Yemen - Demographic and Health Survey - 1998

Publication date: 1998

ebritton 1 CHAPTER 1 INTRODUCTION This chapter presents a brief overview of the Republic of Yemen, its geographical and historical aspects, the existing population, and socioeconomic conditions. The purpose is to provide the reader with a comprehensive background on the country and conditions in Yemeni society before presenting the results and methodological and administrative aspects of the Yemen Demographic, Maternal and Child Health Survey undertaken in 1997 (YDMCHS-97). The first YDMCHS was implemented in 1991-92, after the unification of Yemen on May 22, 1990. The second round of the survey was carried out during 1997 by the Central Statistical Organization with Yemeni personnel who participated in all phases of the study (including planning, preparation, implementation, supervision, and writing of this report) in cooperation with the Ministry of Planning and Development, the Ministry of Public Health and the National Council for Population on the one hand, and Macro International Inc. (Macro) on the other. This survey is considered an important benchmark in statistical work since it covers all the governorates of the Republic and went through highly precise phases during preparation and set-up, training and testing, follow-up and implementation. The survey comes after the first census (1994) under a unified country, the Yemen Republic. 1.1 Geography of Yemen The Republic of Yemen is located in the southern part of the Arabian Peninsula and is bordered by the Kingdom of Saudi Arabia to the north, the Arabian Sea and Gulf of Aden to the south, the Sultanate of Oman in the east, and the Red Sea to the west. The Bab Al Mandab strait lies off the southwestern tip of the Republic, Mayoun, a Yemeni island in the middle of the strait, controls the passage into and out of the Red Sea. There are over 112 Yemeni Islands in the Red Sea and the Arabian Sea. The largest is Sucotra, which has an area of 3,650 square kms and is inhabited by a population of 37,623, according to the results of the 1994 census. Socotra Island lies 510 kilometers southeast of the Yemeni seaport of Mukalla. Next is Kamaran Island with an area of 110 square kms and inhabited by 2,220 persons. In addition, there are the islands of Larger Hunaish and Smaller Hunaish, Zaqar, Al Zubair, and Al Tair as well as other islands. Yemen is characterized by an irregular terrain that accounts in large part for the dispersion of population aggregates. Despite the country’s small size, the terrain makes it hard for statistical work to be undertaken in many areas. Yemen can be divided geographically into five major areas: the Mountainous area, the Coastal area, the Plateau area, the Desert (Al-Ruba Al-Khali) area, and the Yemeni islands. Mountainous Area The Mountainous area consists of two mountain ranges. The first, the north-south mountain range, runs parallel to the Red Sea. The second is the east-west mountain range, which parallels the Gulf of Aden. The height of these mountains varies from 1,000 to 3,700 meters, the highest elevation being on the level of the Arab peninsula and Greater Syria, where the land is around 3,666 meters above sea level at the peak of Nabi Shuaib Mountain. Water from the mountains drains in all directions into a number of agricultural wadis. These mountain ranges contain several plains and basins forming extensive agricultural areas. 2 Coastal Area The coastal plains overlooking the Red Sea, the Gulf of Aden, and the Arabian Sea stretch along a coastal strip approximately 2,000 kms long from the Omani border in the east to Bab Al Mandeb in the west, and then to the border of Saudi Arabia in the north. The width of this coastal area varies from 30 to 60 kilometers. Plateau Area The highest elevation in the Plateau area is around 1,000 meters and lies to the east and north of the mountainous highlands and parallel to them. The Plateau becomes wider towards Al-Ruba Al-Khali (the empty quarter). The outer parts of this hilly area are contiguous in the north with the Al-Rub Al-Khali region, which extends deep into the Arabian Peninsula and comprises almost a quarter of the area of the Arabian Sub-Peninsula. Desert (Al-Ruba Al-Khali) Area The Al-Ruba Al-Khali region is part of the Yemen Desert. It contains some desert plants and herbs, particularly in the outermost parts that are contiguous with the Plateau area. Fewer plants are seen as one goes deeper into the Al-Ruba Al-Khali region of the Arabian Sub-Peninsula where sand dunes increase. Yemeni Islands There are 112 islands scattered in the Yemeni territorial waters of the Red Sea and the Arabian Sea. Many of these islands are inhabited by people and are used by Yemeni fishermen as waiting centers and for fishing purposes. The majority are situated in the Red Sea adjacent to the Yemeni coast. The largest and most important island is Sucotra in the Arabian Sea, which is known world wide as the home of rare trees such as the ormosia, dracaena draco, and pterocarpus draco trees from which gum, various medicines, incense, and pigments are obtained. Kamaran Island is another important Yemeni island. For the purposes of this survey, data were collected from hilly and desert areas, as can be observed from the results presented in this report. Sample segments were selected based on three main regions: the coastal region, the mountainous region, and the plateau and desert region. The islands were excluded from the sample because of the small size of the populations, and the difficulty in accessing them. 1.2 Historical Review In ancient times Yemen’s geographical location and favorable natural conditions played an important role in population settlement and the development of civilization in the territory of Yemen, particularly in the valleys opening into the Al-Ruba Al-Khali desert in the east, the Arabian Sea in the south, and the Red Sea in the west. The eras of Mae’en, Hadramaut, and Saba’a are considered to be the first organized political entities in Yemen before the birth of Christ. The Hemyar era flourished later and ended with the Abyssinian invasion in 525 A.D. The most important activities of the people of these regimes were agriculture and trade; they invented agricultural terracing on the mountains and erected dams, the most famous of which was the Ma’arib dam. 3 They also controlled mercantile caravans and roads which transported commodities from India and East Africa across the Arabian Sub-Peninsula to areas around the Mediterranean Sea (Al-Zoghbi, 1990). Yemen civilization flourished in those years; it was called Arabia Felix (Arabia the Happy) by the ancient Greeks. At the end of the Hamiarite era, Yemen was dominated first by the Abyssinians and then by the Persians. This lasted until the emergence of Islam when the Yemenis embraced the Islamic religion and Yemen became part of the central Islamic state. This period lasted from 628 A.D. to 824 A.D. Small independent states emerged thereafter leaving Yemen weak and divided. The Turks (Ottomans) occupied Yemen from the sixteenth century until the beginning of the seventeenth century; then the British occupied Aden in 1839. The Turks invaded the northern part of Yemen again in 1873 and continued their occupation until the outbreak of World War I, when Yemen came under the rule of the Hamid Al Deen family in the north. This lasted until the outbreak of the Yemeni revolution on September 26, 1962. The British remained in the south until the outbreak of the revolution of October 14, 1963, which resulted in independence on November 30, 1967 (Mustapha, 1984). With the success of these two revolutions, Yemen entered a new era of economic, social, cultural and political change. The latest of these changes was the unification of the two parts of Yemen on May 22, 1990. 1.3 Population The first Population Census under the Republic of Yemen was conducted in 1994. The de facto population of the country reached 15,831,757 persons, of which 14,587,807 were residents distributed in urban and rural areas. The urban population was 3,423,518 and the rural population was 11,164,289, representing 23.5 percent and 76.5 percent of the total population, respectively. The population residing outside Yemen was 737,669. The population density for the country in 1994 was estimated at 28 per square kilometer, distributed among 18 governorates. Including the capital area (Sana’a city), these governorates comprise 226 districts. The cities of Sana’a, Aden, Taiz, Hodeida, Mukalla, and Ibb are considered Yemen’s largest cities from the standpoint of population density. The annual population growth rate resulting from the difference between births and deaths in Yemen was approximately 3.4 percent. The crude birth rate was 45.4 per thousand population according to 1996 estimates, while the crude mortality rate in the same year was 11.3 per thousand. This indicates a tangible decrease in mortality, as the crude mortality rate was 11.4 per thousand in 1994. However, these rates are still high and are a clear sign that the state must adopt a sound population policy aimed at solving current and anticipated population problems. For example, infant and child mortality remain high in Yemen compared with other countries in the region and most third world countries. The impact of high mortality is reflected in life expectancy, which is relatively low. Results of the 1994 census indicate that life expectancy is only 58 years for both sexes. The total fertility rate is still high as well, despite a decrease from 7.7 births per woman in 1991-92 to 7.4 in the 1994 census. 4 1.4 Socioeconomic Conditions Education Education is one of the most important indicators of socioeconomic development; hence, the State has paid great attention to this sector since the revolution in the early 1960's. Illiteracy among Yemenis was the highest among Arab and other developing countries. At the time of the revolution there was not one secondary school in the country, with the exception of Aden. Statistics indicate that considerable progress has been achieved in the area of education. The number enrolled in basic education for the year 1996/97 was 2,557,329 students of both sexes, distributed over 10,355 schools. The number enrolled in secondary education for the same year was approximately 289,578 students of both sexes, distributed over 1993 schools. As for higher education, the enrollment figures in the Yemeni public universities reached 104,784 students of both sexes. The private sector has taken on an effective role in education that needs encouragement, guidance, and supervision in order to maintain a strong supporting role with the State. The private sector can serve the community in this important area by becoming involved in all stages of basic, secondary, and higher education, as well as pre-school nurseries and kindergartens, and technical and vocational training. Illiteracy still characterizes, half the Yemeni population. The results of the 1994 census indicate the illiteracy rate among males 10 years and over is 37 percent while it reaches 76 percent among females in the same age group. Illiteracy is most marked among females, particularly in rural areas. The enrollment rate in basic education for the age group 6-15 years is around 71 percent for males and 38 percent for females. This means the State, the community, and the private sector continue to have an important role in extending basic education through out the population, while still taking into account the high rate of population growth, which remains a significant challenge. Health Health conditions in any community are the result of various social, economic, cultural and environmental factors. Yemen witnessed many changes in the period following the revolution. The number of hospitals in 1997 reached 84 in addition to 421 health centers, with a total capacity of 9,788 beds and a staff of 4,070 doctors, of whom 3,803 are Yemeni doctors. Despite development in the health sector, the rate of coverage by health services for the population is still at the 45 percent level, and this is basically concentrated in urban centers. At the same time rural areas are relatively deprived of these health services, especially the remote areas which have difficult geographical terrain. In fact the private sector has participated in a tangible and effective manner, whether on the level of cooperative or charitable societies or by individual effort. In spite of its growth throughout the country, the private sector for the most part is still confined to the main cities. There is no precise monitoring of the role of the private sector which is in need of support, sponsorship, and supervision from the state and the community, in order to have a more improved and effective role. Labor Force and Food Production The age group 15–64 years represents 46 percent of the country’s population in 1994 compared with 50 percent for children in the age group under 15 years, and about 4 percent in the age group 65 years and 5 over. Therefore, the dependency ratio in Yemen is high: for every 100 persons in the age group 15-64 years approximately 117 persons in the nonproductive age groups are being supported. Around 53 percent of the Yemeni labor force is involved in the agriculture and fishing sectors, while the rest of its labor force is distributed among other sectors. Total arable land in the country is approximately 1.66 million hectares, representing 67 percent of the total land area. Only 1.11 million hectares are under cultivation. Agriculture depends mainly on rain water, thus production is subject to changing climatic conditions. Generally, locally grown fruits and vegetables are sufficient to meet the needs of the population. However, Yemen imports some essential food products such as wheat; two-thirds of flour consumed is imported from other countries. There are indications that Yemen has considerable unexploited mineral wealth, especially oil, which has gained great attention from the state. Oil exploration operations have increased considerably since unification of the country. It is likely that Yemen will be exporting oil in large quantities in coming years. 1.5 Population Policy The National Committee for Population and Family Planning (NCPFP) was established in 1984 to strengthen the government’s capacity to implement population policy in North Yemen. After the achievement of Yemen’s unity in May 1990, the government drafted a national population strategy which, after revision, was adopted as national policy at the National Population Conference in October 1991. The National Population Council was established to oversee implementation of the policy. The overall objectives of the National Population Strategy for the period 1990-2000 are: 1. Reduce the crude death rate (CDR) by at least 50 percent by the year 2000. 2. Reduce the total fertility rate (TFR) to reach 6 births per woman for the same period. 3. Reduce the infant mortality rate to 60 deaths per 1,000 live births and maternal mortality by 50 percent of its 1990 level. 4. Achieve a population growth rate of 2 percent by the year 2000. 5. Achieve a tangible change in the quality of life of the population through the following goals: a) Increase the enrollment rate in formal education to 85 percent of the children in the age group 6-12, especially among girls in rural areas. b) Intensify work in the health sector, especially in primary health care, and improve the preventive and curative areas of the health system; expand family planning and family care services. c) Improve the living conditions of the population, satisfy their basic needs and raise income levels. 6. Achieve a population distribution between urban and rural areas that corresponds to the prevailing environmental, economic, and production requirements. 7. Care about, protect, and improve the environment. 6 8. Follow up and assess overall comprehensive development programs and develop their capacities. 9. To develop and improve population-related legislation. 1.6 Objectives of Family Planning Strategy The objectives of the family planning program in Yemen are: 1. Increase the use of contraception to 35 percent among women of reproductive age and expand family planning services to men, and 2. Make family planning a free choice for couples, a basic human right as well as a factor for social change. Family planning must also include the right to treatment for infertility. The general secretariat of the NCPFP prepared for the Second Conference on Population Policy (held in October 1996) with the aim of evaluating and assessing progress in the implementation of strategy and revising the work plan on population in light of international, regional, and local events. Many participant experts, politicians, interested persons, and concerned international and local organizations attended the Conference and issued an updated work plan on population that took into account the necessity of updating the following fields and work areas: C In the field of health, a few modifications in reproductive health were made regarding quantitative targets especially those concerned with maternal and child health and family planning. C In the field of human resources, in addition to some modifications in the objectives and means of achieving them, two main areas of concern were the specific groups of children, adults, older ages, and invalids, as well as the household. C In the area of ongoing development, issues of poverty were included and the necessity for full incorporation of environmental and population factors into the plans and programs of economic development were discussed. 1.7 Objectives of the Survey The 1997 Yemen Demographic, Maternal and Child Health Survey (YDMCHS-97) has the following objectives: 1. Provide policymakers and decisionmakers with a reliable database and analyses useful for policy choices and population programs, and provide researchers, other interested persons, and scholars with such data. 2. Update and expand the national population and health data base through collection of data which will allow the calculation of demographic rates, especially fertility rates, and infant and child mortality rates; 3. Analyse the direct and indirect factors which determine levels and trends of fertility. Indicators related to fertility will serve to elaborate plans for social and economic development; 4. Measure the level of contraceptive knowledge and practice by method, by rural and urban residence including some homogeneous governorates (Sana’a, Aden, Hadhramaut, Hodeidah, Hajjah and Lahj). 7 5. Collect quality data on family health: immunizations, prevalence and treatment of diarrhea and other diseases among children under five, prenatal visits, assistance at delivery and breastfeeding; 6. Measure the nutritional status of mothers and their children under five years (anthropometric measurements: weight and height); 7. Measure the level of maternal mortality at the national level. 8. Develop skills and resources necessary to conduct high-quality demographic and health surveys. This survey is part of the worldwide Demographic and Health Surveys (DHS) program. Macro International Inc. (Macro) provides technical and administrative support for the DHS program, which is funded by the U.S. Agency for International Development (USAID). 1.8 Survey Activities A number of basic tasks were implemented from May 1, 1997 to September 25, 1997: 1. Preparation of the project document including the work plan, the time table, and the budget; 2. Formation of the survey committees and administrative structure (supervisory and technical); 3. Preparation of the technical documents; 4. Sample design; 5. Household listing to update the selected areas of the sample; 6. Pretest of the survey documents; 7. Estimation for the provision of human and material resources required for the survey. Below are some of the important details for this phase. Preparation of the Survey Project Document The first draft of the survey subcontract between the Central Statistical Organization (CSO), the implementing agency of the YDMCHS-97, and Macro was prepared in December 1996, and finalized a few months later. The subcontract was signed by the CSO and Macro in June 1997 after the delivery order for the Yemen survey was finalized by the USAID Mission in Cairo. Formation of Committees The Council of Ministers decree No. 234 of 1997 was issued to form the Supreme Committee of the Survey or the Steering Committee headed by the chairman of the CSO. The tasks of this committee are defined as the facilitation and provision of the required support to make the survey a success, and implementation of alternative strategies as needed to resolve survey problems. A technical committee was also formed and charged with preparation and approval of all survey technical documents and other tasks associated with specified activities at various stages of the survey, as well as provision of survey personnel and, material and financial resources (see Appendix A for the names 8 of the Supreme Committee and the Technical Committee, the field personnel and other persons involved in the YDMCHS-97). Preparation of Documents The survey documents include the following: Household Questionnaire: The household questionnaire consists of two parts: a household schedule and a series of questions relating to the health and socioeconomic status of the household. The household schedule was used to list all usual household members. For each of the individuals included in the schedule, information was collected on the relationship to the household head, age, sex, marital status (for those 10 years and older), educational level (for those 6 years and older) and work status (for those 10 years and older). It also collects information on fertility, general mortality and child survival. The second part of the household questionnaire included questions on housing characteristics including the type of dwelling, location, materials used in construction, number of rooms, kitchen in use, main source of drinking water and health related aspects, lighting and toilet facilities, disposal of garbage, durable commodities, and assets, type of salt the household uses for cooking, and other related residential information. Individual Questionnaire: The individual questionnaire was administered to all ever-married women age 15-49 years who were usual residents. It contained 10 sections on the followings topics: - Respondent’s background - Reproduction - Family planning - Pregnancy and breastfeeding - Immunization and health - Birth preferences - Marriage and husband’s background - Maternal mortality - Female circumcision - Height and weight (see Appendix E for the English version of the questionnaires). Other Documents: Other documents prepared for use in survey activities were training manuals and field reporting forms (interviewer’s and supervisor’s assignment sheets, and editing and coding instructions). Sample Design The 1997 YDMCHS was based on a national sample in order to provide estimates for general indicators for the following domains: Yemen as a whole, urban and rural areas (each as a separate domain), three ecological zones identified as Coastal, Mountainous, and Plateau and Desert, as well as governorates with a sample size of at least 500 completed cases. The survey sample was designed as a two-stage cluster sample of 475 enumeration areas (EA), 135 in urban areas and 340 in rural areas. The master sample, based on the 1994 census frame, was used as the frame for the 1997 YDMCHS. The population covered by the Yemen survey was the universe of all ever-married women age 15-49. The initial target sample was 10,000 completed interviews among eligible women, and the final sample was 10,414. In order to get this number of completed interviews, and using the response rate found in the 1991-92 YDMCHS survey, a total of 10,701 of the 11,435 potential households selected for the household sample were completed (see Appendix B for a complete description of the sample design). 9 In each selected EA, a complete household listing operation took place between July and September 1997, and was undertaken by nineteen (19) field teams, taking into consideration the geographical closeness of the areas assigned to each team. Pretest The household and individual questionnaires were pretested in August 1997 following a three-week training course. Four male supervisors and 15 female interviewers participated in the pretest. Two hundred and fifty households were interviewed in Sana’a City (70 households) and in rural areas of Sana’a Governorate (180 households). At the end of the pretest fieldwork, a meeting was held with the two teams which conducted the interviews. At the meeting the experiences of interviewers, editors, and supervisors were discussed. The pretest was extremely helpful in revising and modifying the questionnaires and in producing the final version of the questionnaires that was used for the main fieldwork. The completed pretest questionnaires were checked for data quality and completeness of answers to some questions considered “sensitive” such as the questions on female circumcision. The questionnaires were modified and interviewer’s instructions were revised in light of feedback from the field staff and review of the pretest questionnaires. Printing of Survey Documents After finalizing the questionnaires and fieldwork manuals, the basic documents and other forms to be used in the field for monitoring fieldwork operations and checking quality control were printed. The number of documents printed was as follows: Training manuals (200 copies) Household questionnaire (15,000 copies) Individual questionnaire (15,000 copies). Training and Data Collection Activities Training: The CSO organized the interviewer training for the main fieldwork by recruiting interviewers from all over the country. The CSO staff from the central and regional offices who had worked on the household listing were recruited as supervisors. From almost 500 applicants, 132 were selected for training as interviewers. Some of the interviewers had participated in the 1991-92 YDMCHS. From over 55 persons who had participated in the household listing, 32 were selected as candidates for supervisors. Because of the large number of the trainees, two groups were formed to be trained separately, and training on height and weight was given in four MCH centers in Sana’a. The training program included: 1) general lectures related to basic interview techniques and to survey topics (i.e. fertility and family planning, and maternal and child health); 2) opportunities for role playing and mock interviews; 3) field practices in areas not covered in the survey; and quizzes. Training lasted from the end of September to mid-October 1997. After the completion of training and practice interviews, 84 female candidates were selected as interviewers or editors, and 31 men were selected to work as supervisors or editors. Fieldwork: Fieldwork for the 1997 YDMCHS began on October 20, and was completed on December 30, 1997. The field staff was divided into 19 teams; each team had a male supervisor, 4-5 female interviewers, and a male or female editor. During the fieldwork period, the senior project staff from Sana’a visited the teams regularly to monitor the quality of the completed questionnaires and to solve any technical or field problems the teams encountered. 10 Table 1.1 Results of the household and individual interviews Number of households and eligible women, and response rates by residence, Yemen 1997 __________________________________________________ Residence Sample/ _______________ response rate Urban Rural Total __________________________________________________ Household interviews Households sampled Households found Households interviewed Household response rate Individual interviews Number of eligible women Number of eligible women interviewed Eligible woman response rate 3,255 8,180 11,435 3,049 7,846 10,895 3,008 7,693 10,701 98.7 98.0 98.2 3,166 7,992 11,158 2,945 7,469 10,414 93.0 93.5 93.3 In addition, the teams were encouraged to keep the survey operations desk informed about the progress of the work and any problems requiring assistance. Whenever possible, the monitoring staff returned to Sana’a with completed questionnaires so that data processing could be carried out simultaneously with fieldwork. On receipt of the questionnaires at the central office, the process of revising, editing, coding and processing the data was carried out. Data Processing Activities The cental office in Sana’a was responsible for collecting questionnaires from the field as soon as each cluster was completed. Questionnaires were reviewed for consistency and completeness by office editors, and a few questions (e.g., occupation and type of illness) were coded in the office prior to data entry. The machine entry and editing phase began while interviewing teams were still in the field. The CSO made its network of 12 computers available to the survey for data entry. The computer programs that had been prepared at Macro headquarters for use in the 1997 YDMCHS were modified to take into account the network environment. The data from the questionnaires were entered and edited using the Integrated System for Survey Analysis (ISSA), a software package developed especially for the Demographic and Health Surveys program. Twelve data entry personnel participated in processing the survey data. During machine entry, 50 percent of each segment was reentered for verification. The data processing started at the beginning of November 1997 and was completed at the end of February 1998. Tables for the preliminary report were prepared in March 1998 and tables for the final report were completed in June 1998. 1.9 Results of the Household and Individual Interviews A summary of the outcome of the fieldwork for the survey by place of residence is presented in Table 1.1. The table shows that 10,701 households, distributed between urban (3,008 households) and rural areas (7,693), households which were successfully inter- viewed in the 1997 YDMCHS. This repre- sents a country-wide response rate of 98.2 percent (98.7 and 98.0 percent, respectively, for urban and rural areas). A total of 11,158 women were identi- fied as eligible to be interviewed. Question- naires were completed for 10,414 women, which represents a response rate of 93.3 per- cent. The response rate in urban areas was 93 percent; and in rural areas it was 93.5 percent. 11 Table 2.1 Household population by age, residence and sex Percent distribution of the de jure household population by five-year age groups, according to urban-rural residence, sex, and sex ratio, Yemen 1997 _____________________________________________________________________________________________________ Urban Rural Total __________________________ _________________________ __________________________ Age Sex Sex Sex group Male Female Total ratio Male Female Total ratio Male Female Total ratio ______________________________________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Missing/Don't know Total Median Number 14.9 14.7 14.8 109 17.4 16.4 16.9 107 16.7 16.0 16.4 107 14.4 14.4 14.4 107 17.7 17.1 17.4 105 16.8 16.4 16.6 105 15.9 15.0 15.4 113 16.6 15.6 16.1 107 16.4 15.5 15.9 109 13.0 13.9 13.4 100 11.6 11.8 11.7 100 12.0 12.3 12.1 100 9.5 9.4 9.4 108 6.7 7.4 7.1 92 7.5 7.9 7.7 96 6.8 6.8 6.8 107 5.2 5.9 5.6 89 5.6 6.1 5.9 94 5.0 5.5 5.3 97 3.9 4.8 4.3 83 4.2 4.9 4.6 87 5.0 5.4 5.2 99 4.3 5.0 4.6 88 4.5 5.1 4.8 91 3.7 3.3 3.5 118 3.0 3.1 3.0 98 3.2 3.2 3.2 103 2.8 2.3 2.6 128 2.6 2.4 2.5 109 2.6 2.4 2.5 114 2.1 2.9 2.5 79 2.3 3.2 2.7 73 2.2 3.1 2.7 74 1.7 2.0 1.9 89 1.9 2.2 2.1 90 1.9 2.2 2.0 90 1.9 1.4 1.6 141 2.1 1.7 1.9 123 2.0 1.6 1.8 127 1.4 0.9 1.2 171 1.4 1.0 1.2 147 1.4 1.0 1.2 152 1.0 0.9 0.9 116 1.4 1.0 1.2 142 1.3 1.0 1.1 136 0.4 0.4 0.4 111 0.6 0.5 0.6 143 0.6 0.4 0.5 136 0.6 0.8 0.7 77 1.2 0.9 1.1 133 1.0 0.9 1.0 120 0.0 0.0 0.0 84 0.0 0.0 0.0 137 0.0 0.0 0.0 107 100.0 100.0 100.0 107.0 100.0 100.0 100.0 101.0 100.0 100.0 100.0 103.0 16.7 17.0 16.8 NA 14.4 15.3 14.9 NA 15.0 15.7 15.4 NA 9,879 9,251 19,130 NA 27,890 27,569 55,459 NA 37,768 36,820 74,589 NA ______________________________________________________________________________________________________ Note: Table is based on de jure members, i.e., usual residents. Sex ratio is the number of males per 100 females. NA = Not applicable CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter presents information on selected socioeconomic characteristics of the household population and individual survey respondents including age, sex, education, school enrollment and participation in the labor force. The chapter also considers the conditions surrounding the households in which the survey population live, including the source of drinking water, availability of electricity, sanitation facilities, housing materials, and housing congestion. This background information is useful for understanding the factors which affect reproductive and contraceptive use behavior. 2.1 Characteristics of the Household Population The YDMCHS Household Questionnaire was used to collect data on the demographic and social characteristics of all usual residents of the sampled household (de jure population). Age and Sex Composition Table 2.1 presents the percent distribution of the de jure population by age, according to urban-rural residence and sex. The table shows the effects of past demographic trends on the structure of the Yemeni population and indicates the context in which a variety of demographic processes are operating. 12 The YDMCHS households constitute a population of 74,589 persons and the sample is 26 percent urban. There are slightly more men (51 percent) than women (49 percent), and there are larger numbers of the population in the younger age groups than in the older age groups. This applies in both urban and rural areas and among both males and females. The information on sex and age distribution can be used to construct a population pyramid describing the 1997 YDMCHS household population (see Figure 2. 1). The pyramid has a wide-base, with a large concentration (49 percent) of the population under 15 years of age. This pattern is typical of countries with high fertility. As Table 2.1 shows, the median age is 15.4 years, a slight increase compared with the 1991-92 survey (14.1 years). The median age in urban areas (16.8) is higher than that in rural areas (14.9). In addition, the proportion under age 15 is greater in rural areas than in urban population. The differences in the age distribu- tion are evidence of lower recent fertility in urban areas compared with rural areas (see Chapter 3 on Fertility). The distribution of the de jure popula- tion by broad age groups presented in Table 2.2 indicates that children under 15 years of age account for 49 percent of the population, while individuals in age group 15-64 account for 47 percent, with the remaining population over 65 Table 2.2 Population by age, 1991-92, 1994, and 1997 Percent distribution of the population by broad age group 1991-92 YDMCHS, 1994 Census, and 1997 YDMCHS _________________________________________________ 1991-92 1994 1997 Age group YDMCHS Census YDMCHS __________________________________________________ < 15 52.1 50.3 48.9 15-64 43.5 46.2 47.2 65+ 4.4 3.5 3.8 Total 100.0 100.0 100.0 Median age 14.1 13.9 15.4 13 Table 2.3 Household composition Percent distribution of households by sex of head of household and household size and percentage of households with foster children, according to residence, Yemen 1997 _____________________________________________ Characteristic Urban Rural Total _____________________________________________ Household headship Male Female Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size Percentage of households with foster children1 90.6 90.5 90.5 9.4 9.5 9.5 2.7 2.9 2.9 4.9 8.0 7.2 7.5 8.4 8.1 9.4 9.2 9.3 11.0 9.7 10.0 10.8 10.9 10.9 12.5 11.0 11.3 9.9 10.7 10.5 31.3 29.3 29.8 100.0 100.0 100.0 7.2 6.9 7.0 4.7 3.1 3.5 _____________________________________________ Note: By convention, foster children are those who are not living with either of their biological parents. This includes orphans, i.e., children with both parents dead. -- Less than 0.05 percent years of age. The dependency ratio, defined as the ratio of the nonproductive population (the sum of persons under 15 years and over 64 years) to the population age 15-64, is 112 which means that there are 112 persons under 15 years or over 64 years in Yemen for every 100 persons age 15-64 years. The dependency ratio decreased from 130 in 1991-92 to 116 in 1994 and 112 in 1997, indicating a change in fertility levels. Household Composition Table 2.3 presents the distribution of house- holds in the 1997 YDMCHS sample by sex of the head of household and by the number of household members. These characteristics are important because they are often associated with socioeco- nomic differences between households. For exam- ple, female-headed households frequently are poorer than households headed by males. In addi- tion, the size and composition of the household affects the allocation of financial and other re- sources among household members, which in turn influences the overall well-being of these individu- als. Household size is also associated with crowd- ing in the dwelling, which can lead to unfavorable health conditions. Female-headed households make up less than 10 percent of the households in the 1997 YDMCHS., and there is no variation by residence. This is a slight decrease from the 1991-92 survey when the level of female-headed households was 12 percent. There are, on average, 7 persons in a Ye- meni household. Less than one in five households has fewer than four members, while one in two households has seven or more members. House- holds in urban areas are slightly larger (7.2 persons) than those in rural areas (6.9 persons). Foster children are those persons under 15 years of age who are not living with either of their biological parents. Less than 4 percent of households have foster children; urban households are more likely to have foster children than rural households. Information regarding foster children and orphans under 15 years of age is presented in Table 2.4. More than 85 percent of children under 15 years of age live with both parents, 8 percent live with their mothers (but not their living fathers), and 1 percent live with their fathers (but not their living mothers), while less than 1 percent live with neither parent, although both are alive. Four percent of children live with only one parent because the other parent is dead. The percentage of children not living with both parents increases with increasing age of the child. The proportion living with both parents varies little by sex, residence, or region. 14 Table 2.4 Fosterhood and orphanhood Percent distribution of de jure children under age 15 by survival status of parents and child’s living arrangements, according to child’s age, sex, residence, and region, Yemen 1997 _____________________________________________________________________________________________________ Living Living with mother with father Not living with but not father but not mother either parentLiving ____________ _____________ _______________________ Missing with Father Mother info. on Background both Father Father Mother Mother Both only only Both father/ characteristic parents alive dead alive dead alive alive alive dead mother Total Number______________________________________________________________________________________________________ Age <2 3-5 6-8 9-11 12+ Sex Male Female Residence Urban Rural Region Coastal Mountainous Plateau and Desert Total 90.0 8.5 0.5 0.4 0.3 0.2 0.1 -- -- -- 100.0 7,351 86.9 9.1 1.5 0.8 0.8 0.5 0.2 0.1 0.1 0.0 100.0 7,005 84.5 8.9 2.8 1.1 1.2 0.7 0.4 0.3 0.1 -- 100.0 8,027 83.5 7.6 3.6 1.5 1.8 1.1 0.3 0.3 0.2 -- 100.0 7,111 80.9 6.6 5.1 1.8 2.5 1.8 0.3 0.5 0.4 -- 100.0 6,998 85.4 7.9 2.7 1.1 1.3 0.8 0.2 0.3 0.2 -- 100.0 18,862 85.0 8.4 2.6 1.1 1.3 0.8 0.3 0.2 0.1 -- 100.0 17,628 86.2 6.4 2.4 1.3 1.5 1.5 0.3 0.1 0.3 -- 100.0 8,532 84.9 8.7 2.7 1.1 1.3 0.6 0.3 0.3 0.1 -- 100.0 27,959 86.7 7.7 2.3 0.7 1.2 0.9 0.2 0.2 0.2 -- 100.0 7,680 85.2 8.3 2.4 1.1 1.2 0.8 0.4 0.4 0.2 -- 100.0 11,235 84.6 8.3 3.0 1.3 1.5 0.9 0.2 0.2 0.1 -- 100.0 17,575 85.2 8.2 2.7 1.1 1.3 0.8 0.3 0.2 0.2 -- 100.0 36,491 _____________________________________________________________________________________________________ Note: By convention, foster children are those who are not living with either of their biological parents. This includes orphans, i.e., children with both parents dead. -- Less than 0.05 percent 2.2 Education of the Household Population The educational level of household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and the health of children. Educational Attainment The educational level of household members is an important characteristic because educational attainment affects many areas including reproductive behavior, proper hygienic practices, health of children and the status of women. Table 2.5.1 presents data on the educational level of the female population age 6 and over. Overall, two-thirds of the females have no education, less than 21 percent have not completed their primary education, leaving only 12 percent of all females who completed primary education and higher. An examination of the changes in educational indicators over successive cohorts indicates that there has been an increase over time in the educational attainment of women. For example, the percentage of women with some schooling is 55 percent in the 15-19 age group compared with 9 percent in the 35-39 age group. 15 Table 2.5.1 Educational level of the female household population Percent distribution of the de jure female household population age 6 and over by highest level of education completed, and median number of years of schooling, according to selected background characteristics, Yemen 1997 _____________________________________________________________________________________________________ Median Background No Incomplete Complete Incomplete Complete years of characteristic education primary primary secondary secondary+ Missing Total Number schooling ______________________________________________________________________________________________________ Age 6-10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Missing/Don't know Residence Urban Rural Region Coastal Mountainous Plateau and Desert Total 59.0 38.1 0.1 0.1 0.0 2.7 100.0 4,994 0.0 44.9 42.9 6.5 5.5 0.0 0.2 100.0 5,695 1.1 48.6 20.3 8.1 22.4 0.4 0.2 100.0 4,534 1.0 60.7 14.4 5.7 14.0 5.2 0.0 100.0 2,920 0.0 75.9 9.3 3.3 7.5 4.0 0.0 100.0 2,264 0.0 83.2 6.4 2.8 5.5 2.2 0.0 100.0 1,821 0.0 91.1 3.4 1.4 3.2 0.9 0.0 100.0 1,869 0.0 94.5 2.3 0.7 1.6 0.8 0.0 100.0 1,160 0.0 97.2 1.2 0.5 1.0 0.2 0.0 100.0 878 0.0 99.1 0.2 0.1 0.4 0.1 0.1 100.0 1,140 0.0 99.3 0.2 0.1 0.3 0.0 0.1 100.0 792 0.0 99.7 0.1 0.0 0.2 0.0 0.0 100.0 606 0.0 99.7 0.0 0.0 0.0 0.0 0.2 100.0 1,201 0.0 82.2 0.0 0.0 0.0 0.0 17.8 100.0 8 0.0 41.1 28.8 6.9 18.6 3.8 0.8 100.0 7,662 1.5 76.2 17.6 2.5 3.1 0.2 0.4 100.0 22,219 0.0 62.3 19.7 3.9 11.2 2.6 0.3 100.0 6,892 0.0 78.4 16.1 1.9 3.1 0.1 0.4 100.0 9,023 0.0 62.5 23.7 4.5 7.5 1.0 0.7 100.0 13,965 0.0 67.2 20.5 3.6 7.1 1.1 0.5 100.0 29,881 0.0 ______________________________________________________________________________________________________ Note: Six women for whom age was not reported are not shown separately. -- Less than 0.05 percent Urban women are more likely to have attended school than rural women. Fifty-nine percent of females in urban areas have attended school compared with only 24 percent of females in rural areas. By region, the proportion of women with no education is higher in the Mountainous region (78 percent) than in the Coastal (62 percent) or the Plateau and Desert region (63 percent). Table 2.5.2 shows that two-thirds of males age six and over have some education, and that 5 percent have completed at least secondary education. The differentials in the level of education among the male population presented in this table indicate that they follow the same pattern found in the female population. Tables 2.5.1 and 2.5.2 indicate that there is a large gap between male and female education. The proportion of males who have some education is twice that of females—67 percent compared with 33 percent, respectively. This gap widens as the educational level increases. For example, only 12 percent of women have completed at least primary education compared with 37 percent of males. School Attendance Table 2.6 presents the school attendance rates of the household population age 6 to 24 years according to age, sex, and urban-rural residence. A school attendance rate is the number of persons attending school at a specific age group per hundred persons in that age group. Fifty-eight percent of children age 6-15 are in school; and school attendance in urban areas (80 percent) is more than 29 percentage points higher than rural enrollment (51 percent). 16 Table 2.5.2 Educational level of the male household population Percent distribution of the de jure male household population age 6 and over by highest level of education completed, and median number of years of schooling, according to selected background characteristics, Yemen 1997 _____________________________________________________________________________________________________ Median Background No Incomplete Complete Incomplete Complete years of characteristic Education primary Primary secondary secondary Missing Total Number schooling ______________________________________________________________________________________________________ Age 6-10 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Missing/Don't know Residence Urban Rural Region Coastal Mountainous Plateau and Desert Total 36.9 59.8 0.2 0.2 0.0 2.9 100.0 5,263 0.2 7.3 65.0 13.0 14.4 0.0 0.2 100.0 6,183 3.7 5.2 18.9 11.0 63.7 1.1 0.1 100.0 4,514 7.3 6.8 12.1 9.4 55.5 16.2 0.1 100.0 2,817 8.9 16.2 12.6 11.0 39.6 20.5 0.1 100.0 2,129 7.6 34.3 14.5 14.1 25.1 11.8 0.2 100.0 1,581 5.1 52.8 9.4 11.0 17.1 9.3 0.4 100.0 1,694 0.0 70.5 5.2 6.1 11.8 6.2 0.1 100.0 1,199 0.0 78.9 5.5 3.8 6.6 5.1 0.1 100.0 998 0.0 83.8 4.5 3.5 5.1 2.9 0.2 100.0 847 0.0 89.3 3.1 2.5 3.5 1.5 0.0 100.0 712 0.0 93.4 2.4 0.7 2.5 0.8 0.2 100.0 767 0.0 96.8 1.2 0.8 0.9 0.2 0.1 100.0 1,640 0.0 65.6 0.0 0.0 0.0 0.0 34.4 100.0 8 0.0 21.2 28.9 8.8 30.6 9.7 0.9 100.0 8,133 4.9 36.7 31.0 7.6 21.2 3.0 0.5 100.0 22,219 2.0 34.7 31.0 7.0 21.4 5.4 0.5 100.0 7,224 2.4 38.5 29.9 7.1 21.1 2.8 0.6 100.0 8,719 1.9 27.9 30.5 8.8 26.3 5.8 0.7 100.0 14,410 3.6 32.6 30.4 7.9 23.7 4.8 0.6 100.0 30,352 2.8 _____________________________________________________________________________________________________ Note: Eleven men for whom age was not reported are not shown separately. Table 2.6 School Enrollment Percentage of the de jure household population age 6-24 years enrolled in school by age group, sex, and residence, Yemen 1997 _____________________________________________________________________________________________________ Male Female Total Age ________________________ _________________________ ________________________ group Urban Rural Total Urban Rural Total Urban Rural Total ______________________________________________________________________________________________________ 6-10 80.2 63.4 67.1 75.9 31.5 41.2 78.1 47.8 54.5 11-15 90.2 81.4 83.6 74.6 25.7 38.4 82.6 54.7 61.9 6-15 85.1 71.5 74.8 75.3 29.0 39.9 80.4 50.9 57.9 16-20 58.5 50.2 52.7 39.0 8.5 17.2 48.9 29.2 34.9 21-24 31.8 22.7 25.8 14.3 2.4 6.0 23.5 11.9 15.6 Table 2.6 shows that the gender differences in school attendance are large. For example, while 75 percent of boys age 6-15 are attending school, this figure is only 40 percent for girls age 6-15. Similar differences by gender are observed in the attendance rates for the other age groups, with the gap increasing with age of child. Boys are more than three times as likely as girls at age 16-20 and more than four times as likely at age 21-24 to be attending school. The gender disparity in school attendance widens substantially in rural areas at higher ages. 1 Status categories were the same as those used in the census. 17 Table 2.7 Activity status of household population Percent distribution of the de jure household population age 10-64 years by current activity status, according to residence and sex, Yemen 1997 _____________________________________________________________________________________________________ Urban Rural Total Activity ________________________ _________________________ ________________________ status Male Female Total Male Female Total Male Female Total ______________________________________________________________________________________________________ Currently working Unemployed, worked before Housewife, working Student, working Unemployed, never worked before Housewife Student Income recipient Retired Handicapped Don't know/Missing Total Number 47.5 4.6 26.6 51.5 3.6 27.1 50.4 3.8 27.0 2.6 0.1 1.4 2.0 0.0 1.0 2.2 -- 1.1 NA 2.6 1.3 NA 24.9 12.7 NA 19.0 9.5 1.5 0.1 0.8 2.9 0.3 1.6 2.5 0.3 1.4 6.8 0.7 3.8 5.2 0.4 2.7 5.6 0.5 3.0 NA 60.9 29.6 NA 59.0 30.0 NA 59.5 29.9 38.7 29.7 34.3 34.9 9.8 22.1 36.0 15.1 25.5 0.5 0.1 0.3 0.4 0.4 0.4 0.4 0.3 0.4 0.9 0.1 0.5 0.3 0.0 0.2 0.5 -- 0.3 1.1 0.9 1.0 1.7 1.3 1.5 1.5 1.2 1.3 0.5 0.2 0.4 1.0 0.4 0.7 0.9 0.4 0.6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 6,646 6,283 12,929 16,795 17,396 34,190 23,441 23,678 47,119 ______________________________________________________________________________________________________ Note: Activity status categories are those used in the census. NA = Not applicable -- Less than 0.05 percent 2.3 Employment Status of Household Population In the household questionnaire, three questions were asked about the employment status of household members age 10 years and over.1 Table 2.7 shows that, overall, 50 percent of men were working at the time of the interview with very little difference in urban and rural areas (48 percent and 52 percent, respectively). Thirty-six percent declared that they were nonworking students, 6 percent were classified as unemployed, and 2 percent were handicapped. For women, only 4 percent were working at the time of the survey; 79 percent were classified as either housewives (60 percent) or housewives and working (19 percent). Fifteen percent reported that they were students, and 1 percent were handicapped. 2.4 Household Environment Housing Characteristics The physical characteristics of the household have an important bearing on environmental exposure to disease, as well as reflecting the household's economic condition. Respondents to the Household Questionnaire were asked about a number of questions about their housing situation, including type of dwelling, source of drinking water, type of toilet facilities, floor material, total number of rooms and number of rooms used for sleeping, type of cooking fuel, and type of salt used for cooking. Table 2.8 summarizes this information by residence. 18 Table 2.8 Housing characteristics Percent distribution of households by selected housing characteristics, according to urban-rural residence, Yemen 1997 ___________________________________________________________________________________________________________ Charac teristic Urban Rural Total Charac teristic Urban Rural Total ___________________________________________________________________________________________________________ Type o f household Single hou se 74 .6 87 .1 84 .0 Apartment 19 .3 1.5 5.9 Hut 1.3 10 .3 8.1 Sandaka 4.5 0.6 1.6 Other 0.3 0.4 0.4 Missing 0.0 -- – Total 100.0 100.0 100.0 Main f loor ma teria l Ear th 7.6 39 .3 31 .5 Stone/Mud 3.0 12 .3 10 .0 Gypsum 4.9 1.2 2.1 Wood 0.2 0.0 0.1 Tile 31 .5 1.4 8.8 Marb le 0.1 -- -- Cement 46 .0 33 .3 36 .4 Other materia ls 0.0 -- -- Hut, Sandaka, Other 6.6 11 .8 10 .5 Missing 0.1 0.6 0.5 Total 100.0 100.0 100.0 Number of persons per room <3 68 .7 51 .8 55 .9 3-4 22 .0 28 .6 27 .0 5-6 5.5 10 .5 9.2 7 + 3.8 8.9 7.6 Missing /Don’t know 0.1 0.2 0.2 Total 100.0 100.0 100.0 Mean num ber of persons per room 2.6 3.2 3.1 Persons per s leeping room <3 39 .2 29 .5 31 .9 3-4 40 .5 38 .0 38 .6 5-6 13 .3 17 .7 16 .6 7 + 7.0 14 .5 12 .7 Missing /Don’t know 0.1 0.3 0.3 Mean nu mber of persons per sleeping room 3.5 4.2 4.0 Source of drinking water Piped into residence 66 .3 19 .2 30 .8 Piped outside 2.5 7.8 6.4 Artesian we ll 4.3 13 .1 11 .0 W ell 1.0 32 .0 24 .3 Spring 0.2 15 .6 11 .8 Uncovered pond 0.4 3.5 2.7 Covered pond 0.4 3.7 2.8 Tanker truck 7.8 4.2 5.1 Bottled water 14 .6 0.1 3.7 From the neighbors 2.4 0.5 1.0 Other 0.1 0.3 0.3 Missing -- 0.1 0.1 Total 100.0 100.0 100.0 Time to water source Water within 15 minutes 85 .5 40 .5 51 .7 Median time to source 0.0 14 .9 9.8 Light Government light 85 .2 14 .9 32 .3 Cooperative light 3.5 3.9 3.8 Private light 0.8 4.7 3.7 Generator 0.4 3.5 2.7 Gas 2.8 10 .1 8.3 Kerosene 6.1 61 .9 48 .1 No light 1.2 0.7 0.8 Other 0.1 0.1 0.1 Missing 0.0 -- -- Total 100.0 100.0 100.0 Farm animals in living area No 75.1 21 .2 34 .5 Yes 24 .6 78 .7 65 .3 Missing 0.4 0.1 0.1 Total 100.0 100.0 100.0 Type o f toilet facility Connected flush toilet 36 .4 1.4 10 .0 Disconnected F. toilet 20 .0 3.1 7.3 Tradition al pit 8.5 22 .0 18 .6 Improved pit 26 .7 16 .7 19 .2 Uncovered toilet 4.6 13 .4 11 .2 In the nature 3.5 43 .3 33 .4 Other 0.3 0.1 0.1 Missing 0.0 0.1 – Total 100.0 100.0 100.0 Fuel for cooking1 Gas 85 .2 50 .7 59 .2 Wood 14.6 80 .3 64 .0 Kerosene 5.7 9.6 8.6 Coal/Charcoal 0.4 0.4 0.4 Elec tricity 0.2 0.1 0.1 Cows dung 0.1 3.1 2.4 Other 0.3 0.1 0.2 Type o f Salt Iod ized salt 69 .6 29 .0 39 .0 Non-iodized salt 3.5 3.6 3.6 Local salt/salt not analyzed 26 .5 67 .1 57 .1 Missing 0.4 0.2 0.3 Total 100.0 100.0 100.0 Ga rbage d isposal Garbage collector 6.9 0.9 2.4 Dum ped in special place 65 .0 15 .4 27 .7 Burned 2.0 4.6 3.9 Thrown in street 26 .0 79 .0 65 .9 Other 0.1 -- -- Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Household possessions Radio/cassette recorder 66 .3 45 .9 51 .0 Rad io 26 .1 25 .7 25 .8 Any radio 73 .1 57 .1 61 .1 Black & W hite television 34 .3 20 .1 23 .6 Color television 58 .4 11 .3 23 .0 Any television 83 .4 29 .2 42 .6 Video 17 .0 1.5 5.3 Refrigerator 56 .2 7.7 19 .7 Gas, electric range 82 .4 43 .0 52 .7 Water heater 23 .2 2.6 7.7 Sewing machine 30 .3 10 .1 15 .1 Electric fan 38 .3 4.6 12 .9 Washing machine 51 .3 4.4 16 .0 Telephone 26 .2 1.3 7.5 Air conditioner 11 .1 0.3 2.9 Vacuum cleaner 20 .5 1.4 6.1 Blender 45 .7 5.0 15 .0 Bicycle 11 .4 2.0 4.3 Motorcyc le 3.3 1.5 2.0 Private Car 20 .7 10 .2 12 .8 Taxi 5.7 3.1 3.7 Satellite dish 14 .1 0.5 3.9 Number of households 2,645 8,056 10,701 ___________________________________________________________________________________________________________ -- Less than 0.05 percent 1 multiple answers allowed 19 Type of dwelling: The majority of Yemenis live in separate houses (84 percent). There are more singles homes in rural areas than in urban areas (87 percent and 75 percent, respectively). Huts are second with only 8 percent, followed by apartments with 6 percent. As expected, the majority of huts are found in rural areas (10 percent), and most apartments are in cities (19 percent). Floor of dwelling: More than 36 percent of households live in dwellings with cement floors, 42 percent have earth or mud/stone floors; only 9 percent of households are in dwellings with tile floors. There are substantial differences in the flooring materials in urban and rural areas. Among urban households, 32 percent have a tile floor compared with 1 percent of rural households. Conversely, 51 percent of rural households live in dwellings that have earth or mud/stone floors compared with only 11 percent of urban households. Measure of crowding: Information on the number of persons per sleeping room was collected in the 97 YDMCHS in order to provide a measure of crowding. Table 2.8 shows that 32 percent of households have one or two persons per sleeping room, and 39 percent have three to four persons per sleeping room. The mean is 4.0 persons per sleeping room. Rural households are more crowded than urban households. The mean number of persons per sleeping room in rural areas is 4.2 compared with 3.5 in urban areas. The average number of persons per room (3.1) is lower than the average number of persons per sleeping room (4.0). Crowding is further exacerbated by the presence of animals in the living quarters at night. Sixty-five percent of households keep farm animals in their living area. In rural areas, the proportion exceeds three- quarters (79 percent) compared with one-quarter (25 percent) in urban areas. Fuel used for cooking: Overall, the majority of households (64 percent) use wood as a fuel for cooking, followed by gas as the second most common source of fuel (59 percent). Gas is used by 85 percent of urban households compared with 51 percent of rural households. Conversely, 80 percent of rural households use wood compared with 15 percent of urban areas. Other limited sources of fuel for cooking are kerosene (9 percent), and cow dung (2 percent). Source of lighting: The percentage of households supplied with electricity is about 43 percent of all households. As expected, electricity is more available in urban areas than in rural areas. Nine in ten urban households use electricity for lighting, compared with less than three in ten rural households. The majority of households in rural areas use kerosene lamps for lighting (62 percent). Sources of drinking water: In Yemen, 37 percent of households have access to piped water, mainly within their dwelling (31 percent). The other main sources of drinking water are wells (24 percent), spring water (12 percent) and artesian wells (11 percent). The survey data for urban areas indicate that about seven in ten households are connected to the public water supply; in 1991-92, this figure was almost nine in ten households. The proportion has fallen during the last few years due, probably, to housing expansion, which has outstripped expansion of the water supply network. In rural areas, however, wells are a common source for drinking water. Nearly half of rural households (45 percent) get their water from wells. The majority of these households have wells without pumps (32 percent). Springs are the source of drinking water for 16 percent of rural households. Table 2.8 also shows that about 52 percent of all households can get water within 15 minutes. About 86 percent of urban households obtain water within 15 minutes, compared with only 41 percent of rural households. Overall, the median time to obtain drinking water is 10 minutes. 20 Sanitation system: Only 17 percent of Yemeni households have a modern flush toilet; almost half of households have traditional pit toilets or latrines. One-third of households have no toilet facilities. There are differences in types of toilet facilities available to households by urban-rural residence. More than half of households in urban areas (56 percent) have a flush toilet, and 40 percent have a pit or latrine. Only 4 percent of urban households have no toilet facilities. In comparison, less than 5 percent of rural households have a flush toilet, 52 percent have a pit or latrine, and 43 percent report no toilet facilities. Garbage disposal: Table 2.8 indicates that about two-thirds of Yemeni households (66 percent) dispose of garbage by throwing it in the street, and 28 percent dump it in a special place. Four percent of households burn their garbage, and 2 percent give it to the garbage collector. A majority of urban households (65 percent) dispose of their garbage in garbage containers, and 26 percent throw it in the street. In rural areas, eight of ten households dispose of their garbage by throwing it in the street. This represents a slight decrease from the 1991-92 survey, where nine of ten households threw garbage in the street. Iodine used in food salt: The type of salt used for cooking is included in the Yemen survey in order to assess the presence or absence of iodine in the diet, which has health implication. Interviewers were provided with a special solution to confirm the presence or absence of iodine in the salt. Table 2.8 shows that only 39 percent of households use iodized salt. Looking at the patterns by urban-rural residence, it is clear that urban households (70 percent) use more iodized salt than rural households (29 percent). The table also shows that 57 percent of all households use local salt (not analyzed). This kind of salt is used primarily in rural areas (67 percent); only 27 percent of urban households use local salt. Local salt is commonly used in rural areas because it is low in cost and easily available. Household Possessions Table 2.8 also provides information on household ownership of durable goods and other possessions. With regard to durable goods, more than four in ten households (43 percent) in Yemen own a television (color or black white), more than six in ten households (61 percent) own a radio (radio or radio with cassette recorder), more than one in two households (53 percent) own a stove, two in ten (20 percent) own a refrigerator, and more than one in seven own a washing machine, a blender, or a sewing machine. Possession of other durable goods varies from 2 percent for a motorcycle to 13 percent for an electric fan. Urban households are more likely to have the convenience of these items than rural households. For example, 56 percent of households in urban areas own a refrigerator compared with 8 percent in rural areas. Similarly, 82 percent of urban households own a cooking stove compared with 43 percent of households in rural areas. Table 2.8 also includes information on household ownership of a means of transportation. Almost 17 percent of households own a private car or a taxi, and 2 percent own a motorcycle. 2.5 Background Characteristics of Respondents General Characteristics Table 2.9 presents the distribution of the 10,414 respondents to the individual questionnaire by various background characteristics including age, marital status, urban-rural residence, region and education level. As noted in Chapter 1, ever-married women age 15-49 who were usual residents were eligible to be interviewed in the 1997 YDMCHS. Among the ever-married women in the sample, 94 percent are currently married, 3 percent are widowed, and 3 percent are divorced. In addition, three-fourth of the respondents live in rural areas. 21 Table 2.9 Background characteristics of respondents Percent distribution of ever-married women and currently married women by selected background characteristics, Yemen 1997 __________________________________________________________________________________ Ever-married Currently married _________________ __________________ Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted _________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Marital status Married Widowed Divorced Separated Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary + Currently attending school Yes No Missing Total 10.7 1,110 1,082 10.9 1,063 1,028 19.1 1,992 1,931 19.4 1,902 1,843 18.7 1,943 1,964 19.0 1,855 1,862 16.1 1,680 1,701 16.2 1,585 1,596 17.0 1,766 1,778 16.7 1,637 1,654 10.5 1,091 1,101 10.2 999 1,004 8.0 833 857 7.6 746 763 94.0 9,786 9,750 100 9,786 9,750 2.7 284 288 NA NA NA 2.9 307 337 NA NA NA 0.4 37 39 NA NA NA 25.2 2,620 2,945 24.8 2,427 2,718 74.8 7,794 7,469 75.2 7,359 7,032 22.9 2,381 2,490 22.8 2,226 2,307 30.0 3,125 2,897 30.2 2,952 2,735 47.1 4,908 5,027 47.1 4,608 4,708 84.2 8,765 8,524 84.3 8,248 7,991 5.5 571 623 5.4 528 577 6.1 638 709 6.1 595 657 1.9 198 243 1.9 185 226 2.3 241 315 2.4 230.0 299 1.0 103 107 0.9 93.0 95 99 10,307 10,304 99 9,690 9,652 -- 3.0 3.0 -- 3.0 3 100.0 10,414 10,414 100.0 9,786 9,750 __________________________________________________________________________________ NA = Not applicable -- Less than 0.05 percent Looking at the age distribution in Table 2.9, almost half of the 1997 YDMCHS respondents are under age 30 and around one-fifth are age 40 and over. The percentage of women in the age group 15-19 is smaller than that in 20-24 age group. This is due to the fact that only ever-married women were interviewed, and there has been a trend toward delayed marriage among Yemeni women age 15-19. With regard to education, the majority of respondents are illiterate (84 percent); however, this is down from the 1991-92 survey when 89 percent were illiterate. The proportion of women who can read and write has increased to about 6 percent compared with about 1 percent in 1991-92. The percentage of women who have completed primary education or higher is only 10 percent; among them 2 percent have completed secondary education or higher. Among ever-married women, 1 percent were attending school at the time of the survey. 22 Table 2.10 Respondents level of education by background characteristics Percent distribution of ever-married women by the highest level of education completed, according to selected background characteristics, Yemen 1997 __________________________________________________________________________________________ Level of education Number Background _______________________________________________ of characteristic Illiterate Literate Primary Preparatory Secondary+ Total women ___________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Total 70.7 10.0 13.1 4.4 1.8 100.0 1,110 73.7 8.0 11.4 3.7 3.1 100.0 1,992 82.4 6.3 6.6 1.3 3.4 100.0 1,943 86.5 4.7 5.0 1.4 2.5 100.0 1,680 91.3 3.4 2.5 1.0 1.8 100.0 1,766 94.9 2.5 0.7 0.5 1.4 100.0 1,091 97.2 1.5 0.3 0.5 0.5 100.0 833 63.7 9.6 13.7 5.3 7.7 100.0 2,620 91.0 4.1 3.6 0.8 0.5 100.0 7,794 76.3 5.9 10.4 2.6 4.8 100.0 2,381 93.5 2.9 2.5 0.9 0.3 100.0 3,125 82.1 7.0 6.4 2.2 2.4 100.0 4,908 84.2 5.5 6.1 1.9 2.3 100.0 10,414 Differentials in Education Table 2.10 shows the percent distribution of respondents by the highest level of education attained, according to age, residence, and region. As expected, the level of education decreases with increasing age of the respondent. For example, the percentage of women age 15-19 who have completed at least primary school is more than twice the percentage among women age 30-34 (19 percent and 9 percent, respectively). Women in urban areas are more educated than those in rural areas. The proportion of urban women who have completed at least secondary school is 8 percent compared with less than 1 percent among women in rural areas. Educational levels are lowest among women from the Mountainous region, where nearly 94 percent of women are illiterate. The highest levels are found in the Coastal region, where 76 percent of women are illiterate. Reasons for Leaving School Women age 15 to 24 years who had attended school but were not currently attending were asked in the YDMCHS why they had stopped attending school. One of the most important determinants of a woman's social and economic status is her level of education. Knowledge of the reasons why women leave school can provide guidance for policies designed to enhance women's status. Table 2.11 shows the percent distribution of ever-married women age 15-24 years by whether they are currently attending school and, if not, their reasons for leaving school, according to highest level of edu- cation attended. 23 Table 2.11 School attendance and reasons for leaving school Percent distribution of women 15 to 24 by current school enrollment and percent distribution of women not currently attending school by reason for leaving school, according to highest level of education attended and residence, Yemen 1997 ____________________________________________________________________ School attendance/ Reason for not Incomplete Complete More than attending school primary primary primary Total ____________________________________________________________________ URBAN____________________________________________________________________ Currently attending school Yes 2.7 0.7 17.1 9.2 No 97.3 99.3 82.9 90.8 Total 100.0 100.0 100.0 100.0 Reason not attending school Got pregnant 1.2 0.0 4.3 2.3 Got married 20.6 38.3 39.2 32.8 Take care of children 2.4 4.9 3.4 3.4 Family need help 8.6 7.4 2.0 5.4 Could not pay school 4.1 3.3 4.9 4.3 Need to earn money 0.6 0.3 0.4 0.4 Graduated/Enough school 12.5 9.5 27.1 18.2 Did not like school 22.3 11.7 7.2 13.3 School not accessible 4.9 5.1 2.9 4.1 Parents refused 12.6 14.7 4.9 9.7 Other 8.7 4.1 3.5 5.4 Don't know/Missing 1.4 0.6 0.3 0.7 Total 100.0 100.0 100.0 100.0 Number 143 95 187 424 ____________________________________________________________________ RURAL____________________________________________________________________ Currently Attending School Yes 2.6 1.9 20.4 6.8 No 97.4 98.1 79.6 93.2 Total 100.0 100.0 100.0 100.0 Reason not attending school Got pregnant 0.2 0.0 0.0 0.1 Got married 17.3 34.4 41.3 25.7 Take care of children 2.7 1.5 2.2 2.4 Family need help 15.4 14.7 2.5 12.6 Could not pay school 4.3 2.9 2.3 3.6 Need to earn money 0.0 0.7 1.8 0.5 Graduated/Enough school 9.2 11.9 26.0 13.2 Did not like school 16.8 6.2 4.5 12.1 School not accessible 15.4 12.5 7.5 13.2 Parents refused 9.7 9.5 6.3 9.0 Other 5.8 4.6 5.5 5.5 Don't know/Missing 3.1 1.1 0.0 2.0 Total 100.0 100.0 100.0 100.0 Number 326 111 114 551 ____________________________________________________________________ TOTAL____________________________________________________________________ Currently attending school Yes 2.6 1.4 18.4 7.9 No 97.4 98.6 81.6 92.1 Total 100.0 100.0 100.0 100.0 Reason not attending school Got pregnant 0.5 0.0 2.7 1.1 Got married 18.3 36.2 40.0 28.8 Take care of children 2.7 3.0 3.0 2.8 Family need help 13.3 11.3 2.2 9.5 Could not pay school 4.2 3.1 3.9 3.9 Need to earn money 0.2 0.5 0.9 0.5 Graduated/Enough school 10.2 10.8 26.7 15.4 Did not like school 18.5 8.8 6.2 12.6 School not accessible 12.2 9.1 4.6 9.2 Parents refused 10.6 11.9 5.4 9.3 Other 6.7 4.3 4.3 5.4 Don't know/Missing 2.6 0.8 0.2 1.5 Total 100.0 100.0 100.0 100.0 Number 468 206 301 975 24 Table 2.12 Access to mass media Percentage of ever-married women who usually read a newspaper once a week, watch local television, or listen to local radio, by selected background characteristics, Yemen 1997 _________________________________________________________________________________ No Read Watch Listen to All Number Background mass newspaper local local three of characteristic media weekly television radio media women ___________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary + Total 43.6 18.3 35.2 40.0 8.2 1,110 44.5 16.4 36.4 36.8 8.0 1,992 51.6 11.5 32.2 31.6 5.2 1,943 53.6 8.8 32.3 29.4 3.5 1,680 52.2 6.0 34.6 27.6 2.1 1,766 56.1 3.7 32.8 24.2 1.4 1,091 58.1 1.7 30.3 25.6 0.8 833 16.9 25.6 73.5 44.3 12.6 2,620 62.2 5.0 20.2 26.8 1.8 7,794 49.9 13.2 37.0 24.2 3.8 2,381 64.0 3.6 16.9 28.7 1.2 3,125 42.8 12.9 42.7 36.2 6.9 4,908 57.9 1.2 27.7 27.4 0.4 8,765 17.0 46.9 61.5 51.9 21.4 571 14.5 55.8 64.2 51.8 26.7 638 4.2 75.8 71.4 54.9 31.0 198 8.8 75.1 70.6 46.9 32.6 241 50.8 10.2 33.6 31.2 4.5 10,414 Only a small proportion of the respondents age 15-24 years (8 percent) who have attended school are continuing their education. The proportion currently attending school is highest among those who have more than primary education. Three in ten women (29 percent) who were currently not in school reported that they left because they got married. The proportion mentioning this reason is higher among those who had completed at least primary school than those who had not. Fifteen percent of women who dropped out of school reported that they left because they graduated or had had enough school, while 13 percent cited a dislike for school. The other important reasons for stopping school attendance were “family needed help” (10 percent), “school not accessible” (9 percent), and “parents refused that their daughter continues going to school” (9 percent). 2.6 Access to Mass Media Table 2.12 shows the percentage of respondents exposed to different types of mass media by age, residence, and level of education. It is important to know which persons are more/less likely to be reached by the media for purposes of planning programs intended to spread information about health and family planning. Ten percent of women read newspapers or magazines at least once a week, 34 percent watch local television at least once a week, and 31 percent listen to the local radio at least once a week. Less than 5 percent of women have access (at least once a week) to all three media. More than half of the respondents (51 percent) have no access to mass media. 25 Table 2.13 Respondents' work status Percent distribution of ever-married women by work status in relation to marriage, by background characteristics, Yemen 1997 __________________________________________________________________________________________ Work status and marriage ____________________________________________ Worked Worked before Worked Number Background before and after after Never of characteristic marriage marriage marriage worked Other Total women ___________________________________________________________________________________________ Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary + Total 7.5 10.3 5.2 76.8 0.2 100.0 2,620 6.4 30.9 7.1 55.3 0.3 100.0 7,794 6.3 12.4 6.2 74.8 0.2 100.0 2,381 6.1 32.8 7.0 53.7 0.4 100.0 3,125 7.2 27.7 6.6 58.3 0.2 100.0 4,908 6.8 27.8 6.5 58.5 0.3 100.0 8,765 6.8 12.1 5.3 75.5 0.4 100.0 571 4.6 10.1 4.2 81.0 0.1 100.0 638 6.9 14.8 8.1 70.2 0.0 100.0 198 5.7 31.6 19.1 43.5 0.0 100.0 241 6.7 25.7 6.6 60.7 0.2 100.0 10,414 As expected, access to all three mass media is higher for women in urban areas than in rural areas. Access to at least one type of mass media is 83 percent for women in urban areas, compared with 38 percent in rural areas. Printed material and television are less accessible to people in rural areas because of lower education levels and limited electrification. Young women under 25 years of age and those who are literate or educated are more likely to read newspapers, watch television, and listen to the radio than other women. Women in the Plateau and Desert region are more exposed to media than women in the other two regions. For example, 43 percent of women in the Plateau and Desert region say they watch television once a week, compared with 37 percent of women in the Coastal region and 17 percent of women in the Mountainous region. 2.7 Women's Employment Status The YDMCHS collected information from women regarding their employment, including their current work status, whether they had worked before marriage or after marriage, and whether they had worked during the year before the survey. Women who were currently working were then asked a number of questions about the kind of work they were doing and whether they were paid in cash or not. Those who earned cash for their work were asked who made the decision about how their earnings were used. If they had small children, they were asked about the arrangements they had for child care when they were working. Table 2.13 shows that less than 7 percent of respondents worked before marriage, less than 7 percent worked after marriage, and one-fourth (26 percent) worked before and after marriage. The majority of women (61 percent), however, never worked. A high percentage of women employed before and after marriage is found in rural areas (31 percent), in the Mountainous region (32 percent), and among women who are illiterate (28 percent). This is due to the participation of these women in agricultural work. A high proportion of women with secondary education or higher (32 percent) also reported working before and after marriage. 26 Table 2.14 Employment Percent distribution of women by employment status and continuity of employment, according to selected background characteristics, Yemen 1997 _____________________________________________________________________________________________________ Not currently employed Currently employed ________________ ___________________________________ Did not work Worked All year in last in _________________ Number Background 12 last 12 5+ days <5 days Season- Occasion- of characteristic months months per week per week ally ally Missing Total women ______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary+ Total 73.8 1.5 7.8 1.2 14.3 1.3 0.0 100.0 1,110 75.9 0.9 8.6 0.5 12.7 1.4 0.0 100.0 1,992 73.4 0.7 10.4 0.8 13.3 1.3 0.1 100.0 1,943 70.4 1.1 11.3 0.7 14.3 2.1 0.1 100.0 1,680 68.2 0.5 11.6 0.5 17.2 2.0 0.0 100.0 1,766 61.8 0.9 14.3 1.0 19.6 2.3 0.1 100.0 1,091 63.1 1.1 14.0 0.4 20.1 1.2 0.1 100.0 833 89.8 0.7 6.4 0.2 1.4 1.4 0.1 100.0 2,620 64.1 1.0 12.3 0.9 20.0 1.8 -- 100.0 7,794 82.7 0.9 7.7 0.5 7.2 0.9 0.1 100.0 2,381 62.0 0.7 12.2 0.5 23.5 1.1 0.0 100.0 3,125 70.0 1.1 11.4 0.9 14.0 2.4 0.1 100.0 4,908 68.7 1.0 10.9 0.7 17.0 1.8 0.0 100.0 8,765 85.1 1.0 3.9 0.1 7.5 2.4 0.0 100.0 571 87.2 0.2 5.1 0.4 6.1 0.9 0.1 100.0 638 78.7 0.6 13.7 0.6 5.9 0.0 0.4 100.0 198 52.6 0.8 38.6 1.0 5.8 1.0 0.2 100.0 241 70.5 0.9 10.8 0.7 15.3 1.7 -- 100.0 10,414 ______________________________________________________________________________________________________ -- Less than 0.05 percent Current Employment Table 2.14 presents the percent distribution of respondents according to current and past employment. For those respondents who were currently working, the table provides information on whether the woman was working full-time or not. Overall, 29 percent of women were engaged in some economic activity. Most women who were not working at the time of the survey did not report recent work experience; only 1 percent of respondents said that they had worked in the 12-month period before the survey. One-third of the women (11 percent) who were working reported that they were employed full-time (five or more days per week). As Table 2.14 shows, women in the 40-49 age group are more likely to be currently employed than younger women. As seen in other countries (El-Zanaty et al., 1996), the comparatively small proportion of working young women may be related to their greater child care responsibilities. The majority of women who work seasonally live in rural areas (20 percent compared with only 1 percent in urban areas). Regional 27 Table 2.15 Employer and form of earnings Percent distribution of employed women by employer and whether or not they receive cash earnings, according to selected background characteristics, Yemen 1997 _____________________________________________________________________________________________________ Employed by Employed by Self-employed a nonrelative a relative ________________ ________________ _________________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women ______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary+ Total 2.2 7.9 2.9 2.8 1.5 82.8 0.0 100.0 274 4.5 8.6 7.8 1.8 0.7 76.7 0.0 100.0 461 3.7 15.7 11.7 4.4 1.1 63.4 0.0 100.0 503 6.1 16.9 13.2 2.2 0.7 61.0 0.0 100.0 479 6.0 20.1 9.0 2.5 1.5 60.7 0.2 100.0 552 6.1 14.1 10.2 2.5 1.1 66.0 0.0 100.0 406 3.4 19.9 8.0 4.0 0.4 64.4 0.0 100.0 298 23.7 3.5 62.9 0.6 0.0 9.4 0.0 100.0 250 3.1 16.2 4.5 3.0 1.1 72.1 -- 100.0 2,722 8.2 7.5 40.7 7.0 1.5 35.0 0.0 100.0 391 2.2 22.4 2.6 2.9 0.8 69.2 0.0 100.0 1,166 6.0 11.2 6.4 1.7 1.0 73.7 0.1 100.0 1,416 3.9 15.8 5.0 3.2 0.9 71.2 0.0 100.0 2,659 27.1 14.6 3.4 0.0 2.4 52.6 0.0 100.0 79 14.1 13.1 16.3 0.0 0.8 54.2 1.3 100.0 80 1.7 5.9 72.7 0.0 0.0 19.6 0.0 100.0 41 3.4 3.1 90.4 0.0 3.2 0.0 0.0 100.0 112 4.8 15.1 9.4 2.8 1.0 66.8 0.0 100.0 2,972 ______________________________________________________________________________________________________ -- Less than 0.05 percent differences show that women in the Mountainous region are by far the most likely to be working (37 percent). This is due to the extensive farming activities in this part of the country. In terms of education, illiterate women and highly educated women are the most likely to be employed: 30 percent of women who are illiterate and 47 percent of women who completed secondary or higher are currently working. Employer and Form of Earnings According to Table 2.15, more than two-thirds (68 percent) of employed women age 15-49 work for a relative, and almost all do not earn cash (67 percent). Twenty percent of women are self-employed, only one-fourth of whom earn cash and three-fourths of whom do not. Twelve percent of women are employed by nonrelatives, and the majority earn cash (9 percent). Urban women who work are less likely to work for relatives and more likely to be paid in cash than are rural women. Working women in the Mountainous region are more likely to be self-employed (25 percent) than women in the two other regions (16-17 percent), and women in the Coastal region are more likely to earn cash for their work. More than 90 percent of employed women with secondary education or higher work for nonrelatives compared with 8 percent of illiterate women who are working. 28 Table 2.16 Occupation Percent distribution of currently employed women by current occupation and agricultural land worked, according to background characteristics, occupation codes may need some rearrangement depending on the cso definition of the categories of occupation, Yemen 1997 ______________________________________________________________________________________________________ Agricultural Nonagricultural _____________________ ______________________________ Family/ Prof. Number Background own Rented Other's tech./ Sales/ Skilled Unskilled of characteristic land land land manag. services manual manual Missing Total women _____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary + Total 78.2 4.8 5.6 1.2 2.3 6.1 1.8 0.0 100.0 274 75.6 3.6 4.7 6.1 4.4 4.1 1.3 0.0 100.0 461 67.8 5.9 7.2 7.2 5.6 5.2 1.2 0.0 100.0 503 68.0 4.0 8.5 5.9 5.8 5.4 2.5 0.0 100.0 479 68.9 4.3 6.9 6.0 6.1 5.0 2.5 0.3 100.0 552 72.0 3.5 7.4 3.5 4.4 5.1 3.9 0.2 100.0 406 70.0 6.4 8.3 2.1 4.2 6.4 2.7 0.0 100.0 298 8.8 1.1 1.1 50.5 27.0 1.2 10.1 0.4 100.0 250 76.7 4.9 7.5 0.8 2.9 5.6 1.5 0.1 100.0 2,722 34.4 1.2 20.0 20.8 9.6 7.0 6.8 0.2 100.0 391 79.9 6.1 5.0 0.7 2.1 5.2 1.1 0.0 100.0 1,166 73.7 4.2 5.0 4.2 6.0 4.8 2.0 0.1 100.0 1,416 75.4 4.8 7.6 0.2 4.0 5.6 2.3 0.1 100.0 2,659 60.1 2.7 3.0 4.0 25.2 3.1 1.8 0.0 100.0 79 55.9 5.5 2.4 9.5 19.4 2.7 4.5 0.0 100.0 80 22.9 2.6 3.0 66.4 4.4 0.0 0.7 0.0 100.0 41 2.3 0.0 0.0 93.8 2.7 0.7 0.5 0.0 100.0 112 71.0 4.6 7.0 5.0 4.9 5.2 2.2 0.1 100.0 2,972 Occupation Table 2.16 gives the percent distribution of women age 15-49 who are employed by current occupation and the type of agricultural land worked, according to background characteristics. Most employed women (83 percent) are occupied in agriculture, almost nine in ten of whom work on family land or their own land. Only 17 percent of working women have non-agricultural jobs and more than half of these women are engaged in professional, technical and clerical occupations or in sales and services. As expected, employment in nonagricultural occupations is more common among women who live in urban areas and among those who have more formal education. More than four in ten women (44 percent) in the Coastal region work in nonagricultural activities compared with 9 percent of women in the Mountainous region and 17 percent of women in the Plateau and Desert region. Control of Earnings Information on who decides how to use the cash earned by employed women can be used as a measure of the status of women, particularly of her independence in decisionmaking and control over 29 Table 2.17 Earnings Percent distribution of women receiving cash earnings by person who decides on use of earnings, according to background characteristics, Yemen 1997 __________________________________________________________________________________________ Person who decides how earnings will be used ____________________________________________ Jointly Jointly with Number Background with Someone someone of characteristic Self Husband husband else else Total women ___________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary + Current marital status Not married Currently married Total * * * * * 100.0 18 37.3 6.9 25.1 2.8 27.9 100.0 59 51.9 5.7 35.2 0.0 7.3 100.0 83 48.6 1.2 43.9 1.1 5.2 100.0 95 41.3 3.3 52.5 0.0 2.9 100.0 91 50.5 4.0 41.2 0.0 4.3 100.0 71 (33.7) (2.3) (51.0) (0.0) (13.0) 100.0 35 48.5 2.2 38.2 0.0 11.1 100.0 216 42.9 5.3 43.4 1.8 6.5 100.0 236 37.1 1.7 50.4 1.6 9.2 100.0 197 53.9 7.1 31.0 0.0 8.0 100.0 65 51.4 5.0 34.5 0.6 8.5 100.0 190 46.4 4.1 41.4 1.2 6.9 100.0 261 (53.2) (0.0) (29.1) (0.0) (17.7) 100.0 26 (61.6) (4.8) (28.0) (0.0) (5.5) 100.0 25 (34.9) (2.6) (34.4) (0.0) (28.1) 100.0 30 41.1 4.2 47.4 1.0 6.4 100.0 109 66.6 NA NA 4.1 29.3 100.0 63 42.1 4.5 47.6 0.4 5.4 100.0 389 45.6 3.8 40.9 0.9 8.7 100.0 452 ___________________________________________________________________________________________ Note: Figures in parentheses are based on 25 to 49 women; an asterisk indicates that a figure is based on fewer than 25 women and has been suppressed. resources. Table 2.17 shows that almost half of the women who receive cash for work (46 percent) decide for themselves how to use the money, while 41 percent decide jointly with their partners how the earnings are used. Nine percent of women who earn cash decide jointly with someone other than their partner how to spend their money, and in only 4 percent of cases, women say that the decision as to how to use their earnings is made by their partner. Two-thirds of women who are widowed or divorced (67 percent) say they alone decide how to use their earnings. Among currently married women, 42 percent say that they make the decision, while 48 percent report that the decision is made jointly with their husband. 30 Urban women and those in the Mountainous region and the Plateau and Desert region are more likely to decide for themselves how to spend their earnings than rural women and women in other regions. With respect to education differentials, working women are more likely to decide jointly with their husband how to spend the money they earn if they have completed secondary school or higher than if they have less education. Child Care While Working Table 2.18 presents the distribution of employed women by whether they have a child under six years of age, and if so, the type of caretaker used by the mother while at work away of home. Sixty-nine percent of employed women have a child under six years of age, and 95 percent of these women work away from home. More than one-third of women (36 percent) use relatives other than the husband to look after their children while at work, while more than four in ten women leave their children in the care of another child, either female (30 percent) or male (13 percent). Seven percent of working mothers with pre-school age children look after their own children while working. Working mothers in rural areas, those living outside the Coastal region, and those who are illiterate are more likely than other working mothers to say they leave their children with another child while at work. Use of other children as child care providers is also high among working mothers who are in agriculture. 31 Ta bl e 2. 18 C hi ld c ar e w hi le w or ki ng Pe rc en t d is tri bu tio n of c ur re nt ly e m pl oy ed w om en b y w he th er th ey h av e a ch ild u nd er si x ye ar s o f a ge a nd p er ce nt d is tri bu tio n of e m pl oy ed m ot he rs w ho h av e a ch ild u nd er si x by p er so n w ho c ar es fo r c hi ld w hi le m ot he r i s a t w or k, a cc or di ng to se le ct ed b ac kg ro un d ch ar ac te ris tic s, Y em en 1 99 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ Pe rc en ta ge Em pl oy ed of e m pl oy ed C hi ld ’s c ar et ak er w hi le m ot he r i s a t w or k aw ay fr om h om e w om en w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ w ith N ot O ne o r ch ild re n w or ke d N o m or e < 6 w ho N um be r R e- Se rv an ts / In st itu - O th er O th er Le ft at si nc e B ac kg ro un d ch ild ch ild re n w or k of sp on - O th er N ei gh bo rs / hi re d tio na l fe m al e m al e ho m e la st ch ar ac te ris tic < 6 < 6 at h om e w om en de nt H us ba nd re la tiv es fr ie nd s he lp ca re ch ild ch ild al on e bi rth M is si ng To ta l __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ R es id en ce U rb an R ur al R eg io n C oa st al M ou nt ai no us P la te au a nd D es er t Ed uc at io n I lli te ra te L ite ra te P rim ar y co m pl et e P re pa ra to ry c om pl et e S ec on da ry + E m pl oy er F am ily S om eo ne e ls e S el f- em pl oy ed O cc up at io n A gr ic ul tu ra l N on -a gr ic ul tu ra l Em pl oy m en t s ta tu s A ll ye ar , f ul l w ee k A ll ye ar , p ar t w ee k S ea so na l O cc as io na l To ta l 3 6. 4 6 3. 6 2 0. 2 2 50 1 1. 8 5 .9 3 9. 8 3 .9 6 .0 7 .9 1 3. 4 7 .9 3 .0 0 .4 0 .0 10 0. 0 3 0. 6 6 9. 4 3 .5 2, 72 2 7 .1 1 .6 3 6. 2 3 .3 0 .0 -- - 3 0. 8 1 3. 0 7 .4 0 .6 0 .1 10 0. 0 3 2. 2 6 7. 8 7 .3 3 91 9 .9 4 .9 4 1. 2 2 .3 2 .3 2 .4 2 0. 9 1 4. 1 2 .0 0 .2 0 .0 10 0. 0 3 1. 5 6 8. 5 2 .4 1, 16 6 6 .0 1 .7 3 6. 6 2 .7 0 .0 0 .0 3 1. 9 1 0. 4 9 .9 0 .6 0 .2 10 0. 0 3 0. 4 6 9. 6 6 .1 1, 41 6 7 .8 1 .3 3 5. 0 4 .2 0 .2 0 .5 3 0. 1 1 4. 2 6 .1 0 .6 0 .0 10 0. 0 3 0. 6 6 9. 4 4 .0 2, 65 9 7 .5 1 .7 3 4. 2 3 .4 0 .0 -- - 3 1. 5 1 3. 5 7 .5 0 .6 0 .1 10 0. 0 3 9. 4 6 0. 6 3 5. 7 7 9 0 .0 0 .0 6 2. 5 0 .0 1 .6 -- - 1 9. 8 1 2. 6 3 .5 0 .0 0 .0 10 0. 0 4 0. 3 5 9. 7 1 4. 7 8 0 1 2. 9 6 .2 5 6. 2 0 .0 0 .0 2 .0 1 6. 6 3 .7 2 .4 0 .0 0 .0 10 0. 0 3 7. 6 6 2. 4 0 .0 4 1 4 .8 0 .0 7 0. 3 8 .0 0 .0 4 .5 5 .5 2 .5 4 .3 0 .0 0 .0 10 0. 0 2 6. 2 7 3. 8 1 .9 1 12 5 .5 6 .8 5 3. 3 4 .6 8 .6 9 .8 6 .2 2 .2 2 .2 0 .6 0 .0 10 0. 0 3 0. 5 6 9. 5 1 .1 2, 01 5 7 .5 1 .8 3 8. 6 3 .4 0 .0 0 .0 2 9. 4 1 1. 2 7 .1 0 .7 0 .2 10 0. 0 3 0. 1 6 9. 9 0 .8 3 64 6 .2 2 .9 3 6. 1 3 .2 3 .0 3 .8 2 4. 9 1 3. 3 6 .4 0 .2 0 .0 10 0. 0 3 3. 4 6 6. 6 2 0. 9 5 91 7 .8 1 .7 2 6. 6 3 .2 0 .0 0 .3 3 4. 4 1 8. 4 7 .6 0 .1 0 .0 10 0. 0 3 0. 1 6 9. 9 0 .9 2, 36 1 7 .3 1 .5 3 5. 8 3 .2 0 .0 0 .0 3 0. 3 1 3. 6 7 .6 0 .6 0 .1 10 0. 0 3 4. 9 6 5. 1 2 1. 1 6 09 8 .2 4 .8 4 0. 6 4 .1 3 .0 4 .1 2 4. 8 6 .3 3 .7 0 .4 0 .1 10 0. 0 3 1. 1 6 8. 9 4 .4 1, 12 6 8 .0 2 .5 3 4. 7 3 .5 1 .0 1 .4 2 7. 8 1 2. 5 8 .2 0 .4 0 .0 10 0. 0 2 9. 5 7 0. 5 1 3. 7 7 2 6 .9 1 .8 4 2. 8 0 .0 0 .0 0 .0 2 8. 0 1 7. 6 1 .0 1 .9 0 .0 10 0. 0 3 1. 4 6 8. 6 1 .5 1, 59 4 6 .7 1 .4 3 8. 1 3 .5 0 .0 0 .0 3 0. 4 12 .7 6 .3 0 .7 0 .2 10 0. 0 2 9. 2 7 0. 8 3 4. 0 1 75 1 1. 0 3 .7 2 6. 2 2 .0 0 .0 0 .0 3 7. 6 8 .7 1 0. 9 0 .0 0 .0 10 0. 0 3 1. 1 6 8. 9 4 .8 2, 97 2 7 .4 1 .9 3 6. 4 3 .4 0 .4 0 .5 2 9. 6 1 2. 6 7 .1 0 .6 0 .1 10 0. 0 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ -- L es s t ha n 0. 05 p er ce nt N A = N ot a pp lic ab le 33 CHAPTER 3 FERTILITY One of the main objectives of the 1997 Yemen Demographic and Maternal and Child Health Survey (YDMCHS) is to examine issues related to fertility and childbearing. This chapter deals with the following topics: fertility levels, trends, and differentials; future indicators of fertility; the age at which Yemeni women begin childbearing; birth intervals and adolescent fertility (i.e. before age 20). The estimates of fertility in this chapter are based on the data recorded in the birth histories of ever-married women age 15-49 years. Although the birth histories in the YDMCHS cover only ever-married women, it is possible to calculate fertility levels for all women of childbearing age, based on the assumption that never-married women have not given birth. Present, past and future estimates of fertility are based on carefully gathered survey data. First, women were asked a series of questions about all the live births that occurred in their lifetime. To encourage getting complete data, women were asked the number of male and female children who (a) lived at home with the family, (b) lived elsewhere and (c) had died. The interviewers verified the information given by respondents to reconcile the total births in the above-mentioned categories with the total reported by the women. Second, complete data on every child born were collected from the birth histories. The table of live births for every woman included for each live birth the name of the child, sex, date of birth (month or season and year), and the age at death for those who died. The birth history also included information on whether any document, such as birth certificate, was used to ensure the date or year of birth. Third, the number of stillbirths, miscarriages, and abortions were recorded. Finally, married women were asked if they were pregnant at the time of the interview. This was done to obtain estimates of future fertility. In spite of efforts taken to minimize errors in the collection of data on births, birth histories are affected by underreporting of the number of live births and errors in specifying birth dates. Reasons for not obtaining accurate information on the number of births include underreporting of births and omission of births (especially regarding children who died following birth or were married and left the household). Also, some women, who had no surviving children, may have declared themselves childless. Problems of this kind usually occur in communities where the level of female literacy is very low. 3.1 Levels and Differentials in Fertility Table 3.1 presents age-specific fertility rates and other summary indicators calculated from survey data such as the crude birth rate (CBR), the general fertility rate (GFR) and the total fertility rate (TFR). The crude birth rate is the number of births per 1,000 population. It is an unrefined indicator of fertility, but used commonly because of ease of understanding. The general fertility rate is the number of births per 1,000 women age 15-44. The age-specific fertility rate is the number of births per 1,000 women in a specified age group. The total fertility rate is a 34 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by urban-rural residence, Yemen 1997 _________________________________________ Age group Urban Rural Total _________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 TFR 15-44 GFR CBR 85 113 105 237 296 279 246 323 301 227 269 258 143 215 196 56 123 105 8 67 54 5.01 7.03 6.48 4.97 6.69 6.22 167 221 206 35.2 40.6 39.2 _________________________________________ 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 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. summary indicator of the number of births a woman would have during her childbearing years if the current age-specific fertility rates prevailed. It is calculated by summing the age-specific fertility rates. The crude birth rate in Yemen (for 1996) is 39.2 births per 1,000 population. There is a clear differential in this rate by residence, 40.6 in rural and 35.2 in urban areas. The general fertility rate in Yemen is 206 per 1,000 women, with the rate being much higher in rural areas (221) than in urban areas (167). On the basis of births during the three years preceding the survey, the total fertility rate (TFR) in Yemen is 6.5 births per woman, which is considered one of highest rate in the world. The TFR in rural areas is 7.0 compared with 5.0 in urban areas. In other words, rural women will, on average, have two more births than their urban counterparts. The age-specific fertility rates calculated on the basis of the three years preceding the survey indicate that the highest rate is for women age 25–29, as shown in Figure 3.1. In addition, the figure shows that a substan- tial proportion of women continue to bear children in their later years. The age-specific fertility rate rises from 35 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40-49, by selected background characteristics, Yemen 1997 _________________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant age 40-49 _________________________________________________________ Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete+ Total 5.01 8.97 7.82 7.03 12.20 8.54 5.81 8.23 7.72 6.83 12.61 8.51 6.64 12.10 8.63 6.93 12.77 8.52 (5.68) 5.81 6.40 (4.65) 11.00 4.57 [3.21] 5.07 4.18 [3.08] 5.77 3.30 6.48 11.29 8.37 ________________________________________________________ Note: Rates in parentheses are based on 500-999 women; rates in squared brackets are based on 250-499 women. 1Women age 15-49 years 105 births per 1,000 in age group 15-19 to 301 births per 1,000 in age group 25-29 and then falls gradually to 54 births per 1,000 in age group 45-49. Urban-rural differentials in the total fertility rate have already been noted. The age-specific fertility rates also show the pattern of higher fertility in rural areas compared with urban areas for all age groups. Looking at age-specific fertility rates from another perspective indicates that a Yemeni woman bears about two (1.9) children by the time she reaches the age of 25 years, and has 3 more children between ages 25 and 34. When she reaches the age of 40, she will have had an average of 5.7 births and, by the age of 50, a total of 6.5 births. Table 3.2 and Figure 3.2 present fertility differentials according to residence, region, and level of education. The urban-rural differences have already been discussed. By region, the fertility rates are similar for the Mountainous region (6.8 births) and the Plateau and Desert region (6.6 births), but are almost one birth lower in the Coastal region (5.8 births). The current levels of fertility differ even more by the level of educa- tion. The total fertility rate is 6.9 births for illiterate women or 2.2 more births than for women who have completed primary education (4.7 births). As the educational level of women rises, the fertility rate decreases. Among women who have completed the secondary level or higher, this rate falls to 3.1 births. Table 3.2 also shows the mean number of live births for women age 40- 49. This is an indicator of completed fertility or cumulative fertility for women who are approaching the end of their childbearing years. A comparison of the total fertility rate and the cumulative fertility rate gives an indication of fertil- ity trends over time. For all women, the mean number of live births is 8.4, which indicates that fertility has been falling in Yemen in all groups (see Figure 3.2). 3.2 Fertility Trends Table 3.3 shows the trends in age-specific fertility rates and total fertil- ity rates based on the 1991/92 and 1997 YDMCHS surveys and the 1994 census. The fertility rates decreased slowly between the 1991/92 YDMCHS survey and the 1994 census and slightly faster between the census and the 1997 YDMCHS. Between the two surveys, the fertility rate dropped from 7.7 to 6.5 births per woman, or 1.2 births, during a period of just six years. The drop may be due to a number 1 The TRFs for some selected countries are M orocco (1995) = 3.3 , Egypt (1995) = 3.6, Jordan (1997) = 4.4, Kenya (1988) = 4.7, Tanzania (1996) = 5.8, Eritrea (1995) = 6.1, Mali (1996) = 6.7, and Uganda (1995) = 6.9. 36 Table 3.3 Trends in fertility rates Age-specific fertility rates (per 1,000 women) and total fertility rates, Yemen 1991-1997 _________________________________________ YDMCHS1 CENSUS2 YDMCHS1 Age group 1991/92 1994 1997 _________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR 15-49 TFR 15-44 GFR CBR 102 66 105 283 283 279 315 346 301 284 315 258 258 258 196 172 143 105 120 73 54 7.7 7.4 6.48 7.1 7.1 6.22 238 U 206 40 47 42.5 _________________________________________ U = Unknown (not available) 1 Rates are for the 36-month period preceding the survey. 2 Rates are for the 12-month period preceding the census. of factors including an increase in the use of family planning methods, an increase in education levels, or social, cultural, and economic factors in Yemen. Despite the drop in fertility rates, overall, fertility in Yemen has remained high compared with neighboring countries in the Middle East and Africa1. Figure 3.3 shows the trends in age-specific fertility rates between the 1991/92 and 1997 surveys. These results indicate that the fertility rates, including the crude birth and general fertility rates, may continue to fall in the future. Table 3.4 shows the age-specific fertility rates for successive five-year periods prior to the survey. It should be noted that rates shown in brackets are partially trun- cated due to the fact that the data are limited to women who were under 50 years at the time of the survey. Even so, information available in the table should be treated with caution due to the possible occurrence of omission or errors in specifying the dates of events, especially by older women and for periods in the distant past. 37 Table 3.4 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, Yemen 1997 ____________________________________________________ Age Number of years preceding the survey 5-year ___________________________________ group 0-4 5-9 10-14 15-19 ____________________________________________________ 15-19 110 186 238 239 20-24 286 356 396 389 25-29 304 371 415 418 30-34 267 325 379 428 35-39 200 262 [377] - 40-44 115 [204] - - 45-49 [62] - - - ____________________________________________________ Note: Age-specific fertility rates are per 1,000 women. Rates in brackets are truncated. Table 3.4 shows that fertility was at a high level during the period 15-19 years prior to the survey, i.e. during the years 1978-1982; followed by the period 10-14 years prior to the survey, i.e. during the years 1983-1987. In comparison with the other two periods that follow, the fertility rates show a decrease for nearly all age groups. This trend in declining fertility is supported by other statistical sources, such as the results of the 1994 census, especially among younger women, for whom higher levels of education, later age at marriage, and other social, cultural, and health factors play a role. 38 Table 3.5 Fertility rates by number of years since first marriage Fertility rates for ever-married women by number of years since first marriage, for five-year periods preceding the survey, Yemen 1997 ____________________________________________________ Years Number of years preceding the survey since first ___________________________________ birth 0-4 5-9 10-14 15-19 ____________________________________________________ <5 327 360 369 340 5-9 348 411 437 413 10-14 313 374 424 424 15-19 268 328 393 [432] 20-24 189 265 [367] - 25-29 112 [199] - - ____________________________________________________ Note: Fertility rates are per 1,000 woman. Rate in brackets are truncated. Table 3.5 shows the changes in fertility by number of years since first marriage. The pattern is similar to that observed in Table 3.4. Fertility levels were higher during the period 10-14 before the survey years and drop during the period 0-4 years prior to the survey. Furthermore, women who were married for more than 15 years reported low fertility compared with those who were married for a shorter period. This may be due to women who married a long time ago having difficulty remembering births that occurred during earlier periods of their marriage. 3.3 Children Ever Born Table 3.6 shows the number of children ever born (CEB) to all women and to currently married women. These data which reflect cumulative fertility over time, indicate that women who are currently married have had, on average, 5 births, whereas the average number of births to all women is 3.5 births. About 27 percent of married women gave birth to 8 or more children; and 1 in 8 women gave birth to 10 or more children. The differences in the mean number of births between all women and married women is due to the marital status of women under 25 years; a large proportion of women under 20 years and a substantial proportion of those 20-24 years have not yet married. The mean number of births increases with age reflecting the natural family growth process. For example, the mean for women age 25-29 is 3.6 births, for those age 30-34 it is 5.6 births, and, for those age 35-39 years it reaches 7.1 births. At age 45-49, the end of the reproductive years, the mean is 8.8 births. The high level of fertility among Yemeni women is evident from the high percentage of married women in their forties who gave birth to large numbers of children during their reproductive years; 39 percent of women age 40-44 and 46 percent of those age 45-49 have 10 or more births. Results in Table 3.6 show that early childbearing is not common in Yemen. Twelve percent of women who are 15-19 years gave birth to at least one child, compared with about 61 percent of women age 20-24 years. Early childbearing is further discussed in section 3.6 of this chapter. The proportion of women in their late forties, who have never given birth is an indication of primary (permanent) sterility. In Yemen, 1.4 percent of currently married women age 45-49 are childless. 39 Table 3.6 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Yemen 1997 ________________________________________________________________________________________________________________ Mean Mean Number of children ever born Number no. no. Age _____________________________________________________________________________ of of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ________________________________________________________________________________________________________________ ALL WOMEN ________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 87.9 8.0 3.1 0.8 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 4,137 0.17 0.15 39.0 18.8 19.9 12.1 6.4 2.5 1.1 0.2 0.0 0.0 0.0 100.0 2,738 1.41 1.24 14.4 7.1 12.4 15.2 16.1 14.6 9.1 5.8 3.4 1.3 0.6 100.0 2,147 3.55 3.09 7.4 3.5 4.5 8.0 10.8 11.6 15.0 13.6 10.9 7.0 7.7 100.0 1,748 5.57 4.77 4.3 1.9 2.7 4.3 5.8 7.8 11.8 12.9 14.7 11.3 22.4 100.0 1,804 7.07 5.99 4.2 1.5 2.1 2.7 4.9 5.6 7.4 9.9 13.9 12.2 35.7 100.0 1,107 8.02 6.60 2.3 0.4 1.4 2.7 4.4 4.1 5.5 8.6 12.4 14.6 43.7 100.0 839 8.83 7.05 36.4 7.7 7.6 6.6 6.3 5.7 5.7 5.4 5.4 4.2 9.0 100.0 14,521 3.51 2.96 ________________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 54.9 29.7 11.8 3.0 0.4 0.2 0.0 0.0 0.0 0.0 0.0 100.0 1,063 0.65 0.56 15.4 25.1 28.0 17.0 9.1 3.5 1.5 0.3 0.0 0.0 0.0 100.0 1,902 1.97 1.74 5.0 6.9 13.3 16.9 18.4 16.5 10.3 6.6 3.9 1.5 0.7 100.0 1,855 4.00 3.48 3.2 2.3 4.5 8.4 10.7 12.5 16.2 14.6 11.9 7.5 8.3 100.0 1,585 5.94 5.10 1.6 1.4 2.2 4.4 5.7 8.2 11.9 13.3 15.6 11.7 24.0 100.0 1,637 7.39 6.25 2.2 1.3 1.5 2.5 4.3 5.1 7.2 10.3 14.0 13.0 38.6 100.0 999 8.38 6.91 1.4 0.2 1.0 2.5 3.5 3.7 5.3 8.9 12.4 15.2 45.8 100.0 746 9.06 7.27 11.0 10.2 10.6 9.4 8.7 8.0 8.0 7.6 7.7 5.9 12.9 100.0 9,786 4.95 4.19 The last column in Table 3.6 shows the mean number of living children. The difference between the number of children ever born and the number who are still living is small among married women under 30, but increases for those age 30 and above. 3.4 Birth Intervals A birth Interval is defined as the length of time between two successive live births. Short birth intervals adversely affect the health of mothers and their children’s chances of survival. The risk of a child dying increases if the interval between the child’s birth and a previous birth is less than 24 months. Table 3.7 shows birth intervals for five-year periods preceding the survey. About 37 percent of births in Yemen have intervals of less than two years; (about one-fifth are less than 18 months apart). One-third of births have an interval of 24-35 months, and one-third are at least three years apart. The mean birth interval is 28 months in Yemen. The lowest mean birth interval (19 months) is for women in the youngest age groups. For births for which the preceding child died, the mean birth interval is 23 months. This is because the death of a newborn leads to a shortening of the period of postpartum amenorrhea (temporary sterility)—which results from the cessation of breastfeeding—and hence the shortening of the birth interval. The birth interval increases with increasing age of the mother; the longest interval, 35 months, is among women in their forties. Birth intervals are longer (33 months) among women who completed secondary education or higher. With respect to the other characteristics mentioned in Table 3.7, the mean birth interval varies between 26 and 30 months. 40 Table 3.7 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Yemen 1997_____________________________________________________________________________________________________ Median number of months Demographic/ Number of months since previous birth Number since Socioeconomic ______________________________________________ of previous characteristic 7-17 18-23 24-35 36-47 48+ Total births birth______________________________________________________________________________________________________ Age of mother 15-19 20-29 30-39 40 + Birth order 2-3 4-6 7 + Sex of preceding birth Male Female Survival status of preceding birth Dead Living Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete+ Total 40.6 32.4 21.5 4.5 1.0 100.0 215 19.2 23.1 19.3 33.8 14.7 9.1 100.0 4,761 25.8 16.2 15.5 31.7 18.3 18.3 100.0 4,511 30.4 11.6 13.3 26.4 22.1 26.7 100.0 1,192 35.1 23.3 18.3 32.3 13.6 12.5 100.0 3,196 26.1 18.5 16.8 32.5 17.8 14.3 100.0 3,561 28.3 16.6 16.9 30.9 18.6 17.1 100.0 3,921 30.0 18.7 16.7 31.8 17.1 15.6 100.0 5,527 28.9 19.8 17.9 31.9 16.5 13.9 100.0 5,152 27.8 32.9 18.7 23.8 11.7 12.9 100.0 1,208 23.4 17.5 17.1 32.9 17.5 15.0 100.0 9,471 28.8 18.5 16.5 30.7 15.2 19.1 100.0 2,339 28.5 19.5 17.5 32.1 17.3 13.6 100.0 8,340 28.2 17.0 17.5 30.4 17.7 17.4 100.0 2,279 28.8 20.1 17.8 30.9 17.6 13.6 100.0 3,279 28.1 19.7 16.9 33.1 16.0 14.3 100.0 5,122 28.1 19.0 17.1 32.1 17.3 14.5 100.0 8,993 28.4 17.4 18.4 31.8 13.5 18.9 100.0 576 27.9 21.6 16.8 31.6 13.8 16.2 100.0 573 27.8 23.2 13.5 30.3 11.6 21.3 100.0 155 28.6 17.6 13.7 23.6 18.7 26.4 100.0 182 33.0 19.3 17.3 31.8 16.8 14.8 100.0 10,679 28.3 ______________________________________________________________________________________________________ Note: First births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 3.5 Age at First Birth The age at which women begin childbearing has important demographic and health considerations. For example, the magnitude of childbearing among women under 20 is a cause of concern among health specialists. The complications of pregnancy and childbirth are particularly high before the age of 20 and after the age of 34 years. In addition, early childbearing results in large families that can negatively affect the economic and social status of women and their participation in the labor force. A large proportion of Yemeni women in the age group 20-49 years gave first birth before age 20. The proportion varies from 42 percent for women age 45-49 to 58 percent for women age 25-29 and 30-34 years 41 Table 3.8 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Yemen 1997 ______________________________________________________________________________________________________ Women Median with Age at first birth Number age at no __________________________________________________ of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth _____________________________________________________________________________________________________ 15-19 87.9 1.2 8.0 2.9 NA NA NA 100.0 4,137 a 20-24 39.0 4.0 20.6 20.5 11.9 4.0 NA 100.0 2,738 a 25-29 14.4 7.2 30.4 20.2 12.5 11.2 4.1 100.0 2,147 19.2 30-34 7.4 7.9 32.6 17.2 14.6 12.3 7.9 100.0 1,748 19.0 35-39 4.3 5.9 29.8 20.9 15.6 13.0 10.5 100.0 1,804 19.4 40-44 4.2 6.8 27.6 16.7 14.8 17.0 12.9 100.0 1,107 19.9 45-49 2.3 5.6 21.1 15.0 15.1 17.1 23.9 100.0 839 21.1 ______________________________________________________________________________________________________ NA = Not applicablea Medians were not calculated for these cohorts because less than 50 percent of the women in the age group x to x+4 have had a birth by age x. (see Table 3.8). The proportion of women age 25-49 who first gave birth after the age of 24 years, increases with age from 4 to 24 percent, indicating a tendency toward early childbearing in Yemen. The last column in Table 3.8 shows the median age at first birth by age group. Median age is not shown for age groups in which the proportion of women who have no live births exceeds 50 percent. The medians for the different age groups indicate a gradual decrease in age at first birth. The median age at first birth is 21 years for women in the age group 45-49 and 20 years for women in the age group 40-44. It continues to decrease reaching 19 years for the age group 30-34 before increasing to 19.2 for the women age 25-29. In spite of the possibility of childbearing starting at a younger age than in the past, the probable occurrence of errors in reporting dates of first births and dates of deliveries of mothers are relevant, as mentioned earlier. The problem caused by the omission of some births or misreporting of dates of their occurrence may affect information that older women provide. Older women, more than younger women, are liable to forget the timing of some births due to the length of time having passed since those births. This results in birth dates being pushed toward the period of the survey and to a higher age at first birth than when they actually occurred. Table 3.9 shows the median age at first birth by current age according to selected background characteristics. Overall, median age at first birth for women age 25-49 is 19.5 years, which differs by less than one year from the median age for almost all categories in the table. An exception is the median age at first birth for women with preparatory education; the median age is almost four years higher than the overall median. In the Coastal region, median age at first birth is 20.3 years, or almost one year higher than in the other two regions. 3.6 Early Childbearing Reference was made earlier to the concerns of health specialists regarding the adverse health effects of early childbearing (adolescent fertility). It was mentioned that 12 percent of Yemeni women age 15-19 years have given birth to at least one child (Table 3.6). Table 3.10 shows the percentage of women age 15-19 who were pregnant in the past but had no live births at the time of the survey, the percentage who are mothers, and the percentage who were pregnant at the time of the survey but had no live births. 42 Table 3.9 Median age at first birth Median age at first birth among women age 25-49 years, by current age and selected background characteristics, Yemen 1997 _________________________________________________________________________________ Current age Women Background ____________________________________________ age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 _________________________________________________________________________________ Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete+ Total 20.2 19.1 19.0 18.4 19.3 19.3 18.9 19.0 19.5 20.4 21.7 19.5 20.8 20.3 19.8 19.9 21.0 20.3 18.9 18.6 19.6 20.3 21.8 19.5 18.8 18.7 18.9 19.6 20.6 19.1 18.8 18.7 19.3 19.8 21.0 19.3 19.5 20.1 18.8 20.3 * 19.6 19.6 20.0 20.1 * * 19.9 a (21.9) (21.0) * * 23.3 a 26.8 (24.2) * * a 19.2 19.0 19.4 19.9 21.1 19.5 _________________________________________________________________________________ Note: Figures in parentheses are based on 25 to 49 women; an asterisk indicates that a figure is based on fewer than 25 women and had been suppressed. a Medians are not calculated for these cohorts because less than 50 percent of women in these 25 cohorts have had a birth by age 25. The sum of these three groups of women age 15-19 represents the total percentage of women who started childbearing early (Table 3.10). One in 6 women under age 20 (16 percent) either had been pregnant in the past, was a mother, or was currently pregnant with her first child. Two percent of women age 15 have started childbearing; half of them have become mothers. The proportion increases rapidly to 14 percent among women age 17, and 29 percent among those age 18. Almost 40 percent of women age 19 have started childbearing. The proportion of women who started childbearing early is higher in rural areas (17 percent) than in urban areas (14 percent). Teenage childbearing is less common in the Coastal region (12 percent) than in the other regions (17-18 percent). Overall, the relationship between level of educational and early childbearing is irregular; however, women who have completed preparatory school are least likely to start childbearing early (9 percent), while illiterate are most likely to start early (20 percent). 43 Table 3.10 Adolescent fertility Percentage of women age 15-19 who had a pregnancy in the past but no live birth, percentage who are mothers, percentage who are pregnant with their first child, and the percentage who have started childbearing by selected background characteristics, Yemen 1997 _______________________________________________________________ Percentage of teenagers who: _____________________________________ Had Are pregnancy currently Have in the past, pregnant, started Number Background no live Are no live child- of characteristic birth mothers birth bearing teenagers _______________________________________________________________ Age 15 0.4 1.0 0.6 2.0 1,040 16 0.8 3.2 2.0 5.9 851 17 1.4 9.3 2.9 13.6 716 18 0.9 20.1 7.7 28.7 896 19 1.0 34.0 4.4 39.4 634 Residence Urban 0.6 10.3 3.0 14.0 1,138 Rural 1.0 12.8 3.5 17.3 2,984 Region Coastal 0.4 10.2 1.8 12.4 1,007 Mountainous 0.8 11.8 4.1 16.7 1,182 Plateau and Desert 1.1 13.1 3.8 18.0 1,957 Education Illiterate 1.0 15.4 4.1 20.4 2,267 Literate 0.7 7.6 1.3 9.6 657 Primary complete 1.2 11.9 3.9 17.0 585 Preparatory complete 0.3 6.2 2.7 9.2 384 Secondary complete+ 0.8 6.2 5.2 12.2 124 Total 0.9 12.1 3.4 16.3 4,137 45 CHAPTER 4 FAMILY PLANNING Information on contraceptive use is of particular interest to policymakers, program managers, and researchers in the areas of population and family planning. Providing easy access to reliable and safe methods of family planning increases women’s control over there own fertility. This chapter describes women’s knowledge of family planning methods and sources where they can be obtained, use of contraception, sources of information about family planning, and exposure to media messages about family planning. Differentials in knowledge and use are also discussed. In addition, problems with current methods, reasons for first use and current use, and reasons for not intending to use a method in future are included in this chapter. 4.1 Knowledge of Family Planning Methods and Sources Familiarity with contraceptive methods and sources for methods are among the prerequisites for the adoption of fertility regulation. Knowledge of methods is a necessary but not sufficient condition for use. The Yemen Demographic and Maternal Child Health Survey (YDMCHS) provides information on the level of knowledge of family planning methods and providers of family planning services. Knowledge of contraceptive methods was assessed through a series of questions combining spontaneous recall and prompting procedure. Respondents were first asked to name all the contraceptive methods they had heard of (spontaneous knowledge). For methods they did not mention, a brief description was read and they were asked if they had ever heard of the method (probed knowledge). For each method recognized, they were asked if they had ever used the method and whether they knew a place to obtain the method. In the 1997 YDMCHS, information was sought about eight modern methods—the pill, IUD, injectables, vaginal methods (diaphragm, jelly, foam), implants, condoms, and female and male sterilization—as well as three traditional methods—periodic abstinence (safe period or rhythm method), withdrawal, and prolonged breastfeeding. Other methods mentioned by respondents, such as herbs or Arab medicine were also recorded. It should be noted that information about implants was not sought in the 1991-92 YDMCHS. Table 4.1 indicates that 84 percent of currently married women have heard of at least one family planning method and slightly less than four-fifths reported knowing a modern method. This indicates a substantial increase in contraceptive knowledge in Yemen since the 1991-92 survey (see Figure 4.1). The most widely known method is the pill, which is known to more than 75 percent of currently married women. About two–thirds of the women have heard of the IUD, 56 percent know about injectables, and 48 percent have heard of female sterilization. Knowledge of other modern methods is much lower: condoms and male sterilization (24 percent, each), vaginal methods (19 percent), and implants (6 percent). About 7 in 10 women know of a traditional method, mainly prolonged breastfeeding (61 percent), while periodic abstinence and withdrawal are known by smaller proportions of respondents. The results presented in Table 4.1 shows that more than half of currently married women (53 percent) know a source for modern methods, almost double the proportion reported in the 1991-92 survey. Knowledge of sources for specific methods shows that 44 percent of currently married women know a source for the pill. Only 37 percent, 29 percent, and 28 percent, respectively, know a source for the IUD, injectables and female sterilization. Sources for other methods are even less well known. 46 Table 4.1 Knowledge of contraceptive methods and a source for methods Percentage of ever-married women and currently married women who know specific contraceptive method, and who know a source for the methods, by specific method, Yemen 1997 _______________________________________________________________ Know method Know a source _________________ _________________ Ever- Currently Ever- Currently Contraceptive married married married married method women women women women _______________________________________________________________ Any method Modern method Pill IUD Injectables Diaphragm/foam/jelly Condom Female sterilization Male sterilization Implants Any traditional method Safe period Withdrawal Prolonged breastfeeding Other traditional methods Herb, Arab medicine Soap, salt Other methods Any traditional/folk method Number of women Mean number of methods 83.6 83.8 NA NA 79.1 79.2 52.2 52.5 75.9 76.1 44.2 44.4 64.4 64.4 36.3 36.5 55.5 55.7 28.7 28.7 19.1 19.2 11.8 11.9 23.9 24.1 13.6 13.8 47.4 47.7 28.0 28.2 23.4 23.6 14.4 14.5 5.4 5.5 3.3 3.4 65.1 65.4 NA NA 32.4 32.6 NA NA 28.3 28.6 NA NA 60.7 61.0 NA NA 5.8 5.9 NA NA 4.8 4.8 NA NA 0.7 0.7 NA NA 1.3 1.3 NA NA 65.5 65.8 NA NA 10,414 9,786 10,414 9,786 4.4 4.5 1.8 1.8 _______________________________________________________________ NA = Not applicable The percentage of currently married women, who know at least one modern contraceptive method and know a source for the methods, by various background characteristics, is presented in Table 4.2. Only small differences by age exist in knowledge of modern methods among women 15-49; 78 to 81 percent of women 20-49, and 73 percent of the women 15-19 have heard of a modern method of family planning. There is a greater variation in the level of contraceptive knowledge by residence and region. More than 9 in 10 urban women know of at least one modern method compared with less than 75 percent of rural women. Knowledge of modern methods is much higher in the Plateau and Desert (85 percent) and Coastal regions (82 percent) than in the Mountainous region (68 percent). There are substantial differences in knowledge of contraceptive methods by education. Among illiterate women, 76 percent know a modern method compared with 93 percent of women who have completed primary education, and 98 percent of women with secondary or higher education. The differences in knowledge of family planning by education may account, in large part, for the greater knowledge of family planning in urban areas and in the Plateau and Desert region, since a greater proportion of educated women live in those areas. 47 Differentials in knowledge of service providers show relatively more variability than differentials in knowledge of modern methods (see Table 4.2). By age groups, between 53 and 55 percent of currently married women age 20-44 know a source for a modern contraceptive method. Older and younger women are less likely to know about service providers. The differences are much greater by residence. Eighty-one percent of urban women know a source, compared with only 43 percent of rural women. Regionally, a woman in the Plateau and Desert region (62 percent) is more likely to know a source for a contraceptive method than a woman who lives in the Mountainous region (36 percent). The most striking differences in knowledge of service providers are by level of education. Only 47 percent of illiterate women know a source. Among women who have completed primary school, knowledge of service providers is more than 70 percent higher (82 percent), while knowledge of a source is twice as high among women who have completed at least secondary school (93 percent). 4.2 Ever Use of Contraception In the YDMCHS, all respondents who reported knowledge of a specific method were asked if they had ever used the method. As shown in Table 4.3, 38 percent of ever-married women have used a method to regulate their fertility at some point in their lives. The 1997 ever-use rate is almost double the rate in the 1991-92 YDMCHS. Twenty-three percent have used a modern method, a substantial increase since the 1991- 92 survey which reported a 13 percent rate of ever-use. A quarter of ever-married women have used traditional methods (including prolonged breastfeeding); thus, the majority of ever-users have had experience with modern methods, and some have used more than one method. Currently married women and ever- married women have about the same level of experience with ever use of contraceptive. 48 Table 4.2 Knowledge of modern contraceptive methods and a source for methods, by selected background characteristics Percentage of currently married women who know any contraceptive method who know a modern method, and who know a source for a modern method, by selected background characteristics, Yemen 1997 _______________________________________________________________ Know a Know Know source for Number Background any a modern modern of characteristic method method1 method women _______________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete+ Total 76.5 72.5 41.8 1,063 85.7 81.3 54.9 1,902 83.2 78.2 53.1 1,855 86.6 81.4 55.3 1,585 84.7 80.5 54.8 1,637 83.4 79.6 52.6 999 83.3 78.1 48.3 746 96.9 96.2 81.2 2,427 79.5 73.6 43.0 7,359 85.1 82.0 55.4 2,226 74.7 68.3 36.0 2,952 89.0 84.9 61.6 4,608 81.7 76.4 47.1 8,248 94.1 92.5 73.9 528 94.6 93.4 81.6 595 96.4 96.4 84.9 185 98.4 98.4 93.1 230 83.8 79.2 52.5 9,786 _______________________________________________________________ 1Includes pill, IUD, injection, vaginal methods (diaphragm/foam/jelly), condom, female sterilization, male sterilization, and implants. The age differentials for ever use among currently married women indicate that the rate for women age 15-19 is only 13 percent; it increases to 34 percent for women age 20-24, and to 42 percent among women age 25-29. Ever-use peaks at 45 to 47 percent among women in their thirties before declining to 39 percent among women age 45-49. The modern methods most used by married women are the pill (16 percent) and the IUD (7 percent). Overall, however, the most widely used method is prolonged breastfeeding (20 percent). 4.3 Number of Children at First Use of Contraception Table 4.4 shows the percent distribution of ever-married women by the number of living children at the time they first used contraception. Fourteen percent of women, or 38 percent of ever-users start using contraception before having their second child. This tendency to begin using contraception early—probably for the purpose of spacing births—is most noticeable among younger women, i.e. women under 35 years of age. 49 Ta bl e 4. 3 E ve r u se o f c on tra ce pt io n A m on g ev er -m ar rie d w om en a nd c ur re nt ly m ar rie d w om en , t he p er ce nt ag e w ho h av e ev er u se d a co nt ra ce pt iv e m et ho d, b y sp ec ifi c m et ho d an d ag e, Y em en 1 99 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ M od er n m et ho d Tr ad iti on al m et ho d Fo lk m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ _ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ __ __ __ D ia - Fe m al e M al e Pr o- A ny H er bs , A ny A ny ph ra gm / st er i- st er i- A ny W ith - lo ng ed fo lk A ra b tra d. / N um be r A ny m od er n In je ct - fo am / C on - liz a- liz a- Im - tra d. Sa fe dr aw - br ea st - m et h- m ed i- So ap , fo lk of A ge m et ho d m et ho d P ill IU D ab le s je lly do m tio n tio n pl an ts m et ho d pe rio d al fe ed in g od ci ne sa lt O th er m et ho d w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ EV ER -M A R R IE D W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 15 -1 9 13 .3 5 .9 4 .5 1 .1 1. 1 0. 1 0. 6 0. 0 0. 0 0. 0 9 .9 1. 3 2. 1 7 .6 0. 2 0. 2 0. 0 0. 0 9 .9 1, 11 0 20 -2 4 32 .9 15 .6 10 .8 4 .4 1. 9 1. 1 2. 0 0. 0 0. 0 0. 0 24 .1 4. 5 5. 9 19 .1 0. 6 0. 5 0. 0 0. 2 24 .3 1, 99 2 25 -2 9 41 .4 23 .9 16 .8 7 .0 4. 7 1. 1 3. 3 0. 3 0. 0 0. 0 29 .2 5. 5 7. 6 22 .4 1. 0 0. 9 0. 1 0. 1 29 .5 1, 94 3 30 -3 4 44 .1 27 .7 20 .8 9 .5 4. 4 2. 2 3. 0 0. 7 0. 1 0. 1 29 .6 6. 4 8. 2 22 .3 1. 2 0. 7 0. 3 0. 3 30 .0 1, 68 0 35 -3 9 45 .0 30 .0 20 .6 10 .5 5. 8 2. 5 3. 8 2. 3 0. 2 0. 1 27 .9 5. 1 7. 2 21 .9 1. 6 1. 4 0. 1 0. 5 28 .7 1, 76 6 40 -4 4 42 .4 28 .0 19 .5 7 .0 5. 8 1. 9 2. 4 4. 7 0. 6 0. 0 24 .4 3. 3 5. 1 20 .3 1. 6 1. 1 0. 2 0. 4 25 .8 1, 09 1 45 -4 9 38 .1 24 .4 16 .4 5 .2 5. 1 2. 6 2. 1 3. 8 0. 3 0. 1 22 .6 3. 2 4. 1 18 .7 1. 5 0. 8 0. 3 0. 4 23 .1 8 33 To ta l 37 .7 22 .5 15 .9 6 .7 4. 0 1. 6 2. 6 1. 4 0. 1 -- 25 .0 4. 5 6. 2 19 .6 1. 1 0. 8 0. 1 0. 3 25 .4 10 ,4 14 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C U R R EN TL Y M A R R IE D W O M EN __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ 15 -1 9 13 .3 5 .9 4 .4 1 .1 1. 1 0. 0 0. 6 0. 0 0. 0 0. 0 9 .9 1. 4 2. 0 7 .6 0. 2 0. 2 0. 0 0. 0 10 .0 1, 06 3 20 -2 4 33 .6 16 .1 11 .0 4 .5 2. 0 1. 1 2. 1 0. 0 0. 0 0. 0 24 .6 4. 7 6. 1 19 .4 0. 6 0. 5 0. 0 0. 3 24 .8 1, 90 2 25 -2 9 42 .0 24 .1 16 .8 7 .2 4. 7 1. 2 3. 4 0. 3 0. 0 0. 0 29 .7 5. 6 7. 8 22 .8 0. 9 0. 8 0. 0 0. 1 30 .0 1, 85 5 30 -3 4 45 .2 28 .7 21 .5 9 .8 4. 6 2. 4 3. 1 0. 8 0. 1 0. 1 30 .4 6. 5 8. 7 22 .8 1. 3 0. 7 0. 3 0. 3 30 .8 1, 58 5 35 -3 9 46 .8 31 .5 21 .6 11 .0 6. 2 2. 7 3. 9 2. 5 0. 2 0. 1 28 .9 5. 3 7. 7 22 .7 1. 7 1. 4 0. 1 0. 5 29 .8 1, 63 7 40 -4 4 43 .8 28 .7 20 .1 7 .1 6. 1 1. 9 2. 5 4. 9 0. 6 0. 0 24 .8 3. 4 5. 0 20 .6 1. 6 1. 1 0. 2 0. 5 26 .3 9 99 45 -4 9 39 .4 25 .4 17 .1 5 .4 5. 2 2. 5 2. 0 4. 2 0. 3 0. 1 23 .5 3. 4 4. 5 19 .3 1. 6 0. 9 0. 4 0. 4 24 .0 7 46 To ta l 38 .6 23 .1 16 .3 6 .9 4. 2 1. 7 2. 7 1. 4 0. 1 -- 25 .6 4. 7 6. 4 20 .0 1. 1 0. 8 0. 1 0. 3 26 .1 9, 78 6 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ -- L es s t ha n 0. 05 p er ce nt 50 Table 4.4 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Yemen 1997 ____________________________________________________________________________________________________ Number of living children at time Median Never of first use of contraception Number number Current used _______________________________________________ of of age contraception 0 1 2 3 4+ Missing Total women children ____________________________________________________________________________________________________ 15-19 86.7 1.4 9.9 1.5 0.3 0.1 0.0 100.0 1,110 0.5 20-24 67.1 1.3 20.4 7.1 2.6 1.4 0.1 100.0 1,992 0.7 25-29 58.6 0.6 17.5 8.0 6.7 8.6 -- 100.0 1,943 1.3 30-34 55.9 0.7 12.7 6.4 5.3 18.9 0.1 100.0 1,680 2.4 35-39 55.0 0.2 10.4 5.3 4.6 24.4 0.1 100.0 1,766 3.5 40-44 57.6 0.5 9.7 5.0 3.1 24.1 0.0 100.0 1,091 3.7 45-49 61.9 0.1 8.8 3.8 2.2 23.0 0.3 100.0 833 4.2 Total 62.3 0.7 13.7 5.8 3.9 13.4 0.1 100.0 10,414 1.7 _____________________________________________________________________________________________________ -- Less than 0.05 percent 4.4 Reason For First Use of Contraception The YDMCHS questionnaire also obtained information on a woman’s childbearing intentions at the time contraception was first used. These data are used in Table 4.5 to demonstrate the extent of interest in limiting or spacing births at the time of first use. Overall, 82 percent of ever-users began using contraceptive to delay the next birth, while 18 percent started using because they wanted no more children. The proportion of women who began using family planning to avoid the next birth increases rapidly with the number of children the woman has at the time of first use. Among women with four or more children at the time of first use, 40 percent reported that they wanted no more children (see Figure 4.2). The proportion of ever-users who adopted a family planning method for the first time for the purpose of spacing births rather than for limiting family size was higher among urban women than rural women, higher among more educated women than among those who are illiterate, and higher among those living in the Coastal region than in the Mountainous region. 4.5 Current Use of Contraception The contraceptive prevalence rate (including prolonged breastfeeding) for currently married women (pregnant and non-pregnant) is 21 percent (see Table 4.6), or more than double the proportion in 1991-92. Almost half are using a modern method. The modern methods most commonly used are the pill (4 percent) and the IUD (3 percent). One percent of women use injectables and the same proportion use female sterilization; 8 percent depend on prolonged breastfeeding, 2 percent use withdrawal, and 1 percent use periodic abstinence. Table 4.6 also shows the percent distribution of currently married women by contraceptive method currently used, according to age. The pattern of differentials in current use of contraception by age is similar to the pattern for ever-use of contraception, i.e., women in their thirties have the highest level of use. 51 Table 4.5 Reproductive intentions at first use of contraception Percent distribution of ever-married women who have ever used a contraceptive method by reproductive intentions at the time of first use, according to selected background characteristics, Yemen 1997 _____________________________________________________________________________ Wanted Wanted Number Background child no more of characteristic later children Other Missing Total women _____________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete + Children at first use 0-1 2-3 4+ Total 96.2 3.2 0.5 0.0 100.0 147 93.7 5.4 0.6 0.3 100.0 655 87.7 11.4 0.8 0.1 100.0 805 83.8 16.1 0.1 0.0 100.0 741 75.3 23.8 0.3 0.6 100.0 795 67.8 32.2 0.0 0.0 100.0 462 68.6 31.0 0.0 0.4 100.0 318 86.0 13.6 0.3 0.1 100.0 1,553 79.2 20.1 0.4 0.3 100.0 2,371 89.9 9.9 0.1 0.2 100.0 774 75.2 23.5 0.7 0.6 100.0 922 81.9 17.7 0.3 0.1 100.0 2,227 79.0 20.3 0.4 0.3 100.0 3,005 89.7 10.3 0.0 0.0 100.0 296 91.1 8.5 0.4 0.0 100.0 349 91.7 7.4 0.9 0.0 100.0 108 94.1 5.9 0.0 0.0 100.0 166 96.6 2.4 0.8 0.2 100.0 1,508 90.7 9.3 0.0 0.0 100.0 1,008 60.0 39.8 0.1 0.1 100.0 1,398 81.9 17.5 0.3 0.2 100.0 3,924 Table 4.7 and Figure 4.3 highlights the differentials in contraceptive prevalence among currently married women, by residence, region, level of education, and current family size. A large difference in prevalence is observed between urban and rural areas. Thirty-six percent of urban women are using a contraceptive method, compared with only 16 percent of rural women. The prevalence rate in urban areas is more than twice that in rural areas. Prevalence in the Plateau and Desert region is also about twice as high as in the Mountainous region. Pronounced differences in current use exist by level of education. The proportion of married women using contraception increases dramatically from 18 percent among illiterate women to 32 percent among those with primary school completed, and then jumps to 49 percent among women with at least secondary education. Contraceptive use increases with the number of living children. Current use is negligible among childless women and is 16 percent among women with one child. One in 4 women who has three or more children is currently using a method of contraception. Figure 4.4 compares contraceptive prevalence by age and number of living children for the 1991-92 YDMCHS and the current survey. Since 1991-92, contraceptive use has doubled in the age group 20-24 (from 9 to 19 percent) and increased even more dramatically among women age 25-29 and 45-49. Except for childless women, contraceptive use has increased substantially in all groups regardless of the number of children. 52 4.6 Knowledge of the Fertile Period Table 4.8 shows the percent distribution of currently married women who are using periodic abstinence and of ever-married women by knowledge of the fertile period. The most common response, given by 36 percent of women and 47 percent of users, was that risk of pregnancy was greatest after a woman’s period ends. Only 8 percent of ever-married women and 29 percent of users correctly identified the middle of the cycle as the time a women is most likely to get pregnant. Six percent of periodic abstinence users compared with 3 percent of ever-married women believe that the most fertile time in the ovulatory cycle occurs just before the period begins. Almost one-third of ever-married women and 11 percent of users of periodic abstinence say they do not know when a woman is most likely to get pregnant during the ovulatory cycle. 4.7 Consultation Before Using the Pill Table 4.9 presents the proportion of current users of the pill and nonusers who used the pill as their last method, by person consulted before use of the method, according to selected background characteristics. Overall, 71 percent of women consulted doctors and 6 percent nurses/midwives; pharmacists were consulted by 4 percent while 3 percent consulted friends or neighbors. Eleven percent did not consult anyone. For past users, about 73 percent consulted doctors, 5 percent nurses/midwives, and 4 percent pharmacists while 9 percent did not consult anyone. For current users, the most likely persons to be consulted are again doctors (69 percent), nurses/ midwives (8 percent), and pharmacists (4 percent). About 13 percent of current users did not consult anyone before use. 53 Ta bl e 4. 6 C ur re nt u se o f c on tra ce pt io n by a ge Pe rc en t d is tri bu tio n of c ur re nt ly m ar rie d w om en b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to a ge , Y em en 1 99 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ M od er n m et ho d Tr ad iti on al m et ho d Fo lk m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ _ D ia - Fe m al e M al e Pr o- A ny H er bs , A ny ph ra gm / st er i- st er i- A ny W ith - lo ng ed fo lk A ra b N ot N um be r A ny m od er n In je ct - fo am / C on - liz a- liz a- tr ad . Sa fe dr aw - br ea st - m et h- m ed i- cu rr en tly of A ge m et ho d m et ho d Pi ll IU D ab le s je lly do m tio n tio n m et ho d pe rio d al fe ed in g od ci ne O th er us in g To ta l w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 15 -1 9 8 .6 2 .7 1. 2 0. 8 0. 5 0. 0 0. 1 0. 0 0. 0 6 .0 0. 1 0. 8 5 .1 0. 0 0. 0 0. 0 91 .4 10 0. 0 1, 06 3 20 -2 4 18 .7 6 .1 3. 0 2. 5 0. 4 0. 0 0. 1 0. 0 0. 0 12 .6 0. 9 1. 3 10 .3 0. 1 0. 1 0. 0 81 .3 10 0. 0 1, 90 2 25 -2 9 24 .2 9 .8 4. 1 3. 4 1. 6 -- 0. 4 0. 3 0. 0 14 .2 1. 4 2. 1 10 .7 0. 2 0. 2 0. 0 75 .8 10 0. 0 1, 85 5 30 -3 4 24 .8 12 .1 5. 6 4. 0 1. 1 0. 2 0. 2 0. 8 0. 1 12 .7 1. 8 1. 9 9 .0 0. 1 0. 1 0. 0 75 .2 10 0. 0 1, 58 5 35 -3 9 25 .8 14 .7 5. 4 4. 3 1. 8 -- 0. 5 2. 5 0. 2 10 .9 1. 3 2. 2 7 .4 0. 2 0. 1 -- 74 .2 10 0. 0 1, 63 7 40 -4 4 21 .5 12 .9 3. 4 2. 7 1. 4 0. 1 0. 3 4. 8 0. 2 8 .0 1. 4 1. 6 5 .0 0. 6 0. 2 0. 4 78 .5 10 0. 0 9 99 45 -4 9 14 .7 9 .9 2. 4 1. 6 1. 1 0. 2 0. 0 4. 2 0. 3 4 .8 0. 6 1. 9 2 .2 0. 1 0. 0 0. 1 85 .3 10 0. 0 7 46 To ta l 20 .8 9 .8 3. 8 3. 0 1. 2 0. 1 0. 3 1. 4 0. 1 10 .8 1. 1 1. 7 8 .0 0. 2 0. 1 0. 1 79 .2 10 0. 0 9, 78 6 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ -- L es s t ha n 0. 05 p er ce nt 54 Ta bl e 4. 7 C ur re nt u se o f c on tra ce pt io n by b ac kg ro un d ch ar ac te ris tic s Pe rc en t d is tri bu tio n of c ur re nt ly m ar rie d w om en b y co nt ra ce pt iv e m et ho d cu rr en tly u se d, a cc or di ng to se le ct ed b ac kg ro un d ch ar ac te ris tic s, Y em en 1 99 7 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ M od er n m et ho d Tr ad iti on al m et ho d Fo lk m et ho d __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ D ia - Fe m al e M al e Pr o- A ny H er bs , A ny ph ra gm / st er i- st er i- A ny W ith - lo ng ed fo lk A ra b N ot N um be r B ac kg ro un d A ny m od er n In je ct - fo am / C on - liz a- liz a- tr ad . Sa fe dr aw - br ea st - m et h- m ed i- cu rr en tly of ch ar ac te ris tic m et ho d m et ho d P ill IU D ab le s je lly do m tio n tio n m et ho d pe rio d al fe ed in g od ci ne O th er us in g To ta l w om en __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ R es id en ce U rb an 36 .0 21 .2 9 .2 7 .3 1. 0 0. 2 0. 8 2. 4 0. 3 14 .5 3. 1 4. 3 7 .2 0. 3 0. 2 0. 1 64 .0 10 0. 0 2, 42 7 R ur al 15 .8 6 .1 2 .1 1 .6 1. 2 -- 0. 1 1. 1 0. 0 9 .6 0. 5 0. 9 8 .2 0. 1 0. 1 0. 1 84 .2 10 0. 0 7, 35 9 R eg io n C oa st al 17 .2 9 .6 6 .5 1 .7 0. 1 0. 1 0. 1 1. 0 0. 2 7 .3 2. 1 1. 2 4 .0 0. 3 0. 2 -- 82 .8 10 0. 0 2, 22 6 M ou nt ai no us 14 .9 5 .1 1 .9 1 .0 1. 2 0. 1 -- 1. 0 0. 0 9 .7 0. 3 0. 9 8 .5 0. 0 0. 0 -- 85 .1 10 0. 0 2, 95 2 P la te au a nd D es er t 26 .3 12 .9 3 .8 4 .9 1. 7 0. 1 0. 4 1. 9 0. 1 13 .2 1. 3 2. 5 9 .5 0. 2 0. 1 0. 1 73 .7 10 0. 0 4, 60 8 Ed uc at io n I lli te ra te 18 .1 8 .0 2 .6 2 .3 1. 3 -- 0. 2 1. 5 0. 1 9 .9 0. 6 1. 2 8 .1 0. 2 0. 1 -- 81 .9 10 0. 0 8, 24 8 L ite ra te 33 .1 16 .2 9 .3 4 .3 0. 2 0. 3 0. 5 1. 6 0. 0 16 .4 2. 7 4. 2 9 .5 0. 6 0. 3 0. 2 66 .9 10 0. 0 52 8 P rim ar y co m pl et e 32 .2 17 .4 10 .0 5 .6 0. 6 0. 1 0. 3 0. 7 0. 1 14 .8 4. 1 4. 5 6 .2 0. 0 0. 0 0. 0 67 .8 10 0. 0 59 5 P re pa ra to ry c om pl et e 36 .5 20 .5 7 .8 8 .9 0. 0 0. 0 1. 8 1. 7 0. 2 15 .7 4. 8 4. 3 6 .7 0. 3 0. 3 0. 0 63 .5 10 0. 0 18 5 S ec on da ry c om pl et e + 49 .0 31 .4 15 .5 12 .8 0. 5 0. 4 1. 6 0. 2 0. 4 17 .6 8. 4 4. 3 4 .8 0. 0 0. 0 0. 0 51 .0 10 0. 0 23 0 N um be r of li vi ng c hi ld re n N on e 0 .6 0 .3 0 .1 0 .0 0. 0 0. 0 0. 0 0. 2 0. 0 0 .3 0. 1 0. 2 0 .0 0. 0 0. 0 0. 0 99 .4 10 0. 0 1, 18 2 1 15 .5 4 .5 2 .7 1 .1 0. 5 0. 0 -- 0. 2 0. 0 11 .0 0. 8 0. 9 9 .3 0. 0 0. 0 0. 0 84 .5 10 0. 0 1, 14 6 2 22 .5 9 .5 4 .6 3 .7 0. 4 0. 0 0. 3 0. 5 0. 0 13 .0 1. 6 1. 9 9 .5 0. 0 0. 0 0. 0 77 .5 10 0. 0 1, 08 2 3 24 .2 11 .0 5 .0 3 .9 0. 9 0. 0 0. 4 0. 7 0. 1 13 .1 1. 4 1. 7 10 .0 0. 1 0. 1 0. 0 75 .8 10 0. 0 1, 08 7 4 + 25 .4 12 .9 4 .5 3 .8 1. 8 0. 1 0. 3 2. 3 0. 1 12 .2 1. 3 2. 2 8 .7 0. 3 0. 2 0. 1 74 .6 10 0. 0 5, 28 9 To ta l 20 .8 9 .8 3 .8 3 .0 1. 2 0. 1 0. 3 1. 4 0. 1 10 .8 1. 1 1. 7 8 .0 0. 2 0. 1 0. 1 79 .2 10 0. 0 9, 78 6 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ – Le ss th an 0 .0 5 pe rc en t 55 1 Lactational amenorrheic method users are currently married women who are breastfeeding a child under six months of age, are still postpartum amenorrheic, and not feeding the child anything but breast milk, or breast milk and plain water. 56 4.8 Knowledge of the fertile period Percent distribution of currently married women who are using periodic abstinence and of ever-married women by knowledge of the fertile period during the ovulatory cycle, Yemen 1997 __________________________________________ Currently married women who are using Ever- Knowledge of the periodic married fertile period abstinence women __________________________________________ Believe fertile period is: During period 0.0 0.1 After period ends 46.9 35.6 Middle of the cycle 29.1 7.9 Before period begins 5.5 3.2 At any time 7.2 22.0 Other 0.0 0.1 Don't know 11.3 31.1 Missing 0.0 0.1 Total 100.0 100.0 Number 112 10,414 The differentials in consulting medical profes- sionals before starting use of the pill by residence and education are small. 4.8 Knowledge of Contraceptive Effects of Breastfeeding Information on knowledge of the contraceptive effect of breastfeeding is shown in Table 4.10. About 4 in 10 currently married women believe that breastfeed- ing does not affect the chances of becoming pregnant. About 20 percent of women either do not know about the contraceptive effects of breastfeeding or believe that breastfeeding increases the risk of pregnancy. Only 32 percent correctly reported that breastfeeding can reduce the risk of pregnancy. Differentials in knowledge of the contraceptive effects of breastfeeding by age show that correct knowl- edge is lowest among women under 20 (24 percent), and ranges from 32 to 34 percent among other age cohorts. Correct knowledge of the contraceptive effect of breastfeeding is higher among women in urban areas, and in the Plateau and Desert region. Compared with illiterate and less educated women (32-37 percent), knowledge that breastfeeding can decrease pregnancy risk is slightly higher among those who have completed preparatory education and much higher among those with secondary or higher education (45 percent). One in five women has at some time used breastfeeding to avoid pregnancy, 8 percent report they currently rely on breastfeeding as a contraceptive method which is the same percentage as reported current use of the method (see Table 4.6). Four percent of currently married women meet the criteria for use of the lactational amenorrheic method (LAM) of family planning1. 4.9 Timing of Sterilization Table 4.11 shows the distribution of sterilized women by the age at which they had the procedure, according to the number of years prior to survey the procedure was done. The information is useful in understanding when a Yemeni woman is likely to want to use this method of contraception. 57 Table 4.9 Consultation before using the pill Percent distribution of women currently using the pill and women who are not using any method but who used the pills as their last method by person consulted before using the method, according to selected background characteristics, Yemen 1997 ____________________________________________________________________________________________________ Daya/ Number Background Nurse/ Pharma- grand- Neighbor/ of characteristic Doctor midwife cist mother friend No one Other Missing Total women ____________________________________________________________________________________________________ CURRENT USERS ____________________________________________________________________________________________________ Residence Urban 68.0 9.6 2.8 0.0 3.0 12.8 3.2 0.7 100.0 223 Rural 69.3 4.6 4.7 0.0 1.8 13.4 5.8 0.4 100.0 152 Education Illiterate 65.3 5.7 3.9 0.0 3.1 16.4 5.0 0.7 100.0 217 Literate 63.8 16.7 3.0 0.0 1.2 5.7 8.4 1.1 100.0 49 Primary complete 73.7 5.3 5.5 0.0 0.0 13.8 1.8 0.0 100.0 59 Preparatory complete (72.2) (15.9) (0.0) (0.0) (4.4) (7.6) (0.0) (0.0) 100.0 14 Secondary complete+ (84.5) (6.9) (0.9) (0.0) (4.0) (3.7) (0.0) (0.0) 100.0 36 Total 68.5 7.6 3.6 0.0 2.5 13.0 4.2 0.6 100.0 376 ____________________________________________________________________________________________________ PAST USERS ____________________________________________________________________________________________________ Residence Urban 69.8 6.8 3.3 0.2 1.8 9.9 8.3 0.0 100.0 309 Rural 75.4 3.6 5.3 0.0 3.3 9.0 3.4 0.0 100.0 335 Education Illiterate 74.3 3.7 4.0 0.0 3.0 9.9 5.0 0.0 100.0 472 Literate 64.1 6.0 8.5 0.0 1.6 9.1 10.8 0.0 100.0 66 Primary complete 66.6 13.1 3.0 0.8 1.7 5.7 9.1 0.0 100.0 71 Preparatory complete * * * * * * * * 100.0 15 Secondary complete + (85.3) (7.0) (3.8) (0.0) (0.0) (4.0) (0.0) (0.0) 100.0 20 Total 72.7 5.1 4.3 0.1 2.6 9.4 5.8 0.0 100.0 644 ____________________________________________________________________________________________________ TOTAL _____________________________________________________________________________________________________ Residence Urban 69.0 7.9 3.1 0.1 2.3 11.1 6.2 0.3 100.0 532 Rural 73.5 3.9 5.1 0.0 2.8 10.4 4.2 0.1 100.0 488 Education Illiterate 71.5 4.3 4.0 0.0 3.0 11.9 5.0 0.2 100.0 689 Literate 64.0 10.6 6.2 0.0 1.4 7.7 9.8 0.5 100.0 115 Primary complete 69.8 9.5 4.1 0.4 0.9 9.4 5.7 0.0 100.0 131 Preparatory complete (71.8) (10.6) (1.8) (0.0) (2.1) (13.7) (0.0) (0.0) 100.0 30 Secondary complete + 84.8 6.9 1.9 0.0 2.6 3.8 0.0 0.0 100.0 56 Total 71.2 6.0 4.0 0.1 2.5 10.7 5.2 0.2 100.0 1,020 _____________________________________________________________________________________________________ Note: Figures in parentheses are based on 25 to 49 women; as asterisk indicates that a figure is based on fewer than 25 women and had been suppressed. The data indicate that women who decide to be sterilized generally have the procedure done later in their reproductive years. Over one-third (34 percent) of sterilized women had the operation at age 35-39, while 27 percent were sterilized at age 30-34. One in five sterilized women had the procedure when she was in her forties. The median age at sterilization is 34 years. 58 Table 4.10 Perceived contraceptive effect of breastfeeding Percent distribution of currently married women by perceived risk of pregnancy associated with breastfeeding and percentage of currently married women who previously relied and who currently rely on breastfeeding to avoid pregnancy and percentage who meet lactational amenorrheic method (LAM) criteria, according to selected background characteristics, Yemen 1997 ___________________________________________________________________________________________________________ Reliance on breastfeeding Perceived risk of pregnancy to avoid associated with breastfeeding pregnancy __________________________________________ ________________ Don't Meet Number Background Un- In- De- know/ Previ- Cur- LAM of characteristic changed creased creased Depends Missing Total ously rently criteria women ___________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete+ Total 29.7 2.1 24.3 5.9 37.9 100.0 7.6 5.1 4.4 1,063 37.4 3.3 32.2 8.3 18.8 100.0 19.4 10.3 5.8 1,902 37.4 5.0 34.1 8.9 14.6 100.0 22.8 10.7 5.1 1,855 42.1 4.1 32.8 9.4 11.6 100.0 22.8 9.0 4.8 1,585 42.0 4.7 34.1 8.4 10.8 100.0 22.7 7.4 3.5 1,637 42.4 2.9 33.1 10.0 11.5 100.0 20.6 5.0 2.0 999 36.3 6.0 33.8 11.6 12.2 100.0 19.3 2.2 0.6 746 . 36.4 5.4 37.6 9.3 11.3 100.0 23.6 7.2 3.3 2,427 39.2 3.6 30.6 8.6 18.0 100.0 18.8 8.2 4.5 7,359 34.4 5.7 30.2 7.7 22.0 100.0 10.8 4.0 3.7 2,226 41.2 3.7 28.2 9.3 17.6 100.0 19.6 8.5 4.8 2,952 . 38.8 3.5 36.0 8.9 12.8 100.0 24.7 9.5 4.1 4,608 39.1 3.8 31.5 8.6 17.0 100.0 19.7 8.1 4.4 8,248 36.7 4.5 36.5 8.5 13.9 100.0 21.7 9.5 4.3 528 38.2 6.6 32.3 10.2 12.6 100.0 20.7 6.2 3.5 595 33.3 2.7 42.2 8.2 13.6 100.0 22.0 6.7 1.0 185 28.4 6.0 44.5 11.1 10.1 100.0 22.2 4.8 3.1 230 38.5 4.0 32.3 8.8 16.3 100.0 20.0 8.0 4.2 9,786 The data indicate that women who were sterilized in the four years preceding the survey were older, on average, than women who were sterilized four to seven years preceding the survey. For example, in the most recent period 30 percent of sterilizations were done by age 35 compared with 43 percent in the period four to seven years before the survey. 4.10 Problems With Current Method of Contraception Problems experienced while using a family planning method may reduce the effectiveness of the method or lead to termination of use. An understanding of the problems users experience is therefore, important to improving family planning service delivery in Yemen. In order to obtain information about problems associated with use of specific contraceptive methods, women who were using a modern method were asked if they had experienced any problems with their current method, and if so, what the problems were (Table 4.12). 59 4.11 Timing of sterilization Percent distribution of sterilized women by age at the time of sterilization, according to the number of years since the operation, Yemen 1997 ___________________________________________________________________________________________________ Age at sterilization Number Years since ____________________________________________ of Median sterilization <25 25-29 30-34 35-39 40-44 45-49 Total women age ___________________________________________________________________________________________________ <4 1.3 9.5 19.6 40.1 23.8 5.7 100.0 64 35.8 4-7 2.6 7.7 32.9 31.4 25.3 U 100.0 44 33.9 8+ years (6.8) (29.6) (34.2) (26.7) (2.6) U 100.0 34 NC Total 3.0 13.8 27.2 34.2 19.1 2.6 100.0 142 34.2 ____________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 women. U = Unknown (Not available) NC = Not calculated due to censoring Table 4.12 Problems with current method of contraception Percent distribution of currently married women who are using a modern contraceptive method by the main problem with the current method, Yemen 1997 _______________________________________________________________________________ Inject- Female Main problem Pill IUD ables Condom sterilization Total _______________________________________________________________________________ No problem 66.9 59.2 61.3 (90.4) 65.7 64.6 Health concerns 31.1 36.8 36.5 (9.6) 33.3 32.8 Method not efficient 0.3 0.0 0.0 (0.0) 0.0 0.1 Uncomfortable w/use 1.4 3.9 2.2 (0.0) 0.5 2.2 Other 0.0 0.1 0.0 (0.0) 0.0 0.0 Don’t know/Missing 0.3 0.0 0.0 (0.0) 0.6 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 376 293 113 25 138 960 _________________________________________________________________________________ Note: Total includes less than 25 users of vaginal methods and male sterilization. Figures in parentheses are based on 25-49 cases. Ten percent of condom users and a sizeable proportion of women using injectables, the IUD, female sterilization, and the pill reported having problems with their methods. Around 40 percent of IUD and injectables users, and one-third of pill users reported having a problem with their method. Health concerns were the most frequently cited problem regarding the IUD (38 percent), injectables (38 percent), female sterilization (33 percent) and the pill (31 percent). All condom users who reported any problem, mentioned health concerns. One to four percent of women using modern methods reported that the method was uncomfortable to use. The high proportion of women who report health concern regarding the pill, the IUD, and injectables underscores the need to provide information and assurances to current and potential users of these methods. 60 Table 4.13 Source for modern contraceptive methods Percent distribution of currently married women who are using modern contraceptive methods by most recent source, according to specific methods, Yemen 1997 ___________________________________________________________________________ Female All Injec- sterili- modern Source Pill IUD tables Condom zation methods1 ___________________________________________________________________________ Public 51.3 48.0 19.6 (33.4) 73.7 49.4 General hospital 18.4 23.8 13.2 (11.9) 73.7 27.8 Health center 9.5 2.7 4.8 (0.0) 0.0 5.1 Primary health care center 1.2 1.2 0.0 (0.0) 0.0 0.8 MCH center 20.0 16.2 0.8 (18.0) 0.0 13.4 Mobile clinic 0.0 0.4 0.8 (0.0) 0.0 0.2 Yemen Family Care Association 2.2 3.6 0.0 (3.5) 0.0 2.1 Private (medical) 45.1 51.4 75.1 (61.8) 21.6 47.5 Private dispensary 1.0 8.8 16.1 0.0) 7.1 6.2 Private hospital 1.0 8.6 4.8 (0.0) 11.6 5.3 Cooperative health Inst. 0.8 1.3 1.2 (0.0) 1.1 1.1 Private doctor 2.3 32.3 26.5 (0.0) 1.8 14.3 Public field worker 0.2 0.0 0.0 (0.0) 0.0 0.1 Pharmacy 39.8 0.5 26.4 (61.8) 0.0 20.6 Other private 0.2 0.3 0.0 (0.0) 0.0 0.2 Other 0.2 0.3 0.0 (0.0) 0.0 0.2 Don't know 2.9 0.0 4.6 (4.8) 0.6 1.9 Missing 0.6 0.3 0.7 (0.0) 4.1 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 376 293 113 25 142 964 ___________________________________________________________________________ Note: Figures in parentheses are based on 25-49 cases. 1 Includes vaginal methods and male sterilization which are not shown separately because there are fewer than 25 cases of each method. 4.11 Sources of Contraceptive Methods The identification of sources of contraceptive methods for current users is important in order to evaluate the role played by various providers of family planning services and supplies in the public and private sectors. Women who were using a modern method of contraception at the time of the survey were asked where they obtained the method the last time. As shown in Table 4.13 and Figure 4.5 the gap between public and private medical sources has almost disappeared. The public sector provided contraceptives to 57 percent of users in 1991-92. In 1997, this figure has dropped to 49 percent. General hospitals (28 percent) and MCH centers (13 percent) are the main public sources. Among private sources, pharmacies provide contraceptives to 21 percent of users while private doctors provide methods to 14 percent. Public and private sources are almost equally likely to serve IUD users; for pill users, public sources have a slight edge over private medical sources (51 versus 45 percent); for other methods, the source of family planning varies by the method used. For example, more than three-fourths of sterilizations are performed by the public sector (general hospitals), whereas the private medical sector provides injectables to three-fourths of users of that method. 61 4.12 Intention to Use Contraception in the Future Women who were not using any contraceptive method at the time of the survey were asked if they would use a family planning method in the future. Those who responded in the affirmative were also asked how long they would wait to use a method and what method they would prefer to use. Table 4.14 shows the percent distribution of currently married women who were not using contraception by intention to use in the future. The results in the table are presented according to the number of living children (including current pregnancy). Sixty-four percent of currently married women who were not using any method indicated that they did not intend to use a method in the future (compared with 83 percent in the 1991-92 survey). One-quarter of nonusers expressed a desire to use some method, 9 percent in the next 12 months and 4 percent after 12 months; 11 percent were unsure about when they would use a method, and another 12 percent were not sure whether or not they would use a method. The method preferences of potential future users are shown in Table 4.15. The pill is the most popular choice (34 percent), the IUD is second (20 percent), followed by injectables (10 percent). Female sterilization is the preferred method for 5 percent of women, but less than 1 percent of women mentioned male sterilization method, vaginal methods, condoms, or implants. Women’s preferences differ by timing of intended use (in the next 12 months or later). However, the pill, the IUD, and injectables are the most popular methods regardless of timing. 62 Table 4.14 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children, Yemen 1997 _________________________________________________________________________________ Number of living children1 _______________________________________ Future intention 0 1 2 3 4+ Total _________________________________________________________________________________ Intend to use in next 12 months Intend to use later (after 12 months) Unsure as to timing Unsure as to intention Do not intend to use Missing Total Number of women 1.5 6.7 11.4 12.0 10.0 9.0 2.8 4.9 4.5 5.4 3.6 4.0 17.5 11.8 12.2 9.6 8.5 10.5 18.8 14.4 11.1 10.9 10.8 12.2 59.4 62.0 60.7 62.0 66.9 64.2 0.0 0.1 0.1 0.1 0.2 0.2 100.0 100.0 100.0 100.0 100.0 100.0 908 974 882 849 4,137 7,750 _________________________________________________________________________________ 1Includes current pregnancy Table 4.15 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to intended use, Yemen 1997 ____________________________________________________ Intend to use ______________________ In next After Unsure Preferred method 12 12 as to of contraception months months timing Total ____________________________________________________ Pill 27.8 38.9 38.2 34.4 IUD 21.1 17.9 18.9 19.6 Injectables 11.6 10.3 8.0 9.8 Diaphragm/Foam/Jelly 0.2 0.0 0.1 0.1 Condom 0.6 1.3 0.4 0.6 Female Sterilization 6.1 5.9 2.7 4.5 Male Sterilization 0.3 0.0 0.0 0.1 Implants 0.6 0.7 0.2 0.4 Periodic Abstinence 4.1 3.1 2.8 3.3 Withdrawal 1.8 1.2 1.4 1.5 Prolonged Breastfeeding 11.6 4.0 6.0 7.8 Folk method 1.3 0.9 1.2 1.2 Whatever doctor prescribes/ whatever is convenient 5.5 4.7 5.6 5.4 Don't know/Missing 7.4 11.3 14.5 11.2 Total 100.0 100.0 100.0 100.0 Number of women 695 308 816 1,818 63 Table 4.16 Reasons for not intending to use contraception Percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future by main reason for nonuse, according to age, fertility intentions, and ever use of contraception, Yemen 1997 _____________________________________________________________________________________ Fertility intentions ______________________________________ Main Want more Want to limit reason for _____________ _____________ not intending Age Never Never to use ______________ Used used Used used contraception 15-29 30-49 method method method method Other1 Total _____________________________________________________________________________________ Wants more children 33.7 13.4 43.4 44.8 (21.8) 23.0 2.8 22.6 Fear side effects 11.4 12.4 12.8 7.9 (26.1) 8.0 15.2 11.9 Health concerns 5.8 9.3 9.4 3.6 (22.3) 4.3 11.0 7.7 Interferes with body 0.1 0.1 0.0 0.1 ( 0.0) 0.0 0.1 0.1 Knows no method 6.4 6.9 0.5 6.8 ( 0.0) 11.5 6.8 6.7 Knows no source 1.4 1.2 0.0 1.0 ( 0.0) 2.0 1.5 1.3 Lack of access 1.2 0.6 1.4 0.8 ( 0.0) 0.9 0.9 0.9 Cost too much 0.6 1.2 0.5 0.5 ( 0.0) 0.0 1.5 1.0 Inconvenient to use 0.5 2.0 3.2 0.5 ( 0.0) 0.0 2.0 1.4 Religion prohibits 17.1 17.3 6.7 16.3 ( 7.9) 25.8 18.2 17.2 Respondent opposed 2.3 1.8 3.0 2.3 ( 3.7) 4.1 1.5 2.0 Husband opposed 10.6 7.8 6.6 7.5 ( 5.0) 9.9 10.6 9.1 Others opposed 0.4 0.1 0.5 0.3 ( 0.0) 0.6 0.1 0.2 God's will 1.4 2.3 2.2 1.3 ( 1.8) 2.6 2.3 1.9 Infrequent sex 1.8 2.9 4.8 1.9 ( 0.0) 1.3 2.8 2.4 Menopausal/hysterectomy 0.3 8.2 0.8 0.1 ( 0.0) 0.0 9.0 4.6 Subfecund/infecund 1.0 8.9 1.1 0.8 ( 0.0) 2.4 9.7 5.3 Other 1.4 1.5 2.4 1.3 ( 0.0) 0.9 1.6 1.4 Don't know 2.5 2.1 0.4 2.1 (11.5) 2.7 2.5 2.3 Missing 0.1 0.1 0.4 0.1 ( 0.0) 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2,253 2,720 223 2,007 35 212 2,496 4,973 _____________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 women 1Answers other than "want more" or "want no more" to the question on future reproductive intentions. 4.13 Reasons for Not Intending to Use Contraception Currently married women who indicated that they did not intend to use a contraceptive method in the future were asked their reason for nonuse. The percent distribution of these women by reasons proffered for not intending to use a contraceptive method is presented in Table 4.16. The results in the table are shown by (a) two broad age groups and (b) fertility intentions by past experience with contraception. “Other” is a residual category of fertility intentions and includes women who could not be assigned to the categories “want more” or “want to limit”. 64 The reasons expressed by women for not intending to use family planning can be broadly grouped into the following categories: reasons related to contraceptive methods, attitude toward family planning, fatalistic attitude, and “other” reasons. The reasons related to contraceptive methods are lack of knowledge, side effects, inconvenience of use, and difficulty obtaining methods. Twenty-three percent of women said they wanted more children and 10 percent reported that they were either menopausal or subfecund. Only 8 percent of nonusers said they would not use a contraceptive method because they lacked knowledge of methods or their sources while 1 percent mentioned lack of access to methods. Twelve percent of women had no plan to use contraception because of fear of side effects, 1 percent considered contraceptive methods inconvenient to use, and 1 percent said the cost of methods was too high. About 28 percent of women gave attitudinal reasons. Although 2 percent were personally opposed to family planning, the remaining women in this category were split between religious prohibition (17 percent) and disapproval of husbands (9 percent). Two percent of women were fatalistic as far as family size was concerned and implied there was little they could do to control their fertility. Younger women were more likely to mention wanting more children and older women were more likely to say they were menopausal or infecund/subfecund. The major difference in other reasons by age was health concerns and husband’s disapproval. Younger women mentioned health concerns more often and older women mentioned husband’s disapproval more often. Among those who reported wanting more children, the major reason for not using contraception was desire to have more children (around 44 percent) whether they had or had not used a contraceptive method in the past, followed by religious prohibition on contraceptive use (16 percent), fear of side effects, and lack of knowledge of contraceptive methods among those who have never used a method. Among those who had had experience with contraceptive methods and wanted more children, the other important reasons for not intending to use were the side effects associated with contraceptive use (13 percent) and health concerns (9 percent). Among those who reported wanting to limit family size but had never used a method, surprisingly, 23 percent said they would not use a method because they wanted more children. An even higher proportion (26 percent) does not intend to use because they believe that religion prohibits using family planning methods. One in seven women either does not know a method or does not know a source for a method. 4.14 Exposure to Family Planning Messages in the Electronic Media Radio and television are the major sources of information about family planning. Information on the level of public exposure to family planning messages through various media allows policymakers to ensure the use of the most effective media for target groups. To assess the effectiveness of such media for dissemination of family planning information, respondents in the survey were asked if they had heard messages about family planning on radio or seen them on television in the few months preceding the survey. Table 4.17 indicates that one-third of women either heard a family planning message on the radio or saw one on television during the few months preceding the interview. However, only 14 percent of women reported being exposed to family planning messages on both the radio and television. Overall, one-fourth of women heard a family planning message on the radio and 22 percent saw one on television. 65 Table 4.17 Heard about family planning on radio and television Percent distribution of women by whether they have heard a radio and/or television message about family planning in the few months prior to the interview, according to selected background characteristics, Yemen 1997 __________________________________________________________________________ Heard about family planning on radio or television _______________________________ Tele- Background Radio and Radio vision characteristic television only only Neither Missing Total Number __________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete + Total 11.6 12.1 6.3 70.0 0.0 100.0 1,110 14.8 12.4 7.0 65.8 0.0 100.0 1,992 14.1 10.7 8.4 66.7 -- 100.0 1,943 14.6 9.1 7.5 68.8 -- 100.0 1,680 15.6 10.0 7.3 67.1 0.1 100.0 1,766 11.3 9.6 9.0 70.1 0.0 100.0 1,091 13.4 7.9 7.1 71.6 0.0 100.0 833 27.5 6.8 19.8 45.9 -- 100.0 2,620 9.4 11.7 3.4 75.5 -- 100.0 7,794 11.3 5.9 12.9 69.8 0.0 100.0 2,381 9.7 13.4 2.2 74.8 0.1 100.0 3,125 18.0 10.8 8.3 62.9 -- 100.0 4,908 11.1 10.5 5.9 72.5 -- 100.0 8,765 25.2 11.7 12.5 50.6 0.0 100.0 571 29.3 10.0 15.8 44.9 0.0 100.0 638 33.6 11.6 20.6 34.1 0.0 100.0 198 35.2 7.5 22.6 34.8 0.0 100.0 241 14.0 10.5 7.5 68.0 -- 100.0 10,414 __________________________________________________________________________ -- Less than 0.05 percent Differences in exposure to family planning messages on radio and television are generally small across age groups. Urban women are more likely to report exposure to family planning messages than rural women (54 and 25 percent, respectively). By region, the proportion of women who were exposed to family planning message during the few months before the interview varied from 25 percent in the Mountainous region to 37 percent in the Plateau and Desert region. Women who had completed primary school were slightly more likely to have been exposed to family planning messages through the broadcast media than less educated women. The proportion of women who heard a radio message and/or saw a television message increases from 28 percent among illiterate women to 65 percent among women with at least secondary education. 66 Table 4.18 Acceptability of media messages on family planning Percent of ever-married women by acceptability of messages about family planning on the radio or television, by selected background characteristics, Yemen 1997 _____________________________________________________________________________________ Acceptability of Acceptability of radio message TV message _____________________ ______________________ Not Don’t Not Don’t Number Background accept- Accept- know/ accept- Accept- know/ of characteristic able able Missing able able Missing Total women _____________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete + Watch local television Yes No Listens to local radio Yes No Total 25.0 57.0 18.0 26.7 54.6 18.7 100.0 1,110 24.0 58.9 17.2 25.4 56.7 17.8 100.0 1,992 24.4 59.5 16.1 25.7 56.9 17.4 100.0 1,943 24.6 58.2 17.2 25.9 56.3 17.8 100.0 1,680 25.5 55.5 19.0 26.9 53.4 19.7 100.0 1,766 26.4 53.2 20.5 25.9 52.5 21.5 100.0 1,091 28.2 51.1 20.7 29.6 49.2 21.2 100.0 833 19.1 74.3 6.6 12.1 81.8 6.1 100.0 2,620 27.1 51.0 21.8 31.1 45.8 23.1 100.0 7,794 25.4 47.3 27.4 22.7 48.8 28.5 100.0 2,381 27.7 49.9 22.4 33.4 42.5 24.1 100.0 3,125 23.4 66.1 10.6 23.6 65.7 10.7 100.0 4,908 26.8 52.9 20.3 28.9 49.8 21.3 100.0 8,765 17.5 74.4 8.0 17.7 74.2 8.1 100.0 571 16.0 77.3 6.6 12.0 81.8 6.2 100.0 638 14.4 84.7 0.9 10.2 88.2 1.5 100.0 198 16.3 83.0 0.8 5.3 94.0 0.8 100.0 241 19.1 74.5 6.4 12.1 81.6 6.4 100.0 3,504 28.2 48.0 23.9 33.6 41.3 25.1 100.0 6,910 15.4 76.8 7.8 20.7 70.0 9.3 100.0 3,249 29.5 47.9 22.6 28.9 48.0 23.1 100.0 7,163 25.1 56.9 18.0 26.3 54.9 18.8 100.0 10,414 4.15 Acceptability of Media Messages on Family Planning To determine the level of acceptance of the dissemination of family planning information through the media, women where asked in the YDMCHS whether it was acceptable to disseminate family planning information on the radio and television. Overall, a majority of the women interviewed reported that it was acceptable to use radio (57 percent) for family planning massages (see Table 4.18). Acceptability of television was slightly lower (55 percent). Three-fourths of those who listen to local radio and 82 percent of those who watch local television consider broadcast of family planning messages on the respective media acceptable. Attitudes toward family planning messages on radio and television are similar according to various background characteristics. 67 Table 4.19 Family planning messages in print Percentage of ever-married women who have received a message about family planning from the print media in the few months prior to the interview, according to selected background characteristics, Yemen 1997 ___________________________________________________________ Any Number Background printNewspaper/ Leaflet/ of characteristic mediamagazinePosterbrochurewomen __________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete + Total 5.2 3.7 2.6 2.2 1,110 4.9 3.7 2.6 1.8 1,992 4.9 3.7 3.1 1.6 1,943 3.8 3.0 2.4 0.9 1,680 2.3 1.6 1.3 1.0 1,766 2.2 1.4 1.3 0.9 1,091 1.4 1.0 0.7 0.5 833 10.9 7.5 6.3 3.2 2,620 1.4 1.2 0.8 0.7 7,794 5.5 3.4 3.3 1.1 2,381 1.1 1.1 0.6 0.5 3,125 4.6 3.5 2.6 1.9 4,908 0.9 0.5 0.5 0.3 8,765 7.2 5.4 3.9 2.6 571 18.2 13.7 9.9 5.9 638 30.5 24.0 19.4 12.7 198 40.2 32.1 23.7 14.7 241 3.8 2.8 2.2 1.3 10,414 Acceptability of family planning messages on radio and television varies slightly by age. Rural respondents (27 percent) are more likely than urban respondents (19 percent) to view family planning messages on the radio as unacceptable. There is more support for having family planning message on the radio among women in the Plateau and Desert region (66 percent) than women in the other regions (47 to 50 percent). Acceptability of family planning messages increases with education from 53 to 83 percent. 4.16 Exposure to Family Planning Messages in the Print Media Respondents were asked if they had been exposed to a family planning message through newspaper(s)/magazines, posters, or leaflets/brochures (i.e., print media) during the few months prior to the interview. The results are presented in Table 4.19. Less than 4 percent of women received a message about family planning from the print media. Newspapers/magazines were the source of family planning messages for 3 percent of respondents, while posters and leaflets/brochures were the source for 2 percent and 1 percent, respectively. Women in rural areas have almost no exposure to family planning messages in the print media (1 percent), compared with 11 percent in urban areas. Exposed to messages in the print media increases substantially with level of education. Only 18 percent of women who have completed primary education are exposed to family planning messages in the print media, compared with 40 percent of women who have completed secondary education. Similarly, young women (who are probably more educated than older women) are more likely to receive a message about family planning from print media. Only 1 percent of women in the Mountainous region compared with around 5 percent in the other two regions is exposed to family planning messages in the print media. 4.17 Contact with Family Planning Providers Table 4.20 shows the percentage of ever-married women who visited a health facility or physician for any reason in the 12 months prior to interview and the percentage who received information about family planning during the visit. About one-third of women visited a health facility in the 12 month prior to the interview and 21 percent of those who visited received information about family planning. 68 Table 4.20 Contact with family planning providers Percentage of ever-married women who visited a health facility or a physician for any reason in the 12 months prior to interview and percentage of ever-married women who received information about family planning (FP) during the visit, according to current user status and selected background characteristics, Yemen 1997 ______________________________________________________________________________________________ Not using FP Using FP Total _____________________ ______________________ ______________________ No. of No. of No. of women women women who who who Visited visited Visited visited Visited visited Background health Discussed health health Discussed health health Discussed health characteristic facility FP facility facility FP facility facility FP facility ______________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete + Total 30.1 13.5 307 49.0 21.4 45 31.7 14.5 352 32.7 16.0 534 47.9 29.7 170 35.4 19.3 705 31.4 17.0 469 51.6 34.1 232 36.1 22.6 701 30.5 18.4 392 46.5 34.7 183 34.2 23.6 575 28.6 14.8 384 48.3 38.1 204 33.3 22.9 588 25.4 15.3 222 47.4 32.1 103 29.8 20.6 325 25.3 13.0 182 47.5 42.2 52 28.2 19.6 235 47.5 16.4 828 58.0 32.8 509 51.0 22.6 1,337 25.1 15.5 1,664 41.4 35.1 480 27.5 19.9 2,144 34.8 11.9 696 53.6 23.8 206 37.9 14.6 902 21.4 13.1 573 36.4 29.5 160 23.5 16.6 734 33.1 19.3 1,223 51.3 38.4 623 37.6 25.7 1,846 27.0 14.8 1,960 44.8 34.6 669 30.0 19.8 2,629 43.2 14.5 171 53.0 42.1 93 46.2 24.2 264 50.4 21.9 225 60.0 25.0 115 53.3 23.0 340 49.9 17.6 65 66.2 36.5 45 55.5 25.3 110 54.3 25.2 70 60.4 29.3 68 57.2 27.2 138 29.8 15.8 2,492 48.5 33.9 989 33.4 20.9 3,481 Among family planning users, 49 percent had contact with a health facility and 34 percent got information about family planning. Among nonusers of family planing, only 30 percent visited a health facility and half of them got information from health service providers. Although a lower proportion of women in rural areas and women with less education visited health facilities, a proportionately lower proportion received information about family planning. For example, 51 and 28 percent of women, respectively, visited health facilities in urban and rural areas, but 23 and 20 percent of those who visited health facilities, respectively, received information on family planning in urban and rural areas. 4.18 Discussion of Family Planning with Husband While husband-wife communication about family planning and agreement to use contraception is not necessary for adoption of certain methods, its absence may be a serious impediment to use. Interspousal communication is therefore an important intermediate step along the path to eventual adoption and sustained use of contraception. Lack of discussion may reflect a lack of personal interest, hostility to the subject, or a customary reticence in talking about sex-related matters. In order to gain 69 Table 4.21 Discussion of family planning with husband Percent distribution of currently married nonsterilized women who know a contraceptive method by the number of times family planning was discussed with their husband in the past year, according to age, Yemen 1997 ________________________________________________________________________________ Discussed family planning with husband ____________________________________ Number Once or More of Age Never twice often Missing Total women ________________________________________________________________________________ 15-19 46.4 29.5 23.9 0.2 100.0 813 20-24 40.0 28.3 31.7 0.1 100.0 1,630 25-29 36.1 28.2 35.6 0.1 100.0 1,537 30-34 36.9 27.7 35.2 0.1 100.0 1,359 35-39 41.4 21.5 36.9 0.1 100.0 1,344 40-44 49.6 21.4 28.9 0.1 100.0 783 45-49 53.7 22.8 23.5 0.0 100.0 588 Total 41.5 26.1 32.2 0.1 100.0 8,053 insight about spousal communication regarding family planning, currently married respondents in the YDMCHS were asked how often they had talked to their spouse about family planning in the past year. Data for currently married nonsterilized women are shown in Table 4.21. About 42 percent of women said they had not talked to their husband about family planning in the year preceding the survey while 26 percent had discussed it once or twice and 32 percent had discussed it more often. Women in the oldest and the youngest cohorts were least likely to have discussed family planning with their husband. Use of family planning is facilitated when both husband and wife approve of its use. Table 4.22 shows the percent distribution of couples by wife’s perception of her husband’s attitude toward family planning, according to selected background characteristics. In 40 percent of couples, both husband and wife approve of family planning; in 22 percent both disapprove. In 12 percent of couples, the wife approves but the husband does not, while in 4 percent, the husband approves but the wife does not. There are marked differentials by level of education: the higher the wife’s level of education, the more likely it is the couple approves of family planning. Partly for this reason, couples in urban areas are twice as likely to approve of family planning as those in rural areas. Couples’ approval of family planning is highest in the Plateau and Desert region (48 percent) and lowest in the Mountainous region (29 percent). 70 Table 4.22 Attitudes of couples toward family planning Percent distribution of currently married, nonsterilized 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, Yemen 1997 ____________________________________________________________________________________________________________________ Woman approves Woman disapproves _______________ ________________ Husband Husband’s Husband’s Both Respon- Background Both dis- attitude Husband attitude dis- dent Wife Husband characteristic approve approves unknown approves unknown approve unsure Missing Total approves approves Total __________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Coastal Mountainous Plateau and Desert Education Illiterate Literate Primary complete Preparatory complete Secondary complete+ Total 32.7 11.5 12.6 3.2 8.8 20.2 10.9 0.0 100.0 56.9 36.6 813 40.3 13.5 7.2 3.2 4.7 22.0 9.1 0.1 100.0 61.0 44.4 1,630 44.8 12.5 5.3 2.5 5.4 21.3 8.0 0.2 100.0 62.7 48.7 1,537 45.2 12.3 5.4 3.0 4.8 19.0 10.0 0.4 100.0 62.9 49.0 1,359 41.5 10.7 5.1 4.4 4.6 21.5 12.0 0.2 100.0 57.4 47.7 1,344 33.5 11.5 5.9 5.0 7.5 23.5 13.0 0.1 100.0 50.9 40.3 783 31.1 10.6 6.9 4.5 7.7 25.0 14.2 0.0 100.0 48.6 37.0 588 61.2 11.0 4.7 3.0 2.5 12.8 4.6 0.1 100.0 77.0 65.7 2,285 31.7 12.4 7.3 3.7 7.0 24.9 12.7 0.2 100.0 51.5 36.5 5,768 36.5 8.5 6.3 3.4 8.1 24.4 12.8 0.1 100.0 51.4 41.6 1,868 28.7 13.0 8.3 3.4 8.4 23.4 14.6 0.2 100.0 50.1 33.3 2,176 47.9 13.1 5.8 3.6 3.2 19.0 7.1 0.2 100.0 66.9 52.6 4,009 34.5 12.6 6.8 3.9 6.4 23.7 12.1 0.2 100.0 53.8 39.6 6,608 59.2 9.6 6.2 1.9 4.3 14.4 4.4 0.0 100.0 75.0 61.8 488 65.0 10.9 5.5 1.8 2.6 10.6 3.2 0.4 100.0 81.4 67.8 558 66.0 11.3 4.6 2.3 1.9 12.4 1.5 0.0 100.0 82.0 69.1 174 82.3 5.1 5.5 1.3 1.0 4.6 0.2 0.0 100.0 93.0 83.6 225 40.1 12.0 6.6 3.5 5.7 21.5 10.4 0.2 100.0 58.7 44.8 8,053 71 Table 5.1 Current marital status Percent distribution of all women by current marital status, according to age, Yemen 1997 _________________________________________________________________________________ Marital status _____________________________________________ Number Never of Age married Married Widowed Divorced Separated Total women _________________________________________________________________________________ 15-19 73.2 25.7 0.1 0.9 0.2 100.0 4,137 20-24 27.2 69.5 0.5 2.5 0.3 100.0 2,738 25-29 9.5 86.4 1.0 2.8 0.4 100.0 2,147 30-34 3.9 90.7 2.2 3.0 0.3 100.0 1,748 35-39 2.1 90.8 4.0 2.8 0.3 100.0 1,804 40-44 1.5 90.2 6.0 2.2 0.2 100.0 1,107 45-49 0.8 88.9 8.3 2.0 0.2 100.0 839 Total 28.3 67.4 2.0 2.1 0.3 100.0 14,521 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY This chapter explores a number of factors other than contraception which affect a woman’s chances of becoming pregnant and, thus, help to determine fertility levels in Yemen. They include marriage, postpartum amenorrhea, postpartum abstinence, and menopause. Marriage patterns have a major effect on fertility because they influence the onset of exposure to the risk of pregnancy. Populations in which women marry young are usually characterized by early childbearing and high lifetime fertility. Postpartum amenorrhea and postpartum abstinence, which determine the length of time a woman is insusceptible to pregnancy following childbirth, affect birth intervals and, thus fertility levels. Finally, the onset of menopause is important because the probability of becoming pregnant decreases as women near the end of their reproductive years and increasing proportions become infecund. In the YDMCHS, questions about the proximate determinants of fertility were included in the individual questionnaire, which was administered only to ever-married women. However, a number of the tables which examine proximate determinants in this chapter are based on all women, i.e., on ever-married plus never-married women. In constructing these tables, the denominators have been expanded to the ratio of all women to ever-married women reported in the household questionnaire. The inflation factors are calculated by single years of age, either for the population as a whole or, in cases where the results are presented by background characteristics, separately for each category of the characteristic concerned. 5.1 Current Marital Status Table 5.1 presents the distribution of women 15-49 by current marital status. Overall, 67 percent of women are currently married, 2 percent are widowed, 2 percent are divorced, and less than 0.5 percent are separated. Twenty-eight percent of women have never married. Currently, about three-fourths of women 15-19 and one-fourth of those 20-24 have not married. By age 50, almost all women marry. Widowhood increases with age; 6 and 8 percent of women 40-44 and 45-49, respectively, are widows. Divorced women are less than 1 percent among women 15-19 and 2 to 3 percent among women age 20 and over. 1 Four percent have one co-wife and 3 percent have two co-wives. 72 5.2 Marriage Between Relatives In Yemen, as in other Arab countries, marriage between blood relatives (consanguineous marriages), usually occurs between cousins. In the YDMCHS, currently married women who had married only once were asked “Is there a blood relation between you and your husband?” Women who were not currently married and those who had married more than once were asked, “Was there a blood relation between you and your (first) husband?” Table 5.2 indicates that 4 in 10 women had married a blood relative. One-fourth of ever-married women had married a first cousin on their father’s side, 10 percent had married a first cousin on their mother’s side, and 6 percent had married other relatives. There are indications that consanguineous marriages are becoming more common in Yemen. For example, 30 percent of women age 45-49 years had married a blood relative compared with 44 percent among women 20-24, an increase of almost 50 percent. Women who had married at younger ages and those who were married for shorter durations were more likely to have married a relative. Consanguineous marriages occur about equally among women in urban and rural areas and are slightly more likely to be found among women living in the Coastal than in the other regions. There is no relationship between prevalence of marriage between blood relatives and women’s level of education. However, a slightly higher proportion of literate women or women who have completed primary schooling have married relatives than women in other education categories. 5.3 Remarriage Marriage is not as stable in Yemen as it might appear from the small proportion of women who are currently divorced or widowed; remarriage is relatively common. Although, a large proportion of women (91 percent) have married only once; 9 percent have married more than once (see Table 5.3). Not surprisingly, the proportion of women who have married more than once gradually increases with age because divorce and widowhood also increase with age. The proportion of women who have married at least twice increases from around 5 percent among women age 20-24 to 11 percent among women 30-34, and then rises to 16 percent among women in their forties. Dissolution of marriage is as likely to occur among women in rural areas as in urban areas. In the Coastal region, the proportion marrying only once is slightly higher than in the other regions. Illiterate women are more likely to have married more than once than women who are literate or have completed some level of education. 5.4 Polygyny As a Muslim country, Yemen considers polygyny legal. Islam permits a man to have up to four wives at a time, provided the husband treats all of them equally. In order to collect information on the practice of polygyny, all currently married women in the survey were asked whether their husbands had other wives and if so, what was her rank. Table 5.4 shows the percentage of currently married women in polygynous marriages by age and selected background characteristics. Seven percent1 of currently married women live in a polygynous marriage. Women living in urban areas and in the Coastal region are less likely to have co-wives (4-5 percent) than women in rural areas and the Mountainous region (8-9 percent). Although there is no clear-cut relationship between education and polygyny, polygyny is most common among illiterate women and least common among women with secondary or higher education. The proportion of women living in a polygynous marriage increases with age from 4 percent among women age 15-19 percent to 10 percent among women 45-49. In general, this same pattern is seen for most background characteristics. 73 Table 5.2 Consanguinity Percent distribution of ever-married women by relationship to their first husband, according to selected background characteristics, Yemen 1997 ____________________________________________________________________________________ First cousin: _________________ Number Background Father's Mother's Other Not of characteristic side side relative related Missing Total women ____________________________________________________________________________________ Age 15-19 28.3 10.7 7.9 52.9 0.2 100.0 1,110 20-24 27.0 10.6 6.8 55.4 0.2 100.0 1,992 25-29 23.7 9.5 6.4 60.2 0.3 100.0 1,943 30-34 23.9 9.8 5.7 60.4 0.3 100.0 1,680 35-39 22.0 9.3 5.6 62.8 0.3 100.0 1,766 40-44 22.3 8.2 5.1 64.2 0.2 100.0 1,091 45-49 20.9 6.3 3.1 69.6 0.1 100.0 833 Age at first marriage <15 26.2 8.5 5.9 59.1 0.3 100.0 2,830 15 25.1 9.0 5.8 60.0 0.2 100.0 2,301 16-17 22.9 9.8 6.1 61.0 0.2 100.0 2,619 18-19 23.2 11.0 5.7 59.8 0.3 100.0 1,361 20-21 23.0 11.9 5.9 59.0 0.1 100.0 726 22-23 18.9 7.6 8.4 64.6 0.4 100.0 280 24+ 21.1 8.0 6.3 64.7 0.0 100.0 296 Years since first marriage < 5 27.3 10.4 7.2 55.0 0.1 100.0 2,042 5-9 25.8 10.2 6.8 56.9 0.2 100.0 1,763 10-14 22.1 10.4 6.2 61.0 0.3 100.0 1,722 15-19 23.7 9.1 5.5 61.3 0.3 100.0 1,573 20-24 23.5 9.3 5.4 61.4 0.4 100.0 1,596 25+ 21.9 7.1 4.4 66.6 0.1 100.0 1,717 Residence Urban 21.2 9.4 8.0 61.3 0.1 100.0 2,620 Rural 25.2 9.5 5.3 59.8 0.3 100.0 7,794 Region Coastal 27.0 11.4 6.7 54.8 -- 100.0 2,381 Mountainous 23.0 8.9 4.4 63.3 0.4 100.0 3,125 Plateau and Desert 23.5 8.9 6.6 60.7 0.2 100.0 4,908 Education Illiterate 24.4 9.1 5.5 60.7 0.2 100.0 8,765 Literate 24.3 11.0 9.3 55.0 0.4 100.0 571 Primary complete 22.4 12.7 8.1 56.4 0.4 100.0 638 Preparatory complete 18.7 12.7 6.6 61.6 0.4 100.0 198 Secondar

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