . . i i NEVE~ I~RUATED . 9~ • 231 EX)N~r KNOW . . . . . . . . . . . . . . . . . . . 98 t~ C~ 230 C 23OO 2"30E 231 232 For how many days your menstruations usually last? Are your menstrual flows usually light, heavy or normal? Do your menstruations usually occur Without any pain, with little pain, or very painful? Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant then other times? DAys . I-1-1 UGPIT . 1 NORMAL . 2 PIEAV~ . 3 1 . . . . . . . . . . . . . . . . . . . . 3 YES. • . NO . . DON*'[ . . . . . . . . . . . . . . . :7 During which times of the monthly cycle does a woman have the greatest Ghance of becoming pregnant? DURING HER PERIOD . . . . . . . . . . . . . . 0 t RtQ~-~T AFTER HER PERIOD HAS ENDED. . , 02 IN THE MIDDLE OF THE CYCLE . ~.3 JUST BEFORE HER PERIOD BEGINS . 04 OTHE~ (SPECIFY) g 6 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 9B "301 t-J Section 3. OJ~_TCOME OF PREGNANCIES OU I CHECK 226 ONE OR MORE PREGNANCy [ ~ NO PREGNANCy SINCE ~ ~ S I N C E JANUARY Tgg~ ~ JANUARy 199.) tJARY 1994 IN THE TABLE, (IF THERE ARE MORE THAN FOUR PREGNANCtES, USE AE)DITIONAL QUESTIONNAIRE) Now I would like to ask you some questions about ti le pregnancies you have had irl the last three years. UNE NUMRER FROM E~ ~15 LA'~T PR E(.3NAIVC y NEXt -TO -THE Lt~ST pREGN.,~N Cy N~(] *~O.NEX[ =TO THE LAST P~EGN LINE NUMBER . LiNE NUMBER . LINE NUMBER . 30~ SEE Q 216 AN{] 220: OUTCOME OR NAME OL~COME O~R t4AME OUTCOME OR NA~ OUTCC~ E OF PR EG NANCy OR THE NAME OF CI{~LD 304A , I I I i 305A 306 306A When dur ing your p regnancy d id you learn that you are pregnant? At the t ime you became pregnant (w i th NAME) , d id you want to become pregnant then, did you want to wa i t unt i l l a te r , or d id you want no (mo je ) ch i ld renmat al l? How much longer wou ld you l i ke to have wa i ted? At the t ime you became pregnant , were you using a method of contracept ion? Which method? CHECK 304: OUTCOME OF PREGNANCY OAY~ . WEEKS . MONTHS . 3 I I I DON'T KNOW . . . . 998 Tt tE~4 . . . . . . . . . . . . . . . . . ] (~KIP TO 306A) ,( LATEA . . . . . . NO MORE . :3 (SKIP Tl~330FI~ ) • MONT.S . . . . . . . . 'i~2AR S • DON'T KNOW . . . . . . . . . . 998 YE~ . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 INKED ABOrTiON [ ~ 315A MISCARRIAGf . E ~ 32~ ST~LLBIRTN . . . . D q LIVE BIRTH . . . . . . I I - - ,=- I I~EKS . . . . . . M~IT HS . . . . . . [~N,I T KNOW . . . . . . . . g98 THEN . I (SKIP TO 306A) ~. - - LATER . 2 NO MORE . . . . . . . . . 3 (SKIP TO 306A1 ~E y~I : I S . . . . . . . . . . DONT KNOW . . . . . . . . . . . 9~8 YES . . . . . . . . . . I NO . 2 INDUCED A{]ORTEQN E ~ ~ :3 MISCARRIAGE . I ~ 25 LIVE BIRTH WEEKS . . . . . . . . . . . . Mg3N IHS . . . . . . . . D~'T KNOW . . . . . . ggB I XHEN . 1 ] (SKtP IrO 30E~I ~ t LATER 2 NO MORE . 3 (SKIP IC) 306A) • • E.sMON'"S . . . . . . . . . . OONrKNOW . . . . . . . . . . 99B YEN . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2 INDk~CED AB~N] ION [ ~ > 31 ~ MISCAn RIAGE . . . . . . . . . . ~ 3 2 5 NTILL~IRTII . . . . . . ~ ,~q uvT ,°T . . . . . . . . . • (SKIP TO 4~,81 N EJ~T-T O - N EXT*TO - N EXT -TO THE I.~ST PR[ LINE NUMBFR . . . . . OLq COME OR N~ME E~Ay6 . 1 WEEKS . 2 I MONTHS . 3 DON'T KNOW . 998 THEN . I = (SKip T(::~ 3 ~ • I LATEI~ . . . . . . . . 2 NO MORE . 3 YEARS MONTHS . . . . . . . . . . OONT KNOW . . . . . . . . . 998 yES . I fqO . . . . . . . . . . . . 2 M INDUC['U AeORIIOf4 . E ~ 315A MISCARRIAGE . [~'~325 ST]LLOIRTH . ~r~q LIVE BIRTH . I ~ ~07 308 309 312 When you were pregnant (w i th NAME) , d id you see anyone fo r antenata l c~e ~of th i s p regnancy? IF YES: Whom d id you see? Anyone e l se? PROBE FOR THE TYPE OF PEe~ONS How many months pregnant were you when you f i r s t rece ived antenata l care? How many t imes d id you rece ive antenata l care dur ing th i s p regnancy? Where d id the (b i r th o f NAME) / p regnancy te rminat ion) take p lace? HEALTH PRC~E,,~J~Z~ UEALTH i~[~OFFSSIONAL J~L~.~J.TJ~PJ~C~ION~I= PL~,~H PRC~F~SIONAL DOCTOR . . . . . . . . . . . . . . A DOCTOR . A IC~CTO R . A DOCTOR . A NURSE/MIDWIFE . . . . . . . . . . . . . . . B TRADITIONAL BIRTH . C REALTIVE/ERIEND . . . . . . . . D O 1HE~l X (~pEClFY) =NE . y (SKIP ~O 312) ~ I MONTHS . DON'TKNOW . 08 NUMBER . ~ ] DON% KNOW . 98 RESFONDEN~S HOME . 1 OTHER HOME . 1 . . . . . 21 NUBSE/MIDWIFE . I REALTIVE/FBIEND OTHE~ (SPECIFY) ( ~K IP TO 312} NUMBER . . . . RESPONDEN]~S HOME . 1 | OTHER HOME . 12 . ~5 ~UH~/MIU~PaPt . B ~MF~ICAL pERSONS C T~OITIOC*IA L BIRTH . C O REALTIVE/FRIEND . D X . . . . . . . Y *" M . 98 OON~ KNOW . 98 . 21 OBGYN HOSPITAl . 2 I HOSPITAL . 2 2 HOSPITAL . 2 2 HOSPITAL . . . . . . . . . . 2 2 I DC, CTOR'S ~SI STANT/MID~VIFE DOCTOR'S ASSISTANT/M$ D~NIF E DOCTORS ASSISTAN T/MID~**VIFE IP~C~T IFAP) . 23 POST (FAP) . . . . . 23 O1HER HEALTH FACIL fTY OTHER HEALTH FACILfTY 26 26 ( S F~t~CIFY) (SPECIFY) 96 OIHER 95 OTHER I~UFISE(ME)WIF~" NURSE/~I~F~ . B ~ONM EDICAL pERSONS TRADITIONAL BIRTH . C REALTNE/FRIEND . D OTH~ ~ O THE~ X (~PECIFY) (SPEC4FY) NO ONE . . . . . . . . . . . . . Y NO ONE . y c SKIP XO 312) < ~ ( SK*P TO 3,2) • MONTHS . i I ~ MONTHS . ['IlI ] DON'T KNOW . 98 - -Ea . . . . . . . . . . I -- I --1 .o - - . . . . . . . . . . . . . . I T1 ~N"r NNI2~ . . . . . . . . . . . . . . . . 98 I i RESPONDENTS HOME . 11 RESPONDENTS HOME . 11 OTHER HOME . t 2 OTHER HOME . 12 IN THE HEALTH FACILITY IN "~HE HEALTH FACIU TY I OBQYN HOSPITAL . 21 HOSPITAL . ~,2 I CC, C~O~¢ S ASStSTANT/~ E i POST (EAP) . . . . . . 23 POST (FAP) . 23 OTHER HEALTH FACILITY OTHER HEALTH FACIUTY (SPECIF~) 26 i (SpECiFy) 26 = (SPECtPC) (SPECIFY) LAST PREGNAI~Cy NEXT.TO.THE*L~T PRE(~NA NCY NEXT*II~. NEXT.TO IHE LAST PREEN NEXT TO- NEXT.TO.NEX~'.TO LAST PREO. O~JTCOME OR NAME OUTCOME OR N~ME OUTCC~M E OR NAME ~)UTE~OME O~ NAME 313 314 G% Who assisted with the (delivery of IN.ME)/ pregnancy termination? Anyone else? At the time of the (birth of (NAME)/ ending of the pregnancy), did you have any of the following problems: Long labor, that is, d id your regular contractions last more than 18 hours? Excessive bleeding that was so much that you feared i f was life threatening? A high fever with bad smelling vaginal discharge? Convulsions not caused by fever? Early rupture of amniotic f tu id sac? N~TOR . . . . . . . . . . . . . . . . . . B DOCTOR . . . . . . . . . . . . . . B DOnaTOR . . . . . . . DOCTOR . . . . . . . . . NURSE/MIDWIF E . . . . . . . . . . NURSE/MIDWIFE . . . . . . . NURSE/MIDWI F~ NURSE/MIDWIFE . . . . . . . . . I~'.~L~J.~L pERS~ J~N MEOI~L pE R~(~N ~ N ~ D~ C~L pERSON ~ M~ t~tC~[ ~F RS(3~ TRADITIONAL MIDWIFE . C TRADITIONAL MIDWIFE . C TRADITIONAL MIDWIFE f~ TRAI3~TIONAL MIDWIFE . RELATIVE/FRIENO . D RE~LATIVE/FRIENE) . . . . . . . . . . D RELATIVE/FRIEND £) REI ATIVE/FRIENI3 . OTHER pERSON X OIHE R pERSON X OTHE R I~ERSON. X OIliER PERSON (SPECIFYJ ( S~ECl F~f) (SPECIF~) (S PEGIF~') NO ONE . . . . . . . . . . . . . Y NO ONE . . . . . . . . . . . . . . . y NO ONE . . . . Y NO ONE . . . . . . . . . . . . y i I l I I YES NO yES NO yES NO yES NO LONG LABOR . . . . . t Z LONG LAQOR . . . . 1 2 ~ ONG L~BOF~ . . . . I 2 LONG I~B O ~ . I BI~EEDING . . . . . . . 1 2 BL EEOIN~ . . . . . . . . 1 2 RLEEDINO . . . . . . . . 1 2 BLEEDING . . . . . . . . . . . . F EVER/BAO SMELLING . I 2 FL~/ER/BAB SMELLING 1 2 FEVER/BAD SMEI I ING 1 2 FEVER/BAD SMELt tNG . 1 CONVULSIONS 1 2 CONVULSIONS . I 2 CONVULSIONS . . . . . . . . . . 1 2 CONVULSIONS . . . . . . . . . . . . 1 EArLy RUPTURE OF A]~ NIOTIC EARLy ~u~Tr URE OF ,t~%~ N IO] IC EJ~:~ L y ~UPTUR~ OF AJ~IOTIC E~3:~ Ly RUPTURE OF ~ NIOT~C FLL] tO~, ,a .C . : 2 FLUII~ SAC . I 2 FLUIE) SAC . 1 2 FLUID SAC . . . . . . . . . I 115 Was the (b i r th of (NAME) /pregnancy te rminat ion) by caesar ian sect ion? C~ ;15A 15B H6 }17 How did you determine you were pregnant? Who suggested you to do abortion? Wh~re w~,s the induced abor t ion performed? NO . 2 NO . . . . . . . . . . . . . . . . . . . 2 NO . ~ ~ . 2 i 3~3( / , 325( 3~( 325( = L NAw A [2~C~TOR . . . . . . . . . . . . . . . 1 SAW A ~ T O R . . . . . . . . . . . . 1 S~W A DOCTOR . . . . . . . . . . . . . . . I SAW A IDC~ON . . . . . . . . . . . . . 1 I CON~UCl~-D NEI~ pREGN TFST . 2 CON~)UCTED SEt~- pREGN TEST. 2 CONOUCTIED SErf PREG, N TEST. 2 N ~ O NEt~ ~R~*~ ~'EST , 2 D~C~ DED M~t~ELF BECAUSE OF ~ECIO~E) MY~ ELF BECAUS E (g~ (~ECII~. p MYSELF BECAL~ E 01- ~(-CI~E 0 M~r~ ELF B ECAL~ E OF MISSED PERIOD . 3 MISSED PERIOD . 3 M~SED PERIOD . 3 MISSED PERIOD . 3 OTHETt 6 O~HE~ 6 O~ER 6 OTHE~ 6 (SPECifY) ( Sl~EcIf~l (S~ECIP 0 I ,~F CIFfl HEALTH PREFESSIONAL . I HEALTH pREFE,~SIONAL . I HEALTH pREFESSIONAL . . . . . 1 HEALT H pROFESSIONAL . I HL~AND . 2 HL~BAND . . . . . . . . . . . . 2 HL~DAND . 2 HUSBAND . . . . . . . . . . . . . . 2 MOTH ER/MO~ -IN- LAW . 3 MOTHER/MOTHER-IN*LAW . 3 MOTHER/MOtHER *1N~ LAw . 3 M~ H~.R/MO3H~R~IN .L&W . FRIF~IDS/RE~T IV~ . 4 FRIENOS/REL~TIV~ . 4 FRIENDS/RELATIVES . . . . . . . . 4 FRIEN DS/REL.~.TIVES . . . . . . . . . . . 4 DECIDED HERSELF . 5 DECIDED HERSELF . 5 DEC~DEO HERSELF . 5 DECIDED HERSELF . 5 OTHER 6 O114ETI 6 O~HE~ 6 OTHER 6 (SPECIFY) (SPECIFY) (~EC*~) (SPECIFY) DON'T K~K~W . . . . . . . . . . . . . 8 DON~ K~OW . 8 DON'T KNOW . 8 DOn'T KI~K)W . 8 P~JBUC S.E.~ ~ L ~ ~E'CT~ 1 1 PUBUC SEC~r C~ PUBUC .%ECT ~ HO~pEAL . . . . . . 1 I H~pITAL . HO~PIT.~ L . . . . . . . . . . . 1 t p~PITAI~ . 11 P(~.~YCLINIC . I 2 P{~_yCLINIC . I 2 12 P~LYCLINIC . . . . . . . . . . 12 . pOlYCLINIC . AMB ULATC~Y . I 3 AMBULATORy . . . . . . . . . . . t 3 AMBU LATO~y . 13 AMBULATORy . 13 MOEqLE CUNIC . 14 M O~ILt~. G~LI~I~C ~._ ~ . 14 MOBILE CLINIC . 14 MO~ILE (~L~N~ . 14 Can you te l l me what procedure was used to te rmi~Dte the pregnancy? OTHER HFJ~LTH CARE UI PI~p~ H pJ,,L e M ~p;t- F ~-C~L ~TY 16 F'~C~L~Pf ] 6 (SPECIFY) (SPECIFY) PRWATIE SECTC*R f~WATF pRiVATE CUNK~ . . . . . . . . 21 PRtVATE CLINIC . 2t PRIVATE DOCTOR . ~ PRIVATE DOCTO~ . . . . . . . . . 2 ;~ O(~F=Rp~P4ATE=~ALT~ CADRE 26 O ~ R P~A~EH£J~L~'~ CARt 26 FACIU]~t ~ FACIL~ (SPECIFY) (SPECfFY) RpRJV~T~¢ pER SOI~Lf NC~ M ED~C~LJ 3 I pR~VATE pFJ:~SON IN~+,~ ME~JC~. 31 OTHER 96 OTHER 96 {SPECIFY) {SPECIFY} • I D&C . 1 [}&C. , 1 ASPIRA~'ION . . . . . . . . . . 2 ASpIp~TION 2 OTHER HEALTH CARE FACiLITy 16 (SPECIFY) ~Lt y~ATE SECTC~ pRt VATI~ CtJNIC . . . . . . . . . 2 I PRIVATE ~ T O R . . . . . . . . ~2 OTHER I:~NATE ItEAL~ C&R~ 26 FACILrr/ (SPECIFY b PRIVATE pER ~ p j ~ , ~ J 31 C2~'~f~ SPECIFY ~ 96 D&C . . . . . . 1 = - 2 Q X ~ HE~-TH C~.~ FACILIT~ t 6 {SPECIFY) PRIVATE SECT(~R p~IVATE CUNIC . 21 pI~V~.TE ~OCTOFt . 22 OT HtE R p'RIVAT E HEALT~ CARTE 26 FACfLrlY I~ECIFY~ PRIVATE~PERSON~ MED4C/M~ . 31 O3~'t E~ (SPECIFY) 96 D&C . . . . . . . . . 1 CAESA}~IAN SEL-~IION . 3 CAESARIA N SECTION . , 3 I CAESARIAN SECTION . 3 CAESARIA N SECTION 3 TRACTIONAL METHOD . 4 TRAD(TtONA L METHOD. . . . . . . . . . . . . . ' . 4 I TRADITIONAL METHOD . . . . . . . 4 TRA[~TIONA L MEIHOO . 4 OTHE3q OTHE~ O3~-iE]~ OTH~ 6 .6 .6 E, I (SPECIFY) (SPECIFY) I {SPECIF~I {SPECIF~) DON'T KNOW . . . . . . . . . . . . 8 DON, T KNOW . . . . . . . . . . . . . . . 8 I: DON' T KNOW 8 DON, T KNOW . . . . . . . 8 ~C L~T P~EGNANCy NEXT.TO.THE LAST pREGNANCY NEXT ]0- NEXT.TO THE LAST I~ItEG N OUTCOME OR NAME OUTCON~ E O~ NAME OUTCOME OR NAME I ~t8 DOCTOR . . . . . . . . . . A DOCTOR . . . . . . . . . A C<~C TO~ . . . . . . . . . . . . A rig 120 Who helped you to perform that procedure? Sorne~mes, a woman has health problems after an induced abortion. Did you ha~ any health probterns aftervrards? What health problems did you have: sterility? infection? lack of menstruation? irregular b~eeding? NURSE/MIIOWlFE . . . . . . . . B TRADITI(3NAL MIDWIFE C (SPECIF.f. j "X NO ONE . . . . . . . . YES . . . . . . . . . . . . 1 NO . . . . . . . . 2. DON'TKNOW . . . . B- INFECTION . . . . . . . LACK OFMENSTRUA~I IRREGULAR 8LEEOtN~ OTHER (SPECIFY) NURSE/MID~ SON (SPECIFY) NO ONE . . . . . . 326 • X OTHER (SPECIP~K) B . . . . C . 2-- 8~ . A . B . C . D . E X NURSE/MIDWIFE . B TRACTIONAL MIDW~FE . . . . . C O~}~ PER~N (SPECIFY) 'X NO ONE . . . . . . . . . . . . . . y YI:S . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . 2 DON'T ~Cf~(]W . 8 325 ~ItHILIIY . B INFECTION . C LACK OF MENSTRUATION . . . . . . . O IAREGULAR BLEEOIN~ . E OTHER X ISPECIFY) NEXT TI . A NURSE/MIDWII=E . 13 ($PlECtFY) X other? Did you seek care because of these complications? ~lZS. , , NO. . . . . . . . ~ NO. . I . . . . . . . . 1 . . . . . . . . . 2 . y VES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . 1 NO . . . . . . . . . . . . . 2 . 325 ~ PELVIC PAIN . A STER~LI'Pf . B INFECTION . . . . . . . . . . . . . . C LACK OF MEt~STRUATION . D IRREGULAR BLEEDING . E {SPECIFY) ~ N T KNOW . . . . . . . . . . . . . . . y YES,. . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . 2 t~ 323 322 324 325 Where did you seek care? E~,~UC S~EC~3 R PUBU C SECTO R ~JBUC SECTQR pUBUC ECTOR HOSPITAL . A HOSPITAL . A HOSPITAL . A HOSPITAL . A POLYCLINIC . pOLYCLINI C . pOLYCLINIC , , POLYCLINIC . , AMBULATORy . . . . . . . . . . . . . . B B . B . B AM~LA I'ORY . AI~BULATORY . AMBULATORY . MOBILE CLINIC . C MOBIL E CLINIC . C MOBILE CLINIC . C MOBILE CLINIC . C OTHER H EALTII CARE D OTHI~ H~ILT H CARE O OTH ~1 HEALTH CARE D OTHER HEALTH CA~E D FAC( UTY FAQUW FACIUW FAC4 UTY E E E E (SPECIFY) { SPECIF~f~ (SPECIFY) (SPECIR) pR~/ATE SECT(:~ ERIVATE S ECT(3~ pCiNATE SECTOR pRIVATE SECTC~ PRIVATE CLINIC . F PRIVAT E CLINIC . F pRIVAT E CLI I~C . F PRIVAT E CUNIC . F PRIVATE DOCTOR . (] O'{]'1FJR p RiVAT E HEALTH CJ~E FAC~ LPP( H ($PECIFYJ p~JVAI~E pFR.qt~N tN(3N MFrJlCAI~. ! OTHER K (SPECtFY) OT•ER p FACILITY (SPECIFY) PRIVATE pERSQNJ (SPECIFY) ~R E " ,, O pHIVA~ U~I~ . . . . . . . . . . . . . G OTHER pRiVA1]E HFJ~LTH CALVE FACILIW H H (SPECtFY) • ! PRIVATIF pERSON IN~M MEI~IC.~ . ! K OI"H~ K (SPECIFY) PRIVATE DOCTOR . O O~R~ER p~VATE HEALTH CARE FACIUW H (SPECIFY) pRiVATE pERSON tNON MFJ)EAI ~ . ! OTH~ K (SPECIFY) Have you been hosp i ta l i zed becau of these prob lems? How many days? e YES . NO . DON ¸ . ~ yE S , . I . . . . . . . . . I ~ 1 NUMB . . . . . . . . . . . . . 98 DON'T I 5 IN NEXT CCLIJMN, GOBAE NANCy, GO TO O 40t IFNON 325,( m . . . . . 08 yE~S . NQ . DC . ~ yEIS . . . . . . . . . . . . . . ~ . NO . 3~5'( I . . . . . . I T ] NUMBER . 98 DONT KNOW . 5 IN NEXT COLUMN GO BACK TO Q, 305 IN NE NANCy, GO TO Q.401 . lm . 2- m . . . . . 98 ,. Jub IN NB(T COLUMN IF NO MORE pREGNANCy, GO TO O.401 _Se_ction 4A. CHILD HEALTH AND _NUTRITION PRACTICES. 40~ CHECK 306A: , + + + + L+ +++ +o t+E +,~+ B,NCE +uA+ ,+~ I S$NCE J~NU&Ry 199:- / / I---I I LT~ ). {SKIp TO 458) i 40~ / CHECK 303 AND 306A; ENTER THE L4NE NUMBER FOR EACH LIVE BIRTH ASK THE QUESTIONS ABOUT EACH OF THESE BIRTHS BEGINNIN~ WITH THE LAST BIRTH (fF TP~ERP ARE MORE THAN ~ ntR7HS, U~E ADDJTJONAI OUESTJONN#~]RE) Now I would like to ask you some questions about your children born in the past three years. Let's talk about one child at a time. 4o+ + E + + + + • i LINE NUMBER . • LINE NUMBER . • 404 NAME FROM 304 I NAME NAME O 404A During your pregnancy with (NAME), did you have any of the following diseases? Anemia Heart or circulatory diseases Kidney diseases Liver or gastrointestinal diseases Lung diseases Normonal diseases YES NO 1 2 1 2 1 2 1 2 1 2 1 2 YES NO 1 2 1 2 1 2 1 2 1 2 1 2 ~04B CHECK 404A: YES . 1 ONE OR MORE RESPONSES "YES' NO . 2 (SKIP TO 405) • 404c During your pregnancy with (NAME) did you visit a health care facility for preventive care because of this illnesS:? I YES . . . . . . . . . . . . . . . . . . . I I NO . . . . . . . . . . . . . . 2 ISK IP TO 4O5) • J ( SKIp TO 405) "~FS . . . . . . . . . . . . . NO . . . . . . . . . . . (.~t(tp TO ,~OS~ . t I 2~ • II 404D What type of health care facility did you visit for preventive care? C OTHER (SPECIFY) 1 . 2 . 3 . 4 . 5 6 D~NW KNI~V . . . . . . . . . . . . . . . . . 8 | 405 When I~E~ was born, was he/she: pOLYCLINiC . I WOMEN'S CONSULTING CTR . 2 HOSP(TAL . 3 M~S~'~ICHAST . . . . . . . . . . . . . . 5 OTH~ 6 (NPECIP~I DON'T KNOW . . . . . . . . . . . . . . . . . . 8 VERY LARGE . 1 VERY LARGE . . . . . . . . . . . . . . . . 1 La, R GER THAN AVERAGE . 2 L.~RG ER THAN AVERAGE . 2 AVERAGE . 3 AVERAGE . 3 SMALL . 4 SMALL . 4 VERY SMALL . 5 VERy SMALL . 5 DON+T KNOW . B DeNT KNOW . 8 very large, larger than average, average, smaller than average, or very small? 406 Was (NAMEI weighed at birth? YEs . NO . . . . . . . . . . . . . . . . . . . . . . . (NKIP TO 40B) • I I 407 How much did (he /she) we igh? GRAMS CARD . . . . . . . . . . 1 RECORD VVIEIGHT FROM HEALTH C~: tD, IF AVAI~B~ ~ S RECALL . . . . . . . . . 2 ! 408 Was the length of (NAME) measured at b i r th? 409 YES . . . . . . . . . . . . . . . . . i .o ,s.,PTO.;i, . . f GRAMS CARl ) . . . . . . . . 1 RECALL . . . . . 2 What was length of (NAME) at b i r th? DON'T KNOW . . . . . . . . . 9~g8 [~ON'T KNOW . . . . . . . . . . . . . . . . 99998 I I I I ye S . I YES . 1 . o . . . . . . . . . . . . . . . . . . . . . . . . y .o . (SKIP TO 410) • (SKIP TO 4101 • l I I CB~METERS ~'] CEN~MErERS i ~ FROM CARD . 1 FRO M CARD . 1 CENTIM EF-J~S M CEJ~FfIMETERS r ~ FROM RECALL . 2 FROM RECJ~LL . . . . . . . 2 DeNT KNOW . 906 DON'T KNOW . . . . . . . . . . . . . . . . . 410 Has your period returned since the birth of (NAME)? LAST BIRTH | NEXT TO LAST BI~H NAME | ~ Y~S . . . . . . . . . . . . . . . . . . 1 (SKIP TO 412) ~ J NO . . . . . . . . . . . . . . . . . . . 2 (SKIPTO413) • I bJ h3 411 Did your period return between the birth of (NAME) and your next pregnancy? I 412 For how many months after the birth of (NAMEI did yOU nOf have a period? 413 414 Have you resumed sexual realtions since the birth ot (NAME)? 415 For how many months after the birth of (NAME) did yOU ~ have sexual relations? I 416 Did you ever breastfeed (NAME}? DON'T KNOW . 9B 98 PREG- OR ~ ~NURE (NKIP TO 415) 417 How long after birth did you first put (NAMe~ to the breast? IF LESS THAN I HOUR, RECORD 00 HOUR~ IF LESS tHAN 24 HOURS, RE( DAYS NO . . . . . . . . . . . . . . . . . . 2 (SKIP TO 416) • I I ONTHO . . . . . . . I - - F I ONTHO . . . . . . . . . I - - i - - DON'T KNOW . 9B DON'T KNQW . 9B I YES . . . . . . . . . . . . . . . . . . I yES . t NO . 2 NO . 2 I i (SKIP TO 422) • I (SKIP TO 422) ~ IM MEDIAIELy . . . . . . . . . . . 0Q0 IMMEDIATELy . : . 000 ~1 C)A YS, 2 DAYS . 418 CHECK 222: ALIVE L] NOTNJVE F'-- ] CHILD AUV~? (SKIP TO 420) 419 Are you still breast feedlng (NAME)? YES . . . . . . . . . . . . . . 1 (SKIP TO 423) • I NO . . . . . . . . . . . . . . . . . . . . . 2 AUVE [] NOTAUVE ? (SKIP TO 420) I f YES . . . . . . . . . . . . . . . . . . . . . . . . I (SKIP TO 423) • I NO . 2 420! For how many months did you breast feed (NAME)? F '~ ~]~ MONTHS . MONTHS . 1 I DON'T KNOW . . . . . . . . . . . . . . . ~ ~N~T KNOW . . . . . . . . . . . . . . . . ~ 421 Why did you stop breast feed ing (NAME)? MOIHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . . . . . . . . . . . 03 NIPPLE pROBLEM . . . . . . . . . . 04 NOT FNOUGH MILK 05 MOTHER W~KING . . . . . . . . . . . . . 06 CHILD REFUSED . . . . . . . . . . . . O7 W~NING AG~AGE TO NTOP . . . . . . 08 BECAME PREGNANT . . . . . . . . og S T ~,HIE D ~IN G CON I~AC EPTION 113 OTH~ (SPECIFY) MOTHER I L L/~A~K . 01 CHILD ILL/VVEJ~K . 02 CHILD DIED . 03 NIPPLE PROB Lt:M . 04 NOT ENOUGH MILK . 05 MOTHER WI~I K IN~ . . . . . . . . 0~ CHILD REFUSED . . . . . . . . . . . . . . 07 WEANING A~F~AGE TO STOp . 0B N ECAME pREGNANT . . . . . . . . . . . . 09 ST~' tTED ~A~ ING CON~AC E I~g lON, , 10 OTHEI~ 96 (~PECIFY) 422 CHECK 418 LAST BIR'n~ NEXT =TO.LAST BIRTH NAME NAM E (SKIP TO 425J (GO BACK TO 405 (SK(p TO 4~ (00 BACK TO 405 IN NEXT COLUMN IN NEXT COLUMN OR IF NO MORE B~RTHS. GO 10433) BIRTHS "c 423 424 425 How many times did you breastfeed last night between sunset and sunrise? IF ANSWER I~ NOT NUMERIC PROBE FOR APPRO)~MA~ E NUMBER NUMBER OF N~P~rnM E M FEEDINGS . NUMBER OF NIGPa33ME FEEDINGS . . . . . . . . NUMBER O~ NUMBER OF How many times did you breastfeed yesterday during the daylight hours? DA~rlIME M DAYTIME FEEDINGS . FEEDINGS . IF ~'~ SWIF R I s NOT NUMERIC, PROBE FOR APP~OYJMATE NUMBER I I Did (NAMEr drink( anything from a bottle with a nipple yesterday or YES . ~ YES . last night? NO . 2 NO . 2 DONT KNOW . B DONT KNOW . B 426 At any t me yesterday or ast night, was (NAME) given any of the following? Water (boiled and not boiled)? Sugar water? Juice? Tea? Baby formula? Milk products (fresh, powdered, tinned milk)? Fermented milk (kefir, air'an, kumys, yogurt)? Any other liquids (soup6, coca-cola, etc.)? Fruits and vegetables? Any food made from wheat, rice, maize, such as bread, noodles, pasta, etc.? Any food made from potatoes, carrots, or tuber?. Eggs, fish, poultry?. Meat (lamb, beef, ham, horse meat, etc.)? Sweets, chocolate, cookies, etc.? Any other solid or semi-solid foods? - - I 427 CHECK 426; FOOD OR U(~JID CJVE N YESTEROA'~ ;~'30 I (Aside from breastfeeding,) how many times did ( ~ ) eat yesterday, including both meals and snacks? IF 7 OR MORE ~MES, RECORD T YES NO IDK WATER . . . . . . . . . . . . . . . 1 2 8 SWEET WATER . 1 2 S JUICE . 1 2 B TEA . t 2 8 BABy FO~%qUZ~ . 1 2 B MILK . 1 2 [I FIERM ES~ITED MILK . 1 2 8 O~Efl UQUIDS . 1 2 O FRUIT~ AND VEGETABLES.1 2 8 pASTA N*IO FOOD MADE FROM C.RNN . .I 2 8 PQTATOE AND TUBER . 1 2 8 EGG/IFtSH/POULI~y . T 2 8 MEAT . 1 2 8 SV~rS . . . . . . . . . . . . . . I 2 e OTHER SOUD OR SEMI- SOLID FOODS . 1 2 8 WATER . 1 2 8 SWEET WATD~ . . . . . . . . . 1 2 8 JUICE . 1 2 8 TEA . 1 2 8 B/~y F ORI~AJ~ . 1 2 B MILK . 1 2 O FB~MENTED MiLK . 1 2 O OTHER U(2~p, D6 . . . . . . . . I 2 8 FRUITS AND VIEEiErABLES. | 2 8 pASTA ~**tO F(~) 14AJ~E F~OM GRAJN | 2 B POTATOIE AND TUB~ . . . .1 2 8 EG(~I/FISH/T:'OUL~Y . I 2 B MEAT . 1 2 8 SWEETS . 1 2 8 OTHER ~LID OR SEM4* SOLID FCOOS . I 2 8 n No E; TO ONE TO ONE TO ALL OF( MQRE OR MORE (SKIP TO 43T )) (SKIp TO 431 )) [ I I D E] NUMBER OF TIMES . NUM I~E~FI OF MES . DON'T KNOW . 8 I~ONT" KNOW . 8 i DIM = rl NEXT _TO .LAST BIRTH NAME NAM E t~J O~ 31 32 On how many days during the fast seven days was (NAME) given anyof ~he foUo.~g? Water? Milk and fermented milk products? Any other liquids? Fruits and vegetables? Any food made from wheat, POe, maize, such as bread, noodles, pasta, etc.? Any food made from potatoes, carrots, or tuber? Eggs, fish, poultry? Meat products, ? Any other solid or semi-solid foods? MILK • . EGG~/'FISHj MEAT . ~DS ~ OR • • FOODS E~YS i WATER . MILK I OTHE R LIC4JIOS i FRUITS AND Vt'GI PASTA ~IO GRAI i pOTATO(E AND O ] I FRUITS AND V~'G~--CTAIB LE S . , . N . EGG~/FIS H/POULTRy . MEAT . OTHER SOLID OR . SEMI-SOUD FOCOS GO BACK TO 405 IN NF~T COL/JM N; C~ BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTH~, GO TO 433 OR IF NO MORE BIRTHS, GO TO 433 Sect ion 4B . IMMUNIZAT ION AND HEALTH 4 3 3 CHECK 403. 404 AND 418: ENTER LiNE NUMBER FOR EACH U~IE BIRTH SINCE JANUARY 199~1N THE T,~BUE. INO(CAIE WHETHER THE CHILD IS ALIVE (~( NOT ALI~I~. ~K THE OUESllON S ABO~T EACH OF THESE BIF~HS BEGINNING WITH THE LAST BIRTH+ (IF ~'-~ ERE ~IE MORE THAN 2 ~IRTHS. U6E AD~IONAL QUESllONNAIRE), I I, I I 4 3 5 N/liE FROM 404 NAME NAME SURVIVORSHI p STATUS FROM 418 (GO TO Q 435 IN (G,O TO O 435 IN NEXT COI-Lq~N NEXT COLUMN+ I~ GQ TO 45~). 436 437 Do you have a card where (NAME'S) vaccinations are written? =F YES: May I see it please? Did you ever have a vaccination card for (NAME)? f YES, SEEN . 1 ~ I ~yE~ t SEEN 1 (SKIP TO 438) ~ / 1 (SKIP TO 438) • I yES, NOT SEEN . 2 YES, NOT SEEN . 2 (SKIP TO 440) . o c~o . . . . . . . . ~ . 31 (SKLP TO.O) < I MO CARO . . . . . . . . . . . . . . . . . . . 3 YES . I (SKIP TO 440) • l NO . 2 l rE~ . . . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 440) 2 J NO . J Oo 438 ~39 ( 1 ) COPY VACC (2) WRITE I~ II BC G (IM M UNIZATIO N AGA]NST TUB ERC ULOSI S ) BCG I MANTU PROE4E (1 2003 DILLrnoN) MANTU I IMMUNIZATION AGAINST PO[ IOMyELITIS: OF,~t 0 POLIO 0 (AT THE HOSPITAl I OPVt . POLIO 1 OPV2 . pOLIO 2 • OPV3 . POLIO :3 POLIO 4 POLIO 5 I )PT /DT 1 DPT/OT 2 E~IA, pERTUSSIS TETANUS (DPTI; [DI) DPT/'DT 3 DPT-DT 4 OPV5 • D1 • 02 D3 . D4 iMMUNIZATION AGAINST M E.&8 LES . . . . . . . . Has (NAME) received any vaccinations that are not recorded on this card? RECORD ~S ONLY IF RESPOND~T ME.tONS BC~, POLIO $ . 5, DP~DT 1 . 4, AND/OR M~S{ F~ VACCINE(S) DAY M(31~rrH YEAR DAY MONIH yEAR YES . 1 _ CES . I (PROBE FOR VACCINATIONS, C-Q • (pROBE FOR VACCINATIONS, GO ~[ 7 BACK TO 438 AND WRI~ "6@. IN THE BACK TO 438 AND W~RI]~_ ,~, IN THE CORRESPONDING DAY COLUMN ] CORRESPONDING DAy COLUMN ] 1DON'T KNOW . 8~ 3ONT KNOW . 8 (SKIP TO 442) • (SKIP TO 4"12) ,( 40 41 41A 41 41C 41D 41 41 41C NAME Did (NAME) ever receive any vaccinations to prevent him(her) from getting diseases? Please tell me if (NAME) received any of the following vaccinations: A BCG vacc inat ion aga ins t tuberculosis, that i s , an in jec t ion in the arm or shou lder that [e f t a scar? Po l io vacc ine , that is d rops in the mouth? How many t imes? When was the f i r s t po l io g iven , jus t a f te r b i r th o r la te r? DPT/DP vaccination, that is, an injection usually given at the same time as polio drops? How many times? An in jec t ion to prevent meas les? YES . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . 2 (SKIP TO 442) • 8 YES, I 2 6 YES . NUMBER OF TIMES . [ ] 1 2 . . . . . . . . . . . 8 YES I NO . 2 (S'~P TO 441 G) • IW . . . . . 6 R YES . 1 . 2 OON'T KNOW . 8 ~ ~10 . . . . . . . . . . . . . . . . 2 {NKIP TO 4421 . 8 - 1 NO,,, 2 8 YES . I NO, , , 2 . (SKIP TO 441E) DON'T KNOW 8 - NUMBER OF TIMES . [ ] JL~T AFTER BIRI~ . 1 LATER 2 :)W 8 YES . . . . . 1 NO . . . . . . 2 (SKIP TO 441 G) ~ - ~ 3W. 8 -- [] YES . t NO. 2 DON'T KNOW . . . . . . . . 8 442 Has (NAME) been i l l w i th a fever at any t ime in the las t 2 weeks? yES . . . . . . . . . . . . . . 1 i yE S . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . 2 i DONor I(NOW . . . . . . . . . . . . B DONOr KNOW . B II I I 443 Has (NAME) been i l l w i th cough a t any t ime in the las t 2 weeks? YES . . . . . . . . . . . . . . . . . . . . . I I YeS . . . . . . . . . . . . . . . . . . . . . . . . ,.~ . 2 7 I (SKI p TO 447} • / ! DON'T KNOW . I i 1 444 YES When (NAME) was i l l w i th cough, d id he /she breathe fas ter than usua l w i th . shor t , fas t b reaths? NO . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . 8 | I I 445 YES 1 Did you seek adv ice or t reatment fo r the cough? . . . . . . . . . . . . . . . . . . . . . . . . . 446 O Where d id you seek adv ice or t reatment? Anywhere e l se? NO . k~- (SKIP TO 447) • FIJBIJ C SECTOR HOSPII'AL . A . 2_ (SKIp TO 447) 9[ i DON'T KNO~/ . B- I YES . . . . . . . . . . . . . . . . . . . . . 1 NO . 2 DON'T ~NOW . . . B ~ES . . . . . . . . . . . . . . . . . . . 1 NO . '3 (SKIP TO ,1~7) • | I PUBLIC SECTOR H~SPITAI . A MENTIONED. FOLYCLINIC . B pOLYCLINI C . . . . . . . . . . . . B AMI~ ULATC~y . C AMBULATORy . C pHARMACy . O pHARMACy . . . . . . . . . . . . D FAP . E FAp . E OTHER PU~UC HFJkL*r H FACIU~ O~HER pUeUC HEALTH FACILITY F F {SPECIFY) (SPECIFY) PRIVATE HEALTH SECTOR PRIVATE HEALTH SECTOR PRIVAT~ CLJN)C . . . . . . . . . . . . ~ P f~IVATE CU NIC . (~ PRIVATE pHARMACy . H PRIVATE PHARMACy . H pRIVATE DOCTOR . i PIalVAT E DOCTOR . . . . . . . . . . . i O~ER PRIVATE HEALTH FACILITY J . . . . . . . K [NON MEDICAL) • X (SPECIFY) OTHER (SPECIFY) OTHER pFJ VATE HEALTH FAClUTY J ($PEClF~() OTHER pRiVATE SHOP . K pRIVATE pERSON (NON MEQICAL I L OTHFj~ X (SPECIFY) 447 Has (NAME) had diarrhea in the last two weeks? 4 4 8 Was there any blood in the stools? l 4 4 9 On the worst day of the diarrhea, how many bowel movements did (NAME) have? | 4 5 0 Was he/she given the same amount to drink as before the diarrhea, or more, or less? = 4 5 1 Was he/she given the same amount food to eat as before the diarrhea, or more, or less? | 452 Was (NAME) given rehydron, fluid made from a speciat packet to drink? I 453 Was anything (else) given to treat the diarrhea? I 454 LAST BiR1]I NEXT -TO - L/~T 61R "i'~ NAME NAME Whet was given to treat the diarrhea? Anything else? RIECORD ALL ME~ITIONED YES . . . . . . . . . . . . . . . . . . . . . . . t yES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 " N O . 2 7 J (SKIP TO 457) • (SKIp TO 457) • DON'T KNOW . 8 - DON'r KNOW . i B ' 1 ' YES . . . . . . . . . . . . . . . . . . . . . . 1 yES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 ~ . . . . . . . . . . . . . . . . . . . . . . 2 DONOr KNOW . . . . . . . . . . . . . . . . . . . . B DONOr KNOW . 8 | I DON'T KNOW . . . . . . . . . . . . . . . . . . ~ DON'T KNOW . . . . . . . . . . . . . . . . . . g6 I | I SAME . 1 S/~IE . 1 MORE . . . . . . . . . . . . . . . . . . . . . . . 2 MORE . . . . . . . . . . . . 2 UESS . 3 LESS . 3 DONor KNOW . (I DONOr KNOW . 8 | | I SAME . . . . . . . . . . . . . . . . . . . . . . . 1 S l~,k IE . . . . . . . . . . . . . . . . . . . . . . . 1 MORE . 2 MORE . . . . . . . . . . . . . . . . . . . . . . . 2 LESS . 3 LESS . :3 DONT KNOW . 8 ~ KNOW . . . . . . . . . . . . . . . . . . . 8 I l I ~ES . 1 YES . 1 NO . . . . . . . . . . . . . . . . . . . 2 NO . 2 ICX~N'T KNOW . . . . . . . . . . . . . . . . . . 8 DON'T KNOW . . . . . . . . . . . . . . . . . . 8 | | I YES . t ~IES . 1 NO . 2 -= NO . 2 (SKIp TO 455) • '~ (S KIP TO 455) • |! J J DON-r KNOW . 8 DON'T KNOW . IS I I RECOMMENDED HOME FLUIC~ . A RECOM MENDED HOM~ F L ~ . A P'~LL~ UH b,HUP" . B tNJECTION . C (I.V.) INTRAVENOUS . D HOME REMEDIES/HERBS . I~ OTHER X (SPECIFY) PILLS OR SYRUP . . . . . . . . . . . . . . . . B INJECTION . C (I.V } (NTRAVENOUS . ,O HOME REMEDtES/PIERBS . I~ OTHER X I SPECtFY) ha ho I'J 455 456 Did you seek advice or t reatment for the diarrhea? Where did you seek advice or treatment? Anywhere else? RECC YES . . . . . . . . . . . . . . . . . ~ yES. NO . 2 7 NO (SKIP TO 457} • j IS½ DONT KNOW . . . . . . . . . . B J DON, ] PUBUC SECTOR PUBU, HOSPITAL . A POLYCLINIC . B AMBULATOR Y . C i AME pHARMACY D FAP . . . . . . . . . . . . . . . E OTHER PUBUC H ~J~ L~ PI FAC~UTY F (SPECIFY) PR {VAT F HF~.LTH SECTOR PRIVA . . . . . . . . . . . . . . . . t . 2 HOSPITAL . A POLYCLINIC . B AMBULATORY . C PHARMACy . D FAP E OTtt~R e UE] U~, IIF~[ TI I EA~LIIY F [SP[CIFY) TE H'~AL1 H SEC IC.R . G . G PRIVATE pHARMACy H PRIVATE PHARMACy . H PRIVATE DOC T OF1 . . . . . . . . . i PR~MATE DOOTO~ . . . . i OTHER PRIVATE HEALTH FACIUI~ ~ OI~ER PRIVATE HEALTH FACIU i~( J J (SPECIPi'} (SPECIFY) OTHER PRIVATE OTHER pR IVA~E SHOP . K SHOP . K PRIVATE PERSON (NON MEDICAL) L pRIVATE PERSON (NON MEDICAL) L E]~E R X OTIIrR X (SPECIFY) {SPECIF~f} ~. 5 7 GO ~3ACK TO 435 IN NEXT COt L~MN; GO BACK TO 43~ IN N~XI COLUMN; OR. IF ~ MORE BIRTHS, GO TO 4 5 8 OR IF NO MORE BIRTHS, GO TO 4 t~ NO. QUEST IONS AND F ILTERS CODING CATEGORIES 458 When a child has diarrhea, should he /she be given less to drink than usual, about the same amount, or more than LESS TO DRINK . . . . . . . . . . . . . . . . . . . . . . 1 usua l? ABOt 2 . 3 i DON'T KNOW . B LESS TO EAT . . . . . . . . . . . . . . . . . . . . . . . . . . . . t 45 g When a child has diarrhea, should he /she be given less to eat than usual, about the same amount, or more than usual? 2 3 I DON'T KNOW . 8 4 6 O When a child is s ick with diarrhea, what signs of il lness would tell you that he or she should be taken to a health REPEATED WATERY STOOL . A STOOL B facility or health worker? ! REPEATED VOMITING . C 461 463 When a child is sick with a cough, what s igns ot illness would tell you that he or she should be taken to a health REpEAlrED WATERY STOOL . A REPEATED VOMITING . C D BLOOD IN STOOL . . . . . . . . . . . . . . . . . . . . . . . . . E HIGH B RE F MARKED THIRST . G 2/I H NOT GETTING BEr[ER . J OTHER (SPECIFY) DON*T KNOW . . . . . Z FAST BREATHING . . . . . . . . . . . . . . . . . . . . . . . . . A DIFFICULT BREATHING . B facility or health worker? RECORD ~L M~C~EO ~F-CK 452 , ALL COLUMNS NO CHILD RECEIVED r - - 1 ANy CHILD RECEWE[} REHYORON REHYDRON Y Have you ever heard of a spec ia l product ca l led rehydron you can get for the t reatment o f d ia r rhea? NOISY BREATHING . . . . . . . . . . . . . . . . . . . . . . . C HIGH BODY TEMPERATURE . O UNABLE TO DRINK . E NOT F~*II NG]NOT DRINKI I~G WELL . . . . . . . . . . . . . F Gk~nr ING N ICKER]VERY S ICK . . . . . . . . . . . . . . . . G NOT GE IT ING BETTER . . . . . . . . . . . . . . . . . . . . . . H OTHER X (SPECIFY) DON" T KNOW . Z I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 SK iP 501 I 224 Sect ion 5 . CONTRACEPT ION Now I would like to talk about contraception - the various ways or methods that a couple can use to delay or avoid a pregnancy, CIRCLE CODE I IN 501 FOR EACH METHOD MENTIONED SPONTANEOUSLY, THEN PROCEED DOWN COLUMN 502, READING THE NAME AND DESRCiPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED. AND CODE 3 IF NOT RECOGNIZED, THEN. FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 501 OR 502.ASK 503. V~ 501Which ways or methods have you heard about? OI I PILL Women can take a pill every day. I 502 Have you ever heard of (METHOD)? SPONTANEOUS P R O B E O YES yES NO 1 2 O• can have a loop or ¢oif placed tnsld, IUD Women them by a doctor. 3 I Women can have an injection INJECTIONS by a doctor or nurse which stops them from becoming pregnant for several mOnths. OIAPHRAGM. FOAM. JELLY. Women can place a sponge, suppository, diaphragm, jelly inside themslves before intercourse. 1 2 1 2 1 2 3 3 503 Have you ever u~ed (METHOD)? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . 2 YE,~ . 1 NO . 2 YE~ . 1 NO . 2 •6• CONDOM, Men can use a rubber Sheath during sexual intercourse 107 I FEMALE STERIL IZAT ION. Women can have an 09J 101 operation to avoid having any more children. CALENDAR METHOD Every month that a women is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant. 1 2 WITHDRAWAL. Men can be careful before climax, pull out J Have you heard of any other ways or method~ that women or men can use to avoid pregnancy? 504 CHECK 503 yES"(NEVER USED) 1 2 1 2 1 2 (SPECIFY) (SPECIFY) 3-1 3-1 3 3 ATLI (EVER USE~)) YES . , . 1 NO . 2 Have you ever had an operation to avoid having any more children? YES . 1 NC) . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . . 1 NO . 2 No, QUEST IONS AND F ILTERS 505 t~ I'J CODING CATEGORIES ISKIP YES . 1 NQ 2 Have you ever used anything or tried in any way to delay or avoid getting pregnant? NO . . • 531 507 What have you used or done? CORRECT 503 AND 504 ( AND 502 IF NECESSARy) 50 g Now f would tike to ask you about the tirst time that you did something or used a method to avo/d getting pregnant. How many living children did you have at that time, if any? 5 tO 511 512 IF NONE, RECORD "00' When you first time began to use contraception, did you want to have anether child but at a later time, or did you not want to have another child at all? 51 NUMBER OF CHILDREN WANTED CHILD LATER . . . . . . . 1 DID NOT WANT ANOTHER CHILD . 2 O THER 6 {SPECIFY) CHECKS03 WOMAN NOT STE• IUZED CHECK 227 NOT PREGNANT OR T UNSURE Are you currently doing something or using any method to delay or avoid getting pregnant? WOMAN STERIL IZED I I PREGNANT V--1 I yES . I ~ 51.4A ) 532 I • 531 I t~ O~ 514 514A 51 516 517 518 Which method are you using? CtRCLE "07 FOR FEMALE STERILIZATION. May I see the package of pills you are now using? RECORD NAME OF BRAND IF pACKAGE IS SEEN Do you know the brand name of the pills you are now using? RECORD NAME OF BRAND How much does one packet of pi l ls cost you? Where did the steril ization take place? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF OF THE PLACE PROBE TO IDENT( FY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF pLACE) I piLLS . . . . . . . . . . . . . . . . . . . . . 01 I IUD . . . 02 INJECTIONS . 03 ~ • 526 ~ RAG M/FOAM/J ELLY . . . . . 05 CONDOM . FEMALE STERIUZATION . 07 • B 1B CALENDAR M ETF-X~D . 09 • 523 'qAqTH DRAWAL . 10~ ) ~26 96~ (SPECIFY) I PACKAGE SEEN BRNMO NNVE . J ~ - - J pAC KAQE NOT SEEN . 2 BRAND I~N~E DON'T KNC~V . . . . . . . . . . . . . 98 I~REE . . 96 EX~N'I" KN(~N . 999B-- PUBUC S~c'roR I HOSPITAL . pO~.YCUNIC . 2 WOMEN'S CF~IT~ . 3 MOBILE CLINIC . 4 £3TRER HEALTH FACIL rF~ 6 (~PECIFY) D(~'T KNOW . B • 5t7 • 526 No. 521 523 526 527 QUEST IONS AND F ILTERS In what month and year was the sterilization performed? How do you determine which days of your monthly cycle not to have sexual relations For how many months have you been using (Me'n~O) continuously? iF LESS THAN 1 MONTH, RECORD *OO" CHECK 514 CIRCLE METHOD CODE: CODING CATEGORIES I SK IP __ . . . . . . . . . . . . . . . . . . I I BASED ON CALENDAR . 01 BASED ON BODY TEMpERATUrE . O 2 BASED ON CERVICAL MUCUS (B ILL ING METHOD} . . . . . . . . . . . . . 03 O~1RIECIrAL ~ T U F I E. . 04 NO SpECiFIC SYS T FJ*t . O 5 Ol~Bq 96 (SPECIF~ MONll-IS . I ~ 8 YEARS OR LONGER . . . . . . . . . . 96 P ILLS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 ]UD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 IN JECTIONS . (30 O¢~R-I RAG M/(:DAM / JELLy . 05 C O N ~ M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 ~ STP~t l I~-AT ION . . . . . . . . . . . . . . . . . . 07 ~,~ H ~,VAI - . . . . . . . . . . . . . . . . . . . . . . . . • 527 ~529A • 532 O 527A 528 529 529A Who recommended you to use this method of contraception? Where did you obtain (MEIHOO) the last time? DOCTOR @OM THE ROS pfTAI 01 DOCTOR FROM W'OM EN ~ CENTER . (}2 OTHER H E~M~T H pRO FESS ~l%tAL . 03 I~'t4~M~IST . . . . . . . . . . . . . . . 04 F~IIEN DS/R ELATIVF~S . . . . . . . . . . . . . . . . . . 05 DECIDED HERSELF . 06 OTMpmq 96 SPECIFY PUBUC SE~ ;'O F1 HOSpbTAL . . . . . . . . . . . . . . . . ~1 POLYCLINIC . . . . . . . . . . . . . . . 12 F#MM ~ Ly p IJ~N NIN~ CUNIC . 13 PHARMACY . . . . . . . . . . . . 14 IF SOURCE IS HOSPITAL, HE.~LTH CENTER, OR CUNIC, WRrTE THE NAME OF OF THE pij,.C E COMM UNI~' HEALTH ~tvORKER . . . . 15 PROSE TO [DENTIFy THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. OTHER PUBUC itF~,LTll FAClU W {NAME OF PLACE) Do you know another place where you could have obtained (ME[HOD) the fast time? At the time of the sterilization operation, did you know another place where you could have received the operation? 16 ISPECI~ PRIVAIE MEDICAL SECTOR PRiVAI[E HOSpITA[/C~ INEC . 2 PRIVATE PHARMACy . . . . . . . . . . . . . . 22 PRIVATE DOCTOR . . . . . . . . . . . . . . 23 MOBILE CLINIC . 24 PRIVATE HEALTH WORKER . 25 OTHER PRIVATE PIEALTH FACILITY 26 (SPECIFy) OT~ER SOURCE SHOP . . . . . . . . . . . . . . . . . . 31 RELICt OUS ORG#,NIZATt ON . 32 FRIENDS/RELATIVES . OTftER 36 (SPECiFy} YES . . . . . . . . . . . . . . . . . . . . . . . . t NO . 2-- • 534 t ,o No. 530 531 QUEST IONS AND F ILTERS People select the place where they obtain contraceptives for various reasons, What was the main reason you w~nt to (N~'~E OF pLACE tN O.S2a OR O.S~ e) Instead of the other place you know about? RECORD RESPONSE AND CIRCLE CODE What is the main reason you are not using a method of contraception to avoid pregnancy? CODING CATEGORIES ACCE:F~ * ,¢~E~tTE, I~ RF J~SC~S CLOSER TO HOME . . . . . . . . . . . . . . . . . . . . . 11 CLOSER TO "¢VCJRK . 12 AVAILAalUTY OF TRANSPOftT . . . . . . . . . . . . . 1 a S ER'vlCE- RELATEO REASON S STAFF MORE COMpEFENI'/FpJENDL Y . 21 CLEANER FACILITy . . . . . . . . . . . . . . . . . . . . . . 22 OFFERS MORE PRIVACY . 23 SHORTER WAITING TIME . . . . . . . . . . . . . . . . . 24 LONGER HOUR~ OF OPERATION . 2 5 USE OTHER ,SERVICES AT THE FACIUTY . 28 LOV~ER COST/CHEA~ER . 31 WANTED ANONY]~I~ . 41 OTH~ g6 {SPECJFy) DON'T KNOW . 9B NOT MARRIED . 1 t RERTILITY- RELATED REASON S NOT HAVING SEX . . . . . . . . . . . . . . . . . . . . . . 21 INFREQUENT SEX. . . . . . . . . . . . . . . . . . . . . . MENOPAUSN-/H YSTER ECTOM y . 2 3 SUB FECUND/I NFECUN D . 24 POS Tp/~R TUM/13REASTFE E D( NG . 25 WANTS (MORE)CHILDREN . . . . . . . . . . . . . . . 26 PREGNANT . 27 OPPO$1~ON TO USE RESPONDENT OPPOSED . 3 | H U~SBAN D OPPOSF3~ . . . . . . . . . . . . . . . . . . . 3 ;~ OTHERS OPPOE; ED . . . . . . . . . . . . . . . . . . . . . 33 RELIGIOUS pRO~IIBIllON . 34 LACK OF KNOWLEI3GE KNOWS NO METHOD . 4 t KI~JWS NO SGdJRCE . . . . . . . . . . . . . . . . . . . 42 MEfHOD RELATED REASONS REAL~p~ CONCERN S . . . . . . . . . . . . . . . 5 I FE*~R OF SIDE EFFECT S . 5 2 LACK OF ACCESS/TOO FAR . 5 3 COST TOO MUCH . 54 INCONVEf~ENT tO USE . 5 S INTERF1ERES ~%~ ~R-I BCO~*S NORMAL pROCESSES . 56 OTHER 96 (SPECIFY) OOf4'T KNOW . 98 I SK IP • 534 532 t~ 533 Do you know of a place where you can obtain a method of contraception? YES . ~ I NO . 2- - ~ 534 I I | PUBLIC ~ECTO R HOSPITAL . 11 Where iS that? POLYCLINIC . . . . . . . . . . . . . . . . . . . . . . . . 12 FAMILy pLANNiNG CUNIC . 13 PH/~M/ICtf . 14 IF SOURCE IS HOSPtTAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF OF THE pLACE COMMUNITY HEALTH WORKER . 15 PROBE TO iDENTIFY THE TyPE OF SOURCE AND CtRCLE THE APPROPRIATE CODE O1HB pUBLIC HEALTH FAQUW (NM,4E O~ F~CE) 534 Were you visited by a health worker who discussed the use of contraception during the last 12 months? I 535 Have you visited a health facility for any reason in the last 12 months? z 536 Did any staff member at the health facility speak to you about contraception? | 537 Do you think that breast feeding can affect a woman's chance of becoming pregnant? 538 Do you think that e woman's chance of becoming pregnant is increased or decreased by breastfeeding? 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVA}E HOSPITAL/CUNIC . 21 pRIVATE pHA~*MACy . 22 PRIMA~r E DOCTOR . 23 Me'BILE CUNIC . 24 PRIVATE H~¢ALTH WORKER . 25 OTHER p~VATE HEe, LTH FACIUW 26 (SPECIFY) eTHER SOURCE REL~fOUS ~ N I Z A T ~ N . . . . . . . . . . . 32 FRIENDS/RELATIVES . 33 O TH~ 36 (SPECIFy) YES . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I | YES . I I NO . 2 ~ 537 I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . 2 I I YES . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - - - • 543 EX~N~r KNOW . 8 -- I INCRF~sEO . t :L 543 DECREASED . 2 DEPENDS . 3 DON'T KNOW . 8 No, | QUEST IONS AND F ILTERS I CODING CATEGORIES | SK IP t~ 540 542 543 544 545 CHECK 208 ONE OR MORE BIRTHS U Have you ever relied on breastfeeding as a method of avoiding pregnancy?. CHECK 227 AND 514 NOT PREGNANT OR UNSURE AND re you currently relying on breastfeeding to avoid getting pregnant? (SHOW LOGO 1) Have you ever seen this symbol? Where have you seen it? Anywhere e lse? What does this symbo l mean? NO BIRTHS VES . I NO . 2 YES . 1 NO . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2 pHARMACy . 1 WOMEN'S CENTER . 2 POLYCU~qC . 3 ~pE LEVIS ION . 4 O ~ 5 CON1P, ACEPTI VES . DRUG . OIHIN~ I--1 EITHER OR PREGNANT STERILIZED (SPECIFY) DON'T ~KJ~IOVV . .543 I 54B t~ 4~ ,343 544 545 549 a. b. C. d. (SHOW LOGO 2) Have you ever seen this symbol? Where have you seen it? Anywhere else? What does this symbol mean? Now I would like to read you some statements about oral contraeptives (pills) nd injectable contraceptives. For each statement, please tell me whether you strongly agree, agree somewhat, disagree somewhat or strongly disagree. STATEMENT Taking oral contraceptives (pills) usually does not harm a woman's health If a woman experiences nausea when she starts taking oral contraceptives, she should not stop taking them immediately. Women who use injectable contraceptives cannot get pregnant again after they stop the injection Women who use injectable contraceptives often stop mestruating while they are taking them. STRONGLY AGREE AGREE SOMEWHA ~EE; . NO . FH ARIV~ACy . WOMEN'S CEN]T~R . POLYCMNIC . TI=LEVlsK=*N . 011-~R Ow . . . . . . . . . . . . . . . . . . . . DISAGREE STRONGLY SOMEWHAT DISAGREE I 3 4 3 4 3 4 3 4 ~4g DON% KNOW FO L~ No. 601 602 603 604 606 607 611 Sect ion 6. MARRIAGE QUEST IONS AND F ILTERS PRESE~N CE OF OTHERS AT THIS POINT Are you currently married or living with a man? Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all? Have you ever been married or lived with a man? What is your rnarltal status now: are you ~dowed, divorced, or separated? Is your husband/partner living with you now or is he staying elsewhere? Have you been married or lived with a man only once, or more than once? CODING CATEGORIES YES NO CHJ LDREN UN[X~110 . . . . . . 1 2 HLISIBAN D/'PARTN ER . 1 2 OTHER MALES . 1 2 OTHER Fi~V,A LES . . . . . . . . 1 2 CURRENTLY MARRtED LJ'V1NG ~,1~ A MAN NOT IN UNION REGULAR SIE~UAL PARTNER 1 OCCASIONAL SEXUAL PAm'NER 2 NO SEXUAL PARTNER 3 SKIP • 2 -- :=607 3 FORMERLy MARRIED 1 LIVED WiTH A MAN . 2 ]=611 NO 3 ~ 615 ~hlDOWED . 1 [~VORCED 2 SEPARATED . . . . . . . 3 UVES ~TH HER 1 STAYING I~SEWH ERE . . . . . . 2 ONCE . . . . . . . . . 1 MORE ~I~.A N ONCE . . . . . 2 • 811 No. 612 613 615 619 QUESTIONS AND FILTERS CHECK 611 MARR~ ED/LIVED WITH A MAN ONLY ONCE In what month and year did you start living with your husband/partner? MARRIED/UVED WLTH A MAN I I MORE THAN ONCE NOW we wtt[ talk about your first husband/ partner. in what month and year did you start living with him? CODING CATEGORIES DON~ KNOW MONlrH 98 DON'T KNOW YEAR . . . . 98 SKIP • 615 How old were you when you first had sexual intercourse? OAY$ AGO t W~EXS AGO . 2 MONTHS AGO 3 , J yEARS AGO 4 I BE~=ORE LAST BRTH . . . . . . . 996 AGE . . . . . I I I RRST TIME Wt'~B~ MARRIED : . 96 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some contraception, When was the last time you had sexual intercourse (if ever)? How old were you when you started living with him? I I I I I I AGE . issues of NEVER . . . . 000 • 712 t~ L~J ~J No. 702 703 Sect ion 7 . FERT IL ITY PREFERENCES QUESTIONS AND FILTERS CODING CATEGORIES CHECK 514 WOMAN NOT STERILIZED [ ~ CHECK 227 NOT FREGN ~NT OR UNSURE E l NOw I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children? CHECK227 NOT PREGNANT OR UNSURE D HOW long would you like to wait from now before the birth of (a/another) child? WOMAN STERILIZED ~1 PREGNANT [ ~ NOW I have some questions about the future. After the child you are expecting, would like to have another child or would you prefer not to have more children? PREGNANT [ ~ HOW long would you like to wait after the birth of the child you are expecting before the birth of another child? HAVE (A/ANOTHER) CHILD 1 NO MORE~ON E 2 SAYS SHE CAN'T GET PREGNANT 3 UNDC-CIDED/DON'T KNOW 8 YEARS . SOON/NOW . 993 SAyS SHE CAN'T GET PREGNANT 994 AFTER MARRIAGE 995 OTHER 996 (SPECIFY) DON'T KNOW 998 SKIP 712 ) 708 • 704 706 No. 705 QUESTIONS AND CHECK 227: FILTERS UNSuRENOT PREGNANT OFt ~ PREGNANT I-- if yoU became pregnant in the next few weeks, would you be happy, unhqpp~, or would t not matter very much? CODING CATEGORIES HAPPy . . . . . . . . . . . 1 UNHAPPY 2 WOULD NOT MATf E~f 3 S K IP t~ 707 708 CHECK 513: USING A METHOD? NOT ASKED m USINGNOT CURRENTLY [ ~ Do you think you wilt use a method to delay or avoid pregnancy within the next 12 months? Do you think you V~ll use a method at any time in the future? CURRENTLY USING [-- YE~ . 1 NO . . . . . . . . . . . . . . . 2 ~N~[ KNOW . . . . 8 YES . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 OON~- KNOW . 8 ~-712 • 709 ~-710 ~o 709 710 Which method would you prefer to use? What is the rn~n reason that you think you will never use a method? P~LLS . . . . . . . . . . . . . . . . . . . . 01 EUD . . . . . . . . . . . . . . . . . 02 INJECTIONS . . . . . . . . . . . . . . . . . . 03 DIAprH RAGM/'FOAM/J ELLY . 05 . . . . . . . . . . . . . . . . . . 06 F:E~MALE STERLIZATION . 07 CALEN D*~R ME~'HOD . . . . . . . . . . . . 09 ~P~(;~RWAL . . . . . . . . . . . . . . . . . 10 96 {SREaFY) UNSURE . . . . . . . . . . . . . . . . . . 9J~ ~OT MARRIED . . . . . . . . . . . 11 FERTIUW-~TED REASONS I N ~ T SEX . . . . 22 MEN OPAU~AL/HYS'nEREC TO~4 Y 23 SUBFECUN D/1NFECUND . . . . 24 WANTS ( fv¥~C4~ L ~ . . . . . 26 0PPO~llON TO USE RESPC~ DEN1" ~%'~=~]E~D . 31 Ht~SAND OPPOSED . . . . . . 32 OTrll~RS OPPOSED . . . . . . . . . . . . 33 R1EUGIOU~ PROHIBITION . . . . . . . . 34 LACK OF KNOWU~GE KNOWS NO METH(X) . . . . . . . . . . . . 41 KNOWS NO SC~RCIE . 42 ME'R'K)O RB.AI~) REASONS HEAL~-I CONCerNS . . . . . . . . . . . . 51 ~--4~R OF ~DE B:RECTS . 52 LACK OF A C C I ~ FAR . . . . . . . . 53 C, OST TCO MUCH . . . . . . . . . . . . . . . . 54 INCONVI~IIENT TO L~- . . . . . . . . . . . . 55 I N ] I ~ WITH EIOD~S NORMAL PP~C ESSES . . . . . . . . . . 56 OTHE}~ g6 (SPEC4FY) l~ON'i" KNOW . . . . . . . . . . . . . . . . . . . g )712 712 t~ NO. 711 712 713 QUEST IONS AND F ILTERS Would you ever use a method if you were married? CHECK 222 CODING CATEGORIES YES 1 NO 2 OONT KNOW 8 P~AS UVING CHILDREN If you could go back to the t ime you did not have any chddren and could choose exactJy the number of children to have in your whole life, how many would that be? I--1 NO LIVING CHILDREN If you could choose exactly the number of children to have m your life, how many would that be? PROBE FOR A N Ut~4ERIC RESPONSE How many of these children would you like to be boys, how manywou ld you like to be girls and for how many would it not ma~er? [~F-} NUMBER I I I OTHER g6 (SPECIFY) BOYS NUMBER ( - ~ QTH(~ g6 (SPECIFY) GIRL.~ NUMBER I I I OTHER q6 (SPECIFY) EJTHER NUMBER . O~ER 96 (SPECIFY) SKIP 714 714 715 716 t~ 718 719 Would you say that you approve or disapprove of couples using a method to avoid getting pregnant? Is tt acceptable or not acceptable to you for information on contraception to be provided: On the radio? On the television? In the last few months have you heard about contraception: On the radio? On the television? In a newspaper or magazine? From a poster? From leaflets or brochures? in the last few months have you disCusSed contraception with your friends, neighbors, or relatives? With whom? Anyone else? RECORD ALL M~TIONED APPROVE . . . . . . . . . . . . 1 DqSAPPROVE . . . . . . . . . . 2 NO OPINION . 3 ACCB ~* NOT ACCIE~- DK TABLE TABLE RA~O . . . . 1 2 8 TE]~'~ISION 1 2 8 YES NO RA~O . . . . . . . 1 2 TELEVISION . 1 2 N EWSPAPE~ OR MAGAZINE 1 2 POSTER 1 2 LE&FLE-I'i, ERS OR BROCHURES 1 2 YES NO . 2 HUSSAN D/PARI~ E~ A MOTHER . . . . . . . . . . . . B FAT;'~R . . . . . . . . . . . C ~ST~(S) . . . . . . . . . D BROTHER(S) . . . . . . . E OAUGHTiE~ . . . . . . . . . . . . . F MOT;-;ER-IN -LAW . . . . . . . . G FRI E~N DS/N BGHBORS . . . . . . . H OTHER X (SPECIFY) 720 No. 721 722 723 QUESTIONS AND FLLTERS CODING CATEGORIES CHECK 602 CURRENTLY MARRIED LIVING [ ~ WITH A MAN NOT IN UNION ['~ Spouses/partners do not always agree on everything, Now I want to ask you about your husband's/partner's views on contraception, Do you think that your husband~partner approves or disapproves of couples using a method to avoid pregnancy? How often have you talked to your husband/partner about contraception in the past year? Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want? APPROVES 1 D~SAPPROVES 2 DON'T KNOW 8 NEVER 1 ONCE OR TWICE 2 MORE OFTEN 3 SAME NUMBER 1 MORE CHILDREN 2 FEWE~CHILDREN 3 DON'TKNOW 8 SKIP • 801 Sect ion 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK No. QUESTIONS AND FILTERS CHECK 602 AND 604 CURRENTLY MARRIED/ LIVfNG WITH A MAN L.-~I FORMERLY M ARR~E D/ L'VED WiTH A MAN I I CODING CATEGORIES I SKIP NEVER MARRIED AND NEVER IN UNION I I ) 809 I 4~ L,J How old was your husband/partner on his last birthday? f--T--] I II AGE . . . . . . I Did your (last) husband/partner ever attend school, technikum, or institute? YES 1 i NO . . . . . . . . . . 2 ~ • 806 What was the highest level of school he attended? PRIMARY/SECONDARY 1 SECONDARY-SPECIAL 2 HIGHER . . . . . 3 DONor KNOW 8 How many years~classes~courses he completed at that Eevel? What is (was) your (last)husband/partner's occupation? That is, what kJnd of work does (did) he mainly do? YEARS . . . . . . . . ~ ] DON't KNOW 98 • 806 L CHECK 806 ~ ~ WORKS (WORKED) IN DOES(DID) NOT WORK IN AGRICULTURE AGRICULTURE ~ 80~ STATE LAND 1 8 0 8 (Does/did) your husband/partner work mainly on the stale land or on his own land, or on family land, or (does/did) he rent land? own LAND . . . . . . . . . . . 2 FAMILY LAND . . . . . . . . 3 REN iTED LAND . . . . . . 4 I'o 4:= 4~ No, 814 QUEST IONS AND F ILTERS Aside from your own housework, are you currently working? IF NOT Are you on maternity leave? As you know, some women take up lobs for which they are paqd in cash or kind. Others sell things, have a small busiess or work on the family farm or in the family business. Are you currently do~g any of these thngs o~ any olhef CODING CATEGORIES YES . . . . . . . NO . MATERNITY LEAVE YES NO . . . . . 2 SKIP 1 >812 2 3 • 812 ~,812 Have you done any work in the last 12 months? YES 1 NO 2 • 826 What is your occupation, that is, what kind of WOrk do you mainly do? CHECK 812 WORKS IN A~RICULTURE Do you work mainly on the state land or or on family land, or do you rent land? ? on your DOES NOT WORK IN AGRICULTURE I own land, [[1 STATE LAND . . . . . . . . OWN LAND . . . . . . . 2 FAMILY LAND . . . . . . . 3 RENTED LANO . . . . . . 4 • 81 ~- ~15 16 Are you public servant, or do you work on slate enterprise, a prvate firm or enterpnse owned by yourself, your husband, member of your family, or by someone else, or are you self-employed? Do you usually work throughout the year, or do you work seasonally, or only once in a while (episodically)? GOVERNMENT/STATE ENTERPRISE 1 FAMILY/OWN BUSINESS . 2 PRIVATE FIRM/PERSON . 3 SE]J:-EMPLOYED 4 THROUGHOUT 1HE YEAR I SEASONALLY . . . . . . . . . 2 I I ONCE IN A WHILE (EPISCO~CALLY) 3 • 811 3 1 7 Dunng the last 12 months, how many months did you work? I ~ I I I NUMBE~ C~: MONTHS I 3 1 8 (In the months you worked.) How many days a week did yoU usually work? I'~ • s20 NUMBER OF DAYS . . . . . I I I 3 1 9 Dunng the tast 12 months, approximately how many days did you work? I I I I N LAMBEI~ OF DAyS 2 0 DO you earn cash for your work? YES . 1 PROBE DO yOU MAKE MONEY FOR WORKING? NO . . . . . . . . 2 • 82: I No. 822 823 824A 825 826 QUESTIONS AND FILTERS CHECK 602 CURRENTLY MARRIED/ LIVING WITH A MAN h Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner iointl¥, someone else,or you and someone else jointly? Do you usually work at home or away from home? NOT MARRIED NOT LIVING WITH A MAN Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly? CODING CATEGORIES RESPONDENT DECIDES . 1 HUSBAND/PARTNER DECIDFS 2 JOINTLY W1TH HUS~N D/PARTN FJ:l 3 SOMEONE ELSE DECIDES . 4 JOINTLY W1TH SOMEONE ELSE 5 CHECK 223 IS THERE A CHILD WHO IS AGE 5 OR LESS'? YES [ ~ Does {NAME OF YOUNGEST CHILD) live with you? Who usually takes care of {NAME OF YOUNGEST CHILD AT HOME) while you are working? RECORD THE T~ME I----I HOME 1 AWAY 2 YES 1 I NO 2 RESPONDENT 01 H USI~,AN D/PA RTN ER 02 OLDER FEMALE CHILD 03 OLDER MALE CHILD (] 4 OTHER RELATIVES 05 NEIGHBORS 06 FRIENDS 07 {~.By SITrER {} 8 CHILD IS iN ClfllLDCARE 10 HAS NOT WORKED SINCE LAST BIRTH 95 OTHER 96 (SPECIFY) )826 I HOUR III MINUTES . . . . SKiP • 826 Sect ion 9 . HE IGHT AND WEIGHT IN 901 AND 902 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT. | 901 RESPONE~ENT~ HEIGPIT (IN CEN~ METERS) ~ ' ~ 1 1 I ~ ! I 902 RESPON[~:NT'S Wl~GHT ( I~ KJ LOGR/~MS ) ~ = I I MF~URED . 903 RESULT FO 4~ CHECK435 NOT MEASURI REFUSED. OTHE~ (SPIECJFy) ONE OR MC~E UVING CHILORE~*t [ ] NO LI~NG CHILDR~I BORN St NCE JAN LAS, RY 1 gg~l aORN ~NCE JANU,~Ry lS~ [ J IN 905 RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY t993 AND STILL ALIVE IN 906 AND 907 RECORD THE NAME AND BIRTH DATE OF THE LIVING CHILDREN, IN 909 AND 911 RECORD HEIGHT AND WEIGHT OF THE LIVING CHILDREN IF THERE ARE MORE = THAN TWO LIVING CHILDREN BORN SINCE JANUARy 1993 USE ADDITIONAL FORMS, • 1001 ] YOUNGEST LIVING CHILD L~J NEXT-TO-YOUNGEST LIVING CHILD I-'/'1 905 u~,~ NUMaeR ~OM ~ I'~ I'~ 906 N,V~ ~'~ ,~S 907 ~]IE 0#- BIRTH FROM 215, AND ASK F(~ DAy (~ BIR~-I (NAME) DAY . MONTH . . . . . . . . . . . . . . . . . . . . . . . . . . yEAR . (NAZ~E I DAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . MONTH . . . . . . . . . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . t~ 0¢ 908 909 910 911 912 913 BCG ~ ON TOP OF SHOULDER NO SCAR . . . . . . . . . . . . . . . . . . . I NO SCAR . . . . . . . . . . . . . . . . . . . . . . . . 1 SCAR I . 4 rnm . . . . . . . . . . . . . . . . . . . . 2 SCAR I . 4 ITml . 2 SCAR 5 mm AND MORE . 3 SCAR 5 mill AND MORE . 3 HEIGFIT (IN CIEIN~ Id~Elr E~S ) I-l-l-113 I-I-[-1 I-1 WAS LIENGI~d/HBGI~T C~': CN LD M EAE~RE D LYING DOWN OR SI'ANDI~ U~ LYING . . . . . . . . . . . . . . . . . . . . . . . . . 1 LYING . . . . . . . . . . . . . . . . . . . . . . . 1 STANDING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ST~I~NG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DATE WE]G,H ED AND ME~C, URED :~E.~JLT DAy . . . . . . . . . . . . . . . MONTH . . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . MEASURED . . . . . . . . . . . . . . 1 CHILDIS SICK . 2 CHILD NOT pRESENT . 3 CHILD REFUSED . 4 MOTHERREFUSED . 5 OTHER 6 (SPECIFY} DAy . MONTH . YEAR . MEASURED . 1 CHILD IS SICK . . . . . . . . . . . . . . . . . . . 2 CHILD NOT PRESENT . 3 CHILD REFUSED . . . . . . . . . . . . . . . . . . . . . 4 MOTHER REFUSED . 5 O~dl~q 6 (SPECIFY) 914 NAME OF MEASURER: NAME OF k.S,34 STkNT: ~ ' ~ 249 LETTERHEAD OF THE INSTITUTE OF OBSTATRICS AND GYNECOLOGY Dear Respondent: The Institute Obstatrics and Gynecology is conducting Demographic and Health Survey in Uzbekistan. As part of this program we study the prevalence of anemia among the women and their children. We ask you to participate in this program, which will assist the Ministry of Health of Uzbekistan to develop the specific measures to prevent and treat anemia. Anemia is a disease, which is characterized by a low count of red blood cells. It results from poor nutrition and can be especially damaging to the health of pregnant and breastfeeding women. Today, it is possible to rapidly (within a few minutes) diagnose this disease. A low level of hemoglobin (less than 1 lg/dL) can be determined by the Hemocue machine on the basis of a single drop of blood. If you decide to participate in this program, we will ask you to provide a drop of blood from your finger for the analysis. Also, if you have a child of age 3 or less, please let ~ur nurse to obtain drop of blood from him. The procedure will be done by sterile instruments. The blood will be analyzed using the new sophisticated American equipment, Hemocue. The result of analysis will be available to you right after the blood is taken and assessed by Hemocue. We will also keep the results confidential. If you decide to participate in this program, please sign at the bottom of this form that you agree to provide a drop of blood and allow us to obtain drop of blood from your child. If you decide not to participate, it is your right, and we will respect your choice. I am Last name, First Name, Middle Name agree to donate a drop of blood for the purpose of anemia diagnosis. I also allow a drop of blood to be taken from my child (children) for the purposes of anemia diagnosis. Signature Date " 1995 250 Sect ion tO . HEMOGLOBIN MEA, SUREMENT IN THE BLOOD ALL INTERVtEWE O WOMEN ARE ELIGIB E FOR HEMOGLOBIN MEASUREMENT IN 1001 RECORD RESPONDENT S HEMOGLOBN LEVEL 1001 J RESPONDENT S HEMOGLGB,N LEVEL (G/DL) ~ . ~'~ 1002 RESULT CHECK 435 ONE OR MORE LMNG CHaLDREN B~N SINC~ JANUARy 1993 I I ME/~S Ufl ED . 1 NOT M ~AS LI~ ED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 REFUSED . 3 OTHER 6 (SPECIFY) NO LIVING CHILDREN BORN SINCE JANUARY 1993 I I ]= 1009 IN 1004 RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1993 AND STILL ALIVE IN 1005 RECORD THE NAMES OF THE LIVING CHILDREN IN 1006 RECORD THE HEMOGLOBIN LEVEL IN THE BLOOD OF THE LIVING CHILDREN IF THEBE ARE MORE THAN TWO LIVING CHILDREN BORN SINCE JANUAAY 1993 USE ADDITIONAL FORMS 1004 1005 1006 ] YOUNGEST LIVING CHILD [] NEXT'TO'YOUNGEST LIVING CHILD I I LRdE NUMBER FROM 434 ~ (NAME) (NAME J t~ 1007 RESULT MOTHEI OTHER USED . [SPECIFY) MEASURED . CHILD REF USED MOTHER REFUSED OTHER (SPECIFY) 10o8 "AMEOF''S0"ER [----~ ." E OE,~,ST", ~ J~ I I 1009 CHECK tOOt AND 1006 [ ~ J'~ NO VALUES BELOW 7 G/DL ONE OR MORE VALUE BELOW 7 G/OL __ • CONS ENT FO~ M NO 2 I RECORD THE RESULTS OF HEMOGLOBIN MEASUREMENT, TEAR OFF HERE AND PRESENT THIS PORTION TO THE RESPONDENT INSTITUTE OF OBSTETRICS AND GYNECOLOGY RESULTS OF HEMOGLOBIN MEASUREMENT IN THE BLOOD Name {G/DL) Hemoglobin Iovll in ~/HO CLASSIFICATION OF ANEMIA_ Normal level Hb level above 11 G/DL Mild anemia Hb (10-11G/DL) Moderate anemia Hb (7-10 G/DL) i Severe anemia Hb (less than 7 G/DL) Date Respondent Last child rl-7. E; YOU have Your ch i id has I Normal level Mild anemia I-I-].I-1 1996 Next-to-youngest child I-1 Normal level Mild anemia Moderate anemia Severe anemia Moderate anemia Severe anemia Normal level Mild anemia Moderate anemia Severe anemia In case of severe anemia (Hb level lass than 7 G/OL), we recommend you to immediately contact your doctor, If you have any question about hemoglobin measurement procedure, please call us at (3712)637830, or write to: Institute of Obstetrics and Gynecology, Ministry of Health of Uzhekistan, 132A Abdultaev Ave, Tashkent, Uzbekistan LETTERHEAD OF THE INSTITUTE OF OBSTETRICS AND GYNECOLOGY CONSENT FORM No 2 Dear Respondent: We detected a low level of hemoglobin in your (your child's) blood. This indicates that you (your child) have developed severe anemia, which is serious health problem. We would like to inform the doctor at health care facility in your area about your condition. This will assist you to obtain appropriate further diagnosis and treatment of your (your child's) condition. If you agree with this please sign at the bottom of this form. Thank you for your cooperation. I am Last name, First Name, Middle Name agree that the information about the level of hemoglobin in my (my child's) blood will be disclosed to the doctor at the local health care facility. Signature Date . . . . 1995 480008 Pecn~onaxa KaaaxeraH, r. AnMar, d, ya, I~oqxoaa 66. Tea. (3272)429-203, ¢i~ax¢. (3272)420-720 P ~.c.tte'rrtrdR error 00060g602 B A.aMaT'~HCKOM O6.rcyaga.BaelCRl~ H~.tmos~'~r~Horo 0aftra. (Kaaaxe'rm~), zoo, 190501109, M@O 61g03 253 COMMENTS Comments about Respondent: Comments on Specific Questions: Any Other Comments: tJ tJ~ SUPERVISOR'S OBSERVATIONS Date Nae'ne of Su~r~snr" EDITOR'S OBSERVATIONS Name of Editor Date Front Matter World Summit for Children Indicators: Uzbekistan 1996 Title Page Citation Page Table of Contents List of Tables List of Figures List of Contributors Summary of Findings Map of Uzbekistan Chapter 1 - Introduction Chapter 2 - Characteristics of Households and Respondents Chapter 3 - Fertility Chapter 4 - Contraception Chapter 5 - Induced Abortion Chapter 6 - Other Proximate Determinants of Fertility Chapter 7 - Fertility Preferences Chapter 8 - Infant and Child Mortality Chapter 9 - Maternal and Child Health Chapter 10 - Nutrition of Women and Children Chapter 11 - Anemia References Appendix A - Sample Design Appendix B - Estimates of Sampling Errors Appendix C - Data Quality Tables Appendix D - Sample Implementation Appendix E - Persons Involved in the 1996 Uzbekistan Demographic and Health Survey Appendix F - Questionnaires Household Schedule Questionnaire Individual Woman's Questionnaire

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