Yemen - Demographic and Health Survey - 2015

Publication date: 2015

YEMEN NATIONAL HEALTH AND DEMOGRAPHIC SURVEY 2013 JULY 2015 Yem en N ational H ealth and D em ographic Survey 2013 Republic of Yemen Ministry of Public Health & Population & Central Statistical Organization Republic of Yemen Yemen National Health and Demographic Survey 2013 Ministry of Public Health and Population and Central Statistical Organization Sana’a, Yemen The Pan Arab Program for Family Health (PAPFAM) Cairo, Egypt The Demographic and Health Surveys (DHS) Program, ICF International Rockville, Maryland, USA July 2015 World Bank The 2013 Yemen National Health and Demographic Survey (2013 YNHDS) was implemented by the Ministry of Public Health and Population (MOPHP) in collaboration with the Central Statistical Organization (CSO). ICF International provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. The funding for the local costs of the YNHDS was provided by the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), The World Bank (WB), the United Kingdom Department for International Development (DFID), the Embassy of the Kingdom of the Netherlands (EKN), and the Government of Yemen. The Pan Arab Program for Family Health (PAPFAM) provided technical as well as financial assistance to the project. Additional information about the YNHDS may be obtained from the Ministry of Public Health and Population (MOPHP), Al Hasabah Zone, P.O. Box 13437, Sana’a, Yemen; Telephone/Fax: +967-1-220-950; E-mail: his@moh.gov.ye, and from the Central Statistical Organization (CSO), Al Horia Street, Sana’a, Yemen; Telephone: +967-1-250-108; Fax: +967-1-250-664; E-mail: cso@yemen.net.ye. Information about the PAPFAM project may be obtained from the Pan Arab program for Family Health (PAPFAM), 22 A Taha Hussien Street, Zamalek, Cairo, Egypt; Telephone/Fax: +202-273-83-634; E-mail: papfamlas@yahoo.com; Internet: www.papfam.org. Information about the The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: 301-407-6500; Fax: 301-407-6501; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Recommended citation: Ministry of Public Health and Population (MOPHP), Central Statistical Organization (CSO) [Yemen], Pan Arab Program for Family Health (PAPFAM), and ICF International. 2015. Yemen National Health and Demographic Survey 2013. Rockville, Maryland, USA: MOPHP, CSO, PAPFAM, and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . vii PREFACE . xiii ACKNOWLEDGMENTS . xv ACRONYMS AND ABBREVIATIONS . xvii MAP OF YEMEN . xviii 1 INTRODUCTION . 1 1.1 Background . 1 1.2 Survey Implementation . 2 1.2.1 Sample Design . 2 1.2.2 Questionnaires . 2 1.2.3 Anthropometry and Anemia . 3 1.2.4 Maternal Mortality . 4 1.2.5 Training of Field Staff . 4 1.2.6 Fieldwork . 5 1.2.7 Data Processing . 5 1.2.8 Response Rates . 5 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 2.1 Household Characteristics . 7 2.1.1 Drinking Water . 8 2.1.2 Sanitation Facilities and Waste Disposal . 9 2.1.3 Housing Characteristics . 10 2.1.4 Household Possessions . 11 2.2 Household Wealth . 12 2.3 Hand Washing . 13 2.4 Household Population by Age, Sex, and Residence . 14 2.5 Household Composition . 16 2.6 Birth Registration . 16 2.7 Children’s Living Arrangements and Parental Survival . 17 2.8 Education of the Household Population . 20 2.8.1 Educational Attainment . 20 2.8.2 School Attendance Rates . 22 2.9 Child Discipline . 23 3 CHARACTERISTICS OF RESPONDENTS . 27 3.1 Characteristics of Survey Respondents . 27 3.2 Educational Attainment by Background Characteristics . 29 3.3 Literacy . 30 3.4 Exposure to Mass Media . 31 3.5 Employment Status . 32 3.6 Occupation . 34 3.7 Type of Employment . 35 4 MARRIAGE . 37 4.1 Marital Status . 37 4.2 Polygyny . 38 4.3 Age at First Marriage . 39 5 FERTILITY . 41 5.1 Current Fertility . 41 5.2 Fertility by Background Characteristics . 42 5.3 Fertility Trends . 43 5.4 Children Ever Born and Living . 45 5.5 Birth Intervals . 45 iv • Contents 5.6 Postpartum Amenorrhea . 47 5.7 Menopause . 47 5.8 Age at First Birth . 47 5.9 Median Age at First Birth by Background Characteristics . 48 5.10 Teenage Pregnancy and Motherhood . 48 6 FERTILITY PREFERENCES . 51 6.1 Fertility Preferences by Number of Living Children . 51 6.2 Desire to Stop Childbearing by Background Characteristics . 52 6.3 Ideal Number of Children . 53 6.4 Mean Ideal Number of Children by Background Characteristics . 54 6.5 Fertility Planning Status . 54 6.6 Wanted Fertility Rates . 55 7 FAMILY PLANNING . 57 7.1 Knowledge of Contraceptive Methods . 57 7.2 Current Use of Contraception . 59 7.3 Current Use of Contraception by Background Characteristics . 61 7.4 Timing of Sterilization . 63 7.5 Source of Modern Contraceptive Methods . 63 7.6 Informed Choice . 64 7.7 Rates of Discontinuing Contraceptive Methods . 65 7.8 Reasons for Discontinuing Contraceptive Methods . 66 7.9 Need and Demand for Family Planning . 67 7.10 Future Use of Contraception . 69 7.11 Exposure to Family Planning Messages in the Media. 70 7.12 Contact of Nonusers with Family Planning Providers . 71 8 EARLY CHILDHOOD AND MATERNAL MORTALITY . 73 8.1 Background and Quality of Data on Early Childhood Mortality . 73 8.2 Infant and Child Mortality Levels and Trends . 74 8.3 Socioeconomic Differentials in Early Childhood Mortality . 76 8.4 Demographic Differentials in Early Childhood Mortality . 77 8.5 Perinatal Mortality . 78 8.6 High-Risk Fertility Behavior. 79 8.7 Maternal Mortality . 80 9 MATERNAL HEALTH CARE . 83 9.1 Antenatal Care . 83 9.2 Number and Timing of Antenatal Visits . 85 9.3 Components of Antenatal Care . 86 9.4 Tetanus Toxoid . 87 9.5 Place of Delivery . 89 9.6 Assistance during Delivery . 90 9.7 Postnatal Care for the Mother . 92 9.8 Postnatal Care for the Newborn . 95 9.9 Obstetric Fistula . 97 9.10 Tumors . 99 9.11 Problems in Accessing Health Care . 102 9.12 Health Insurance Coverage . 103 10 CHILD HEALTH . 105 10.1 Child’s Weight and Size at Birth . 105 10.2 Vaccination of Children . 107 10.2.1 Sources of Information . 107 10.2.2 Vaccination Coverage . 107 10.2.3 Trends in Vaccination Coverage . 109 10.3 Prevalence and Treatment of Acute Respiratory Infection . 110 10.4 Prevalence and Treatment of Fever . 112 Contents • v 10.5 Prevalence and Treatment of Diarrheal Disease . 113 10.5.1 Prevalence of Diarrhea. 113 10.5.2 Treatment of Diarrhea . 114 10.5.3 Feeding Practices during Diarrhea . 117 10.5.4 Knowledge of ORS Packets for Diarrhea . 120 10.6 Disposal of Children’s Stools. 120 11 NUTRITION OF CHILDREN AND WOMEN . 123 11.1 Nutritional Status of Children . 123 11.1.1 Measurement of Nutritional Status among Young Children . 123 11.1.2 Levels of Child Malnutrition . 125 11.1.3 Trends in Child Malnutrition . 127 11.2 Breastfeeding . 128 11.2.1 Initiation of Breastfeeding . 128 11.2.2 Breastfeeding Status by Age . 130 11.2.3 Median Duration of Breastfeeding . 131 11.3 Dietary Diversity among Young Children . 132 11.3.1 Foods and Liquids Consumed by Infants and Young Children . 132 11.3.2 Infant and Young Child Feeding (IYCF) Practices. 134 11.4 Prevalence of Anemia in Children . 137 11.5 Micronutrient Intake and Supplementation among Children . 138 11.6 Presence of Iodized Salt in Households . 141 11.7 Nutritional Status of Women . 142 11.8 Prevalence of Anemia in Women . 144 11.9 Micronutrient Intake among Mothers . 146 11.10 Household Food Security . 148 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 151 12.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods. 152 12.2 Misconceptions about HIV/AIDS . 153 12.3 Knowledge about Mother-to-Child Transmission . 155 12.4 Attitudes toward People Living with HIV/AIDS . 156 12.5 Attitudes toward Negotiating Safer Sexual Relations with Husbands . 158 12.6 Awareness of HIV Testing Services . 159 12.7 Self-reporting of Sexually Transmitted Infections . 159 12.8 Injections . 161 13 FEMALE CIRCUMCISION . 163 13.1 Awareness of Female Circumcision . 163 13.2 Prevalence of Female Circumcision . 164 13.3 Age at Circumcision . 166 13.4 Circumcision of Daughters . 167 13.5 Attitudes towards Female Circumcision . 170 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 175 14.1 Women’s Employment . 175 14.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s Earnings . 176 14.3 Women’s Participation in Decision Making . 179 14.4 Attitudes toward Wife Beating . 181 14.5 Women’s Empowerment Indicators . 182 14.6 Current Use of Contraception by Women’s Empowerment . 183 14.7 Ideal Family Size and Unmet Need by Women’s Empowerment . 184 14.8 Women’s Empowerment and Reproductive Health Care . 184 14.9 Opinions about Domestic Violence. 185 15 HARMFUL HEALTH PRACTICES . 189 15.1 Smoking . 189 15.2 Chewing Al-Qat . 192 15.3 Orange Snuff . 195 vi • Contents 16 CHRONIC DISEASE, DISABILITY, AND INJURY . 199 16.1 Prevalence of Chronic Diseases . 199 16.2 Prevalence of Disability . 202 16.3 Origin and Age at Onset of Disability . 205 16.4 Care and Support for Disabilities . 206 16.5 Injuries and Accidents . 206 REFERENCES . 209 APPENDIX A SAMPLE DESIGN IMPLEMENTATION . 211 A.1 Introduction . 211 A.2 Sampling Frame . 211 A.3 Sample Design and Sampling Procedure . 212 A.4 Sampling Probabilities . 213 A.5 Sample Implementation . 214 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 217 APPENDIX C DATA QUALITY TABLES . 245 APPENDIX D YNHDS PERSONNEL . 251 APPENDIX E QUESTIONNAIRES . 271 Tables and Figures • vii TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Results of the household and individual interviews . 5 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 Table 2.1 Household drinking water . 8 Table 2.2 Household sanitation facilities . 9 Table 2.3 Household characteristics . 10 Table 2.4 Household possessions . 12 Table 2.5 Wealth quintiles . 13 Table 2.6 Hand washing . 14 Table 2.7 Household population by age, sex, and residence . 15 Table 2.8 Household composition . 16 Table 2.9 Birth registration of children under age five . 17 Table 2.10 Children’s living arrangements and orphanhood . 18 Table 2.11.1 Educational attainment of the female household population . 21 Table 2.11.2 Educational attainment of the male household population . 22 Table 2.12 Child discipline . 24 Table 2.13 Attitudes toward physical punishment . 25 Figure 2.1 Population pyramid . 15 Figure 2.2 Age-specific attendance rates of the de-facto population 5 to 24 years . 23 3 CHARACTERISTICS OF RESPONDENTS . 27 Table 3.1 Background characteristics of respondents . 28 Table 3.2 Educational attainment . 29 Table 3.3 Literacy . 30 Table 3.4 Exposure to mass media . 31 Table 3.5 Employment status . 33 Table 3.6 Occupation . 34 Table 3.7 Type of employment . 35 4 MARRIAGE . 37 Table 4.1 Current marital status . 37 Table 4.2 Number of women’s co-wives . 39 Table 4.3 Age at first marriage . 40 Table 4.4 Median age at first marriage by background characteristics . 40 Figure 4.1 Percent distribution of women age 15-49 by current marital status . 38 5 FERTILITY . 41 Table 5.1 Current fertility . 42 Table 5.2 Fertility by background characteristics. 43 Table 5.3.1 Trends in age-specific fertility rates . 43 Table 5.3.2 Trends in age-specific and total fertility rates . 44 Table 5.4 Children ever born and living . 45 Table 5.5 Birth intervals . 46 Table 5.6 Postpartum amenorrhea . 47 Table 5.7 Menopause . 47 Table 5.8 Age at first birth . 48 Table 5.9 Median age at first birth . 48 Table 5.10 Teenage pregnancy and motherhood . 49 Figure 5.1 Trends in fertility . 44 Figure 5.2 Percentage of women age 15-19 who have begun childbearing . 50 viii • Tables and Figures 6 FERTILITY PREFERENCES . 51 Table 6.1 Fertility preferences by number of living children . 51 Table 6.2 Desire to stop childbearing . 52 Table 6.3 Ideal number of children by number of living children . 53 Table 6.4 Mean ideal number of children . 54 Table 6.5 Fertility planning status . 55 Table 6.6 Wanted fertility rates . 55 Figure 6.1 Total wanted fertility rates and total fertility rates . 56 7 FAMILY PLANNING . 57 Table 7.1 Knowledge of contraceptive methods . 58 Table 7.2 Knowledge of contraceptive methods by background characteristics . 58 Table 7.3 Current use of contraception by age . 60 Table 7.4 Current use of contraception by background characteristics . 62 Table 7.5 Timing of sterilization . 63 Table 7.6 Source of modern contraception methods . 64 Table 7.7 Informed choice . 65 Table 7.8 Twelve-month contraceptive discontinuation rates . 66 Table 7.9 Reasons for discontinuation . 66 Table 7.10 Need and demand for family planning among currently married women . 67 Table 7.11 Future use of contraception . 69 Table 7.12 Exposure to family planning messages . 70 Table 7.13 Contact of nonusers with family planning providers . 71 Figure 7.1 Percentage of currently married women using specific contraceptive methods . 61 Figure 7.2 Trends in contraceptive prevalence, Yemen 1997-2013 . 61 8 EARLY CHILDHOOD AND MATERNAL MORTALITY . 73 Table 8.1 Early childhood mortality rates . 75 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 76 Table 8.3 Early childhood mortality rates by demographic characteristics . 77 Table 8.4 Perinatal mortality . 79 Table 8.5 High-risk fertility behavior . 80 Table 8.6 Maternal mortality . 81 Table 8.7 Maternal deaths by background characteristics . 81 Figure 8.1 Trends in under-5 mortality 1985-2011 . 75 Figure 8.2 Infant mortality by demographic characteristics . 78 Figure 8.3 Percent distribution of maternal deaths by place of death . 82 Figure 8.4 Symptoms/conditions of the women before maternal death . 82 9 MATERNAL HEALTH CARE . 83 Table 9.1 Antenatal care . 84 Table 9.2 Number of antenatal care visits and timing of first visit. 85 Table 9.3 Components of antenatal care . 87 Table 9.4 Tetanus toxoid injections . 88 Table 9.5 Place of delivery . 89 Table 9.6 Reason for delivery outside a health facility . 90 Table 9.7 Assistance during delivery . 91 Table 9.8 Timing of first postnatal checkup . 93 Table 9.9 Type of provider of first postnatal checkup for the mother . 94 Table 9.10 Timing of first postnatal checkup for the newborn . 96 Table 9.11 Type of provider of first postnatal checkup for the newborn . 97 Table 9.12 Obstetric fistula . 98 Table 9.13 Origin of fistula . 99 Table 9.14 Treatment of fistula . 99 Table 9.15 Self-reported prevalence of tumors . 100 Table 9.16 Location of tumors . 101 Table 9.17 Tumors . 102 Tables and Figures • ix Table 9.18 Problems in accessing health care . 103 Table 9.19 Health insurance coverage . 104 Figure 9.1 Number of ANC visits . 86 Figure 9.2 Trends in maternal care indicators, Yemen 1997-2013 . 92 10 CHILD HEALTH . 105 Table 10.1 Child’s size and weight at birth . 106 Table 10.2 Vaccinations by source of information . 108 Table 10.3 Vaccinations by background characteristics . 109 Table 10.4 Prevalence and treatment of symptoms of ARI . 111 Table 10.5 Prevalence and treatment of fever . 112 Table 10.6 Prevalence of diarrhea . 113 Table 10.7 Diarrhea treatment . 115 Table 10.8 Feeding practices during diarrhea . 118 Table 10.9 Knowledge of ORS packets or pre-packaged liquids . 120 Table 10.10 Disposal of children’s stools . 121 Figure 10.1 Vaccination coverage among children 12-23 months . 108 Figure 10.2 Trends in vaccination coverage - children 12-23 months, Yemen 1997-2013 . 110 Figure 10.3 Prevalence of ARI, fever, and diarrhea by age . 114 11 NUTRITION OF CHILDREN AND WOMEN . 123 Table 11.1 Nutritional status of children . 125 Table 11.2 Initial breastfeeding . 129 Table 11.3 Breastfeeding status by age . 130 Table 11.4 Median duration of breastfeeding . 132 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 133 Table 11.6 Infant and young child feeding (IYCF) practices . 135 Table 11.7 Prevalence of anemia in children . 138 Table 11.8 Micronutrient intake among children . 140 Table 11.9 Presence of iodized salt in household . 141 Table 11.10 Nutritional status of women . 143 Table 11.11 Mid-upper-arm circumference of women . 144 Table 11.12 Prevalence of anemia in women . 145 Table 11.13 Micronutrient intake among mothers . 147 Table 11.14 Food security . 149 Figure 11.1 Nutritional status of children by age . 127 Figure 11.2 Trends in nutritional status of children, Yemen 1997-2013 . 128 Figure 11.3 Infant feeding practices by age . 131 Figure 11.4 IYCF indicators on breastfeeding status . 131 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 151 Table 12.1 Knowledge of AIDS . 152 Table 12.2 Knowledge of HIV transmission and prevention methods . 153 Table 12.3 Knowledge and misconceptions about AIDS . 154 Table 12.4 Knowledge of prevention of mother to child transmission of HIV . 156 Table 12.5 Accepting attitudes toward those living with HIV/AIDS . 157 Table 12.6 Attitudes toward negotiating safer sexual relations with husband . 158 Table 12.7 HIV testing . 159 Table 12.8 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms . 160 Table 12.9 Prevalence of medical injections . 162 Figure 12.1 Percentage of women seeking treatment for STIs . 161 x • Tables and Figures 13 FEMALE CIRCUMCISION . 163 Table 13.1 Knowledge of female circumcision . 164 Table 13.2 Prevalence of female circumcision . 165 Table 13.3 Age at circumcision . 166 Table 13.4 Daughter’s circumcision experience . 168 Table 13.5 Aspects of circumcision among circumcised women and daughters. 169 Table 13.6 Intention to have daughter(s) circumcised . 170 Table 13.7 Opinions of women about whether circumcision is required by religion . 171 Table 13.8 Opinions of women about whether the practice of circumcision should continue . 172 Table 13.9 Reason for stopping female circumcision . 173 Figure 13.1 Prevalence of female circumcision by governorate . 166 Figure 13.2 Aspects of circumcision among circumcised women and daughters. 169 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 175 Table 14.1 Employment and cash earnings of currently married women . 175 Table 14.2 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 176 Table 14.3 Control over men’s cash earnings . 177 Table 14.4 Women’s control over their own earnings and over those of their husbands . 179 Table 14.5 Participation in decision making . 179 Table 14.6 Women’s participation in decision making by background characteristics . 180 Table 14.7 Attitude towards wife beating . 181 Table 14.8 Indicators of women’s empowerment . 183 Table 14.9 Current use of contraception by women’s empowerment . 183 Table 14.10 Ideal number of children and unmet need for family planning by women’s empowerment . 184 Table 14.11 Reproductive health care by women’s empowerment . 185 Table 14.12 Opinions/facts that mean domestic violence . 186 Table 14.13 Opinions regarding the most common perpetrator of violent acts against women . 187 Table 14.14 Opinions regarding the place of most violent acts against women . 187 15 HARMFUL HEALTH PRACTICES . 189 Table 15.1 Use of tobacco . 190 Table 15.2 Use of tobacco by background characteristics . 191 Table 15.3 Use of al-Qat . 193 Table 15.4 Use of al-Qat by background characteristics . 195 Table 15.5 Use of orange snuff . 196 Table 15.6 Use of orange snuff by background characteristics . 198 Figure 15.1 Percentage of current smokers by sex and age . 191 Figure 15.2 Percentage of current users of al-Qat by sex and age . 194 Figure 15.3 Percentage of current users of orange snuff by sex and age . 197 16 CHRONIC DISEASE, DISABILITY, AND INJURY . 199 Table 16.1 Prevalence of chronic or other diseases . 200 Table 16.2 Prevalence of specific chronic or other diseases . 201 Table 16.3 Prevalence of most common specific chronic or other diseases . 202 Table 16.4 Prevalence of disability . 203 Table 16.5 Common types of disability . 204 Table 16.6 Origin of disabilities . 205 Table 16.7 Age at onset of disability . 205 Table 16.8 Care and support received . 206 Table 16.9 Injuries and accidents . 206 Table 16.10 Types of injuries or accidents . 207 Figure 16.1 Prevalence of most common chronic diseases . 201 Figure 16.2 Prevalence of any disability by age . 204 Tables and Figures • xi APPENDIX A SAMPLE DESIGN IMPLEMENTATION . 211 Table A.1 Population distribution by governorates (2004 General Population, Housing and Establishment Census, Yemen) . 211 Table A.2 Sample allocation of clusters and households according to governorate and by type of residence, YNHDS 2013 . 213 Table A.3 Sample allocation expected number of completed women interviews according to governorate and by type of residence, YNHDS 2013 . 213 Table A.4 Sample implementation . 215 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 217 Table B.1 List of selected variables for sampling errors, Yemen 2013 . 219 Table B.2 Sampling errors: Total sample, Yemen 2013 . 220 Table B.3 Sampling errors: Urban sample, Yemen 2013 . 221 Table B.4 Sampling errors: Rural sample, Yemen 2013 . 222 Table B.5 Sampling errors: Ibb sample, Yemen 2013 . 223 Table B.6 Sampling errors: Abyan sample, Yemen 2013 . 224 Table B.7 Sampling errors: Sana’a City sample, Yemen 2013 . 225 Table B.8 Sampling errors: Al-Baidha sample, Yemen 2013 . 226 Table B.9 Sampling errors: Taiz sample, Yemen 2013 . 227 Table B.10 Sampling errors: Al-Jawf sample, Yemen 2013 . 228 Table B.11 Sampling errors: Hajjah sample, Yemen 2013 . 229 Table B.12 Sampling errors: Al-Hodiedah sample, Yemen 2013 . 230 Table B.13 Sampling errors: Hadramout sample, Yemen 2013 . 231 Table B.14 Sampling errors: Dhamar sample, Yemen 2013 . 232 Table B.15 Sampling errors: Shabwah sample, Yemen 2013 . 233 Table B.16 Sampling errors: Sadah sample, Yemen 2013 . 234 Table B.17 Sampling errors: Sana’a sample, Yemen 2013 . 235 Table B.18 Sampling errors: Aden sample, Yemen 2013 . 236 Table B.19 Sampling errors: Lahj sample, Yemen 2013 . 237 Table B.20 Sampling errors: Mareb sample, Yemen 2013 . 238 Table B.21 Sampling errors: Al-Mhweit sample, Yemen 2013 . 239 Table B.22 Sampling errors: Al-Mhrah sample, Yemen 2013 . 240 Table B.23 Sampling errors: Amran sample, Yemen 2013 . 241 Table B.24 Sampling errors: Aldhalae sample, Yemen 2013 . 242 Table B.25 Sampling errors: Reimah sample, Yemen 2013 . 243 APPENDIX C DATA QUALITY TABLES . 245 Table C.1 Household age distribution . 245 Table C.2 Age distribution of eligible and interviewed women . 246 Table C.3 Completeness of reporting . 246 Table C.4 Births by calendar years . 247 Table C.5 Reporting of age at death in days . 247 Table C.6 Reporting of age at death in months . 248 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 249 Table C.8 Need and demand for family planning for currently married women (definition used in 1997) . 250 Preface • xiii PREFACE t is a pleasure for the CSO (Central Statistics Organization) in cooperation with the MOPHP (Ministry of Public Health and Population) to offer this report which represents the final results of the Yemen National Health and Demographic Survey (YNHDS) 2013. The YNHDS is one of the most important specialized surveys conducted in Yemen. It includes detailed information on many health, social, and economic variables of the country. The YNHDS 2013 sample was designed to provide representative data for every governorate—the first time such data have been available in Yemen. Questionnaires have been adapted to provide information needed by decision makers, policy makers, and all others who must make evidence-based program and policy decisions. These important survey findings are due to the great efforts of the YNHDS management and technical team and all of the staff who have worked on the survey. These professionals have worked diligently to implement every phase of this survey—sampling, pre-test, intensive interviewer training, fieldwork, and writing the final report—and to complete every phase of work according to the planned timetable. I would like to extend our thanks to the development partners for supporting the survey. They have played important roles providing both technical expertise and financial support to make the survey happen. Finally, I would like to extend a sincere thanks to all survey workers and interviewers for their efforts in successfully completing this national mission. President of CSO Vice President of YNHDS Steering Committee I Acknowledgements • xv ACKNOWLEDGEMENTS ccurate health information plays a critical role in developing successful economic and social programs. Thus, the MOPHP (Ministry of Public Health and Population) has planned for some time in collaboration with the Central Statistics Organization (CSO) to carry out many surveys on public health and welfare, in particular the Yemen National Health and Demographic Survey 2013. This survey was undertaken with one primary objective: to provide information to assist policy makers and program managers to develop and evaluate programs and strategies for improving health, nutrition, and family planning services in the country. To this end the survey was designed to be representative of the entire country and to reflect the situation of all married women in Yemeni society. Therefore, it is a pleasure for the MOPHP to offer this final report which provides detailed results for the YNHDS 2013. The survey findings represent the health and demographic situation in Yemen at the national and governorate levels. With this information the MOPHP can accurately assess current policies and programs and make more informed decisions on areas of critical concern to the government such as reducing child mortality and improving maternal health. In addition, researchers, specialists in universities and research centers, and all those interested in health will be able to analyze the survey data sets to achieve a more in-depth understanding of national trends and patterns to further benefit program and policy development. I would like to extend a sincere thanks to the development partners for the financial and technical support they have provided at every phase of the survey. In addition, I would like to extend sincere thanks as well to all survey personnel for the efforts they have made. The YNHDS is the result of all their hard work. Finally, I would like to thank the survey management team, ICF International, and PAPFAM for their unceasing efforts to publish this unique report. Minister of Public Health and Population President of YNHDS Steering Committee A Acronyms and Abbreviations • xvii ACRONYMS AND ABBREVIATIONS AIDS acquired immune deficiency syndrome ARI acute respiratory infection ART antiretroviral therapy ASFRs age-specific fertility rates BCG bacillus Calmette–Guérin (vaccination against tuberculosis) CBR crude birth rate CSO Central Statistical Organization DFID United Kingdom Department for International Development DHS Demographic and Health Surveys DPT diphtheria, pertussis, tetanus EA enumeration areas EKN Embassy of the Kingdom of the Netherlands EPI Expanded Program on Immunization GDP gross domestic product GFR general fertility rate HepB hepatitis B Hib Haemophilus influenzae type B HIV human immunodeficiency virus IYCF infant and young child feeding MDG Millennium Development Goals MENA Middle East and North Africa MICS Multiple Indicator Cluster Surveys MOPHP Ministry of Public Health and Population ORS oral rehydration salts ORT oral rehydration therapy PAPCHILD Pan Arab Project for Child Development PAPFAM Pan Arab Program for Family Health PMTCT prevention of mother-to-child transmission PSU primary sampling unit RHF recommended home fluids STI sexually transmitted infections TFR total fertility rate UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD vitamin A deficiency WHO World Health Organization YDMCHS Yemen Demographic and Maternal and Child Health Survey YFHS Yemen Family Health Survey YMICS Yemen Multiple Indicator Cluster Survey YNHDS Yemen National Health and Demographic Survey xviii • Map of Yemen MAP OF YEMEN Introduction • 1 INTRODUCTION 1 1.1 BACKGROUND 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 to the east, and the Red Sea to the west. While there are more than 112 Yemeni Islands in the Red and the Arabian seas, the most strategic one is Bab Al Mandab. The island, located in the middle of a strait that lies off the southwestern tip of the republic, controls passage into and out of the Red Sea. Yemen is one of the poorest countries in the Middle East and North Africa (MENA) region. The gross domestic product (GDP) per capita was estimated to be US$1,343 in 2013 (CSO, Statistical Yearbook, 2013). According to the first Population Census conducted in 1994 under the Republic of Yemen, the population was 15,831,757 persons. It has increased by 58 percent in the last 20 years to reach about 25 million in 2013 (CSO, Statistical Yearbook, 2013). The growing population will put more pressure on the country to provide social services and public utilities, as well as expand the labor market. This report presents results from the 2013 Yemen National Health and Demographic Survey (2013 YNHDS). The first Yemen Demographic and Maternal and Child Health Survey (YDMCHS) was implemented in 1991-92, after the unification of Yemen in 1990, by the Central Statistical Organization (CSO), with the assistance of the Demographic and Health Surveys (DHS) Program and the Pan Arab Project for Child Development (PAPCHILD). The second round of this survey was carried out in 1997 by CSO with the assistance of the DHS Program. In addition to the two YDMCHS surveys, two other nationally representative surveys on population and health were conducted in the last 10 years. The Yemen Family Health Survey (YFHS) was implemented in 2003 by the Ministry of Public Health and Population (MOPHP), in cooperation with CSO and with the financial and technical assistance of PAPCHILD. Also, the Yemen Multiple Indicator Cluster Survey (YMICS) was implemented in 2006 by the MOPHP with the assistance of the Pan Arab Program for Family Health (PAPFAM – formerly PAPCHILD) and UNICEF. The 2013 YNHDS was implemented by MOPHP in collaboration with CSO. ICF International provided technical assistance through the USAID-funded MEASURE DHS project, which provides support and technical assistance for the implementation of population and health surveys in countries worldwide. PAPFAM also provided technical assistance throughout the implementation of the survey. The survey was funded by the United States Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the World Bank (WB), the United Kingdom Department for International Development (DFID), the Pan Arab Program for Family Health (PAPFAM), the Embassy of the Kingdom of the Netherlands (EKN), and the Government of Yemen. The 2013 YNHDS is considered an important benchmark in statistical work since it covers all 20 governorates of the Republic as well as Sana’a City, and it received considerable review and supervision during preparation and set-up, training and testing, and follow-up and implementation. The survey provides information on chronic illness, disability, marriage, fertility and fertility preferences, knowledge and use of family planning methods, child feeding practices, nutritional status of women and children, maternal and childhood mortality, awareness and attitudes regarding HIV/AIDS, female genital cutting, and domestic violence. This information is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving health, nutrition, and family planning services in the country. In addition, the results from this survey will be used to assess whether Yemen has made gains in 2 • Introduction achieving some of the 2015 Millennium Development Goals (MDGs), especially the two indicators that focus on maternal and child health: to reduce child mortality and to improve maternal health. 1.2 SURVEY IMPLEMENTATION 1.2.1 Sample Design The sample for the 2013 YNHDS was designed to provide population and health indicator estimates at the national and governorate levels. The sample design allowed for specific indicators, such as contraceptive use, to be calculated for each of Yemen’s 20 governorates and Sana’a, the capital city. To have enough cases to report on key indicators in each of the 21 reporting domains, the smallest governorates in terms of population were oversampled while the largest were undersampled. The 2004 General Population Housing and Establishment Census was used as the sampling frame. During the 2004 census, the country was divided into areas convenient for data collection called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster for the 2013 YNHDS, is defined on the basis of EAs from the 2004 EA census frame. The 2013 YNHDS sample was selected using a stratified two-stage cluster design consisting of 800 clusters, with 213 in urban areas and 587 in rural areas. A complete listing of households and a mapping exercise were carried out for each cluster from November 10 to November 30, 2012, with the resulting lists of households serving as the sampling frame for the selection of households in the second stage. All households were listed. In each rural cluster, one household was randomly selected. This household and the next 24 households on the list together constituted the household sample for each of the 587 rural clusters; in urban clusters, the 25 households were randomly selected. The total of 800 clusters was estimated to yield a sample of 20,000 households at the national level. However, for security reasons, ten clusters were not listed. All ever-married and never-married women age 15-49 in each selected household were eligible to be interviewed. In addition, in one-third of selected households, all women age 15-49 as well as children age 6-59 months were eligible to be tested for anemia. The sample design is described in detail in Appendix A, and sampling errors are presented in Appendix B. 1.2.2 Questionnaires For the main survey, four questionnaires were used in the 2013 YNHDS: a household questionnaire, two individual questionnaires (one for ever-married women and an abbreviated version for never-married women), and a maternal mortality questionnaire. The questionnaires were adapted from model survey instruments developed for the MEASURE DHS project to reflect the population and health issues relevant to Yemen. These issues were identified in consultation with a broad spectrum of government ministries and agencies, nongovernmental organizations, and international donors. The Household Questionnaire was used to list all the usual members of and visitors to selected households. Basic information was collected on the characteristics of each person listed, including age, sex, marital status, education, and relationship to the head of the household. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the dwelling, and ownership of various durable goods. The questionnaire was further used to record height and weight measurements for children age 0-59 months and women age 15-49 years, results of the hemoglobin testing for children age 6-59 months and women age 15-49 years, and results of an iodine test of household cooking salt. The data on the sex, age, and marital Introduction • 3 status of household members interviewed with the Household Questionnaire were used to identify the women eligible for the ever-married and never-married individual interview. Several modules or sets of questions were also added to the Household Questionnaire: • A module on child discipline, developed by UNICEF • Modules on chronic diseases, disability, and injuries and accidents, developed by PAPFAM • Questions on food security An Individual Questionnaire, based on the standard MEASURE DHS Woman’s Questionnaire, was used to collect information from all ever-married women age 15-49. It includes questions on the following topics: • Background characteristics (age, marital status, education, media exposure, etc.) • Birth history with information on all live and dead children • Knowledge and use of family planning methods • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Women’s work and husband’s background characteristics • Awareness, attitudes, and behavior regarding AIDS and other sexually transmitted infections (STIs) • Other health issues Several modules were also added to the Individual Questionnaire: • The DHS modules on fistula and female genital cutting • A simplified version of the DHS module on domestic violence • A module on prevalence of tumors, developed by PAPFAM A simplified version of the ever-married woman’s Individual Questionnaire was used for the never- married women. It includes questions on the following topics: • Background characteristics (age, education, media exposure, etc.) • Awareness, attitudes, and behavior regarding AIDS • Other health issues, including prevalence of tumors • Female genital cutting • Domestic violence The Maternal Mortality Questionnaire is discussed in section 1.2.4. 1.2.3 Anthropometry and Anemia The 2013 YNHDS incorporated biomarkers in anthropometry and hemoglobin testing. Anthropometry. In all households, height and weight measurements were recorded for children age 0-59 months and women age 15-49 years. In addition, mid-upper-arm circumference was also measured among women age 15-49. Hemoglobin testing. Hemoglobin testing is the primary method for anemia diagnosis. The 2013 YNHDS included hemoglobin testing for children age 6-59 months and all women age 15-49 years in one- third of the selected households. Only women who voluntarily consented and children for whom voluntary consent was given were tested. Hemoglobin analysis was carried out on site using a battery-operated portable 4 • Introduction AVIE™ Total HB analyzer. A drop of blood taken from a finger prick (or a heel prick in the case of young children with small fingers) was collected in a microcuvette, which was then placed in the analyzer. The AVIE™ Total HB analyzer took about a minute to display the hemoglobin level in the blood. Results were recorded on the questionnaire and explained verbally. Persons whose hemoglobin level was lower than the recommended cutoff point for severe anemia were advised to visit a health facility for follow-up with a health professional. 1.2.4 Maternal Mortality The 2013 YNHDS did not use the Maternal Mortality module developed by MEASURE DHS (which is based on the sisterhood method). Instead it used a methodology previously used by PAPFAM in the 2003 YFHS. The Maternal Mortality component of the YNHDS was implemented in two phases. Household listing. The household listing identified 113,463 households in the YNHDS selected clusters. Two types of key information were recorded in each household listed: the number of births and the number of deaths of women age 12-49 over the past two years. All households with a woman’s death in the past two years were selected to be interviewed during the main survey. It should be noted that these households were not necessarily the same as those randomly selected for the main survey. Maternal mortality data collection. During the data collection, all households identified during the listing phase with a woman’s death in the past two years (whether or not selected for the main survey) were interviewed using the Maternal Mortality Questionnaire to identify maternal deaths and collect additional information on the deceased women. 1.2.5 Training of Field Staff All aspects of data collection were pre-tested from November 20 to December 12, 2012. Twenty- four participants (16 females and 8 males) attended the two-week training in the administration of the YNHDS survey instruments, anthropometric measurement, and hemoglobin testing. Pre-test fieldwork was carried out over four days in urban and rural clusters in and around Sana’a. A total of 124 household interviews (70 in urban and 54 in rural areas) were conducted, in which 161 eligible women were located and interviewed. Following field practice, a debriefing session was held with the pre-test field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. Unfortunately, the main survey was delayed, and the training for the main survey only took place eight months later. The four-week main training that took place from August 18 to September 12, 2013, was conducted by MOPHP and CSO staff, and ICF and PAPFAM consultants. In addition, MOPHP nutritionists participated in the biomarker training. The training started with 278 field staff. Due to the very large number of trainees, training was carried out simultaneously in two classrooms. The training included lectures, role playing, mock interviews, and field practices. Several role playing and mock interview sessions were held so that the interviewers got plenty of practice. The training on biomarker collection was held concurrently with the training on questionnaire administration, two one-day field practices took place during the training. The purpose of field practice was to train interviewers on questionnaire delivery as well as height and weight measurement and hemoglobin testing. Overall, the practice sessions were successful, with interviewers generally performing better during the second round. By the end of each field practice, many interviewers had completed two households; in total, all teams completed 228 household questionnaires, 228 ever-married woman questionnaires, 173 never-married woman questionnaires, 445 height and weight measurement sessions, and 400 hemoglobin tests. Introduction • 5 1.2.6 Fieldwork Fieldwork was launched simultaneously in all governorates immediately upon the conclusion of field staff training. Forty interviewing teams carried out data collection for the 2013 YNHDS. Each team consisted of one male team supervisor, one male field editor, four female interviewers, and one driver. Fieldwork supervision was conducted by MOPHP, CSO, ICF, PAPFAM, and a technical team through regular visits to teams to review their work and monitor data quality. Data collection took place over a two- month period, from September 14 through November 23, 2013, with a two-week interruption (October 10-25) due to Adhah Eid. Questionnaires were regularly delivered to MOPHP headquarters. 1.2.7 Data Processing The processing of the YNHDS data with the CSPro software began as soon as questionnaires were received from the field. Completed questionnaires were returned from the field to MOPHP headquarters, where they were entered and edited by data processing personnel who were specially trained for this task and who had also attended questionnaire training. Data processing was to be concurrent with data collection to allow for regular monitoring of team performance and data quality. However, data entry was slow during the first few weeks, and the “field check” tables that were supposed to be regularly generated to check various data quality parameters were not produced early enough to provide feedback to the data collection teams during the first weeks of fieldwork. Coding was completed on January 15, 2014, and data entry, which included 100 percent double entry to minimize keying error and data editing, was completed on February 15, 2014. Data cleaning was completed on March 15, 2014. Secondary editing, imputation, and calculation of survey weights were completed by mid-April 2014. 1.2.8 Response Rates Among the 800 clusters initially selected, ten were not listed and, at the time of data collection, nine additional clusters had not been visited for security reasons. Consequently, the results of the 2013 YNHDS are based on 781 clusters that were actually visited during the data collection phase. The household and individual response rates are shown in Table 1.1. A total of 19,517 households were selected for inclusion in the YNHDS, and of these, 18,027 were occupied. Of the 18,027 occupied households, 17,351 were successfully interviewed, yielding a response rate of 96 percent (97 percent in rural areas compared with 95 percent in urban areas). Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Yemen 2013 Residence Total Result Urban Rural Household interviews Households selected 5,300 14,217 19,517 Households occupied 4,957 13,070 18,027 Households interviewed 4,693 12,658 17,351 Household response rate1 94.7 96.8 96.3 Interviews with ever-married women age 15-49 Number of eligible ever-married women 4,723 12,595 17,318 Number of eligible ever-married women interviewed 4,548 12,108 16,656 Eligible women response rate2 96.3 96.1 96.2 Interviews with never married women age 15-49 Number of eligible never married women 2,903 6,585 9,488 Number of eligible never married women interviewed 2,720 6,058 8,778 Eligible never married women response rate2 93.7 92.0 92.5 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents 6 • Introduction In the interviewed households, a total of 17,318 ever-married women were identified to be eligible for the individual interview, and 96 percent of them (16,656) were successfully interviewed. For never- married women, 9,488 were identified as eligible for interview, and 93 percent of them (8,778) were successfully interviewed. Housing Characteristics and Household Population • 7 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter presents information on demographic and socioeconomic characteristics of the household population such as age, sex, education, and place of residence. The environmental profile of households in the 2013 Yemen National Health and Demographic Survey (YNHDS) sample is also examined. Taken together, these descriptive data provide context for the interpretation of demographic and health indices and can furnish an approximate indication of the representativeness of the survey. The chapter also includes information about how children in Yemen are disciplined. In the 2013 YNHDS, a household was defined as a person or group of related and unrelated persons who live together in the same dwelling unit and who share the same housekeeping arrangements. Information was collected from all the usual residents of each selected household and visitors who had stayed in the selected household the night before the interview. Those persons who stayed in the selected household the night before the interview (whether usual residents or visitors) represent the de facto population; usual residents alone constitute the de jure population. All tables in this report refer to the de facto population unless otherwise specified. 2.1 HOUSEHOLD CHARACTERISTICS The physical characteristics of households and the availability and accessibility of basic household facilities are important in assessing the general welfare and socioeconomic condition of the population. The 2013 YNHDS collected information on a range of housing characteristics, including source of drinking water; time taken to fetch water; type of sanitation facility; access to electricity; type of materials used for flooring, roofing, and walls; and number of rooms used for sleeping. Questions were also asked about sources of energy for cooking fuel and lighting and whether cooking is done in the house or outside. These data are presented for households and are further disaggregated by urban-rural residence. T Key Findings • Fifty-nine percent of households in Yemen use an improved source of drinking water. • Less than half of households use improved toilets that are not shared with other households; 25 percent of households have no toilet at all. • Three-quarters of households have electricity. • Ownership of telephones has risen dramatically; in 1997, only 8 percent of households owned a telephone of any kind, compared with 80 percent of households owning a mobile phone in 2013. • Less than one-third of children under age 5 have had their birth registered. • Only 4 percent of children under age 18 are orphaned (that is, one or both parents are not living). • Forty-three percent of females and 21 percent of males age 6 and older have never attended school. • Physical punishment is a common form of child discipline; 42 percent of children age 2-14 received severe physical punishment in the month before the survey. 8 • Housing Characteristics and Household Population 2.1.1 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals that Yemen along with other nations worldwide has adopted (United Nations General Assembly, 2002). Table 2.1 includes a number of indicators that are useful in monitoring household access to improved drinking water (WHO and UNICEF, 2012a). The source of the drinking water is an indicator of suitability for drinking. Sources that are more likely to provide water suitable for drinking are identified in Table 2.1 as improved sources. These include piped water, tube well or borehole, rainwater, and bottled water.1 Lack of ready access to a water source may limit the quantity of suitable drinking water that is available to a household. Even if the water is obtained from an improved source, if it is fetched from a source that is not immediately accessible to the household, it may be contaminated during transport or storage. Finally, home water treatment can be effective in improving the quality of household drinking water. Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Yemen 2013 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 78.7 49.7 58.8 76.0 50.1 58.0 Piped government network 40.0 10.5 19.7 40.1 10.8 19.8 Piped local network 1.7 14.1 10.3 1.8 13.9 10.2 Tube well or borehole 2.1 19.2 13.9 2.3 20.0 14.6 Rain water 0.3 4.9 3.4 0.3 4.5 3.2 Bottled water 34.7 1.0 11.5 31.5 0.9 10.3 Nonimproved source 20.6 48.5 39.8 23.2 48.3 40.6 Well 0.5 18.8 13.1 0.5 18.0 12.6 Spring 0.2 14.2 9.9 0.3 13.9 9.7 Tanker truck 19.8 9.4 12.7 22.3 10.4 14.1 Surface water protected 0.1 3.2 2.2 0.1 3.1 2.2 Surface water unprotected 0.0 2.8 2.0 0.0 2.9 2.0 Other 0.5 1.7 1.3 0.6 1.6 1.3 Missing 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 95.1 84.5 87.8 94.7 84.1 87.3 Less than 30 minutes 0.3 1.3 1.0 0.2 1.3 1.0 30 minutes or longer 3.9 13.4 10.4 4.4 13.9 10.9 Don’t know/missing 0.7 0.8 0.8 0.7 0.8 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 1.0 1.3 1.2 0.8 1.2 1.1 Bleach/chlorine added 0.2 0.1 0.1 0.2 0.1 0.1 Strained through cloth 0.9 3.3 2.6 1.0 3.3 2.6 Water filter 7.8 2.7 4.3 8.6 3.1 4.8 Treated at the source 0.2 0.6 0.5 0.3 0.6 0.5 Let it stand and settle 1.5 0.6 0.9 1.3 0.6 0.8 Other 0.1 0.1 0.1 0.1 0.1 0.1 No treatment 88.1 91.3 90.3 87.6 90.8 89.9 Percentage using an appropriate treatment method2 8.9 4.0 5.5 9.5 4.4 5.9 Number 5,413 11,938 17,351 35,523 80,220 115,743 1 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, and filtering. The source of drinking water is important because waterborne diseases, including diarrhea and dysentery, are prevalent in Yemen. Sources of water expected to be relatively free of the agents responsible for these diseases are piped water, tube wells or boreholes, rainwater, and bottled water. Other sources 1 The categorization into improved and nonimproved categories is based on that proposed by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (WHO and UNICEF, 2012b). Housing Characteristics and Household Population • 9 such as regular wells, surface water, and water delivered in trucks are more likely to carry disease-causing agents. Table 2.1 indicates that a majority of Yemeni households (59 percent) utilize improved water sources: 30 percent from piped water (either from a government or local network), 14 percent from tube well or borehole, 3 percent from rainwater, and 12 percent from bottled water. Households in urban areas (76 percent) are more likely than those in rural areas (50 percent) to have access to an improved source of water. According to the 2006 UNICEF Multiple Indicator Cluster Survey (YMICS), 59 percent of the household population used improved sources of water, almost identical to the 58 percent found in the 2013 YNHDS (Ministry of Public Health and Population and UNICEF 2008). For 88 percent of households in Yemen, the source of drinking water is on their premises; 95 percent of urban households and 85 percent of rural households have water on their premises. Ten percent of households in Yemen take 30 minutes or longer to obtain drinking water. Only 6 percent of households appropriately treat their drinking water, mostly by filtering the water or by straining it through a cloth. The findings are comparable to those reported in the 2006 YMICS survey, in which 5 percent of the household population used an appropriate method to treat their drinking water. 2.1.2 Sanitation Facilities and Waste Disposal Ensuring adequate sanitation facilities is another Millennium Development Goal that Yemen shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO and UNICEF, 2012a). In this survey, the types of facilities considered improved are toilets that flush or pour flush into a piped sewer system or septic tank. Table 2.2 shows that only 45 percent of households in Yemen use improved toilet facilities that are not shared with other households, and 4 percent of households use facilities that would be considered improved if they were not shared. Eighty-three percent of households in urban areas have improved toilet facilities that are not shared compared with 27 percent in rural areas. Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Yemen 2013 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour to piped sewer system 63.4 4.8 23.1 61.4 5.4 22.6 Flush/pour to septic tank 20.1 22.4 21.7 21.5 25.1 24.0 Total 83.4 27.2 44.8 82.8 30.5 46.6 Shared facility1 Flush/pour flush to piped sewer system 2.9 0.7 1.4 3.1 0.7 1.4 Flush/pour flush to septic tank 1.2 3.4 2.7 1.2 3.1 2.5 Total 4.1 4.1 4.1 4.2 3.8 3.9 Nonimproved facility Pit 6.9 20.9 16.5 7.1 20.3 16.3 Bucket 2.2 10.1 7.6 2.3 9.8 7.5 Latrine 0.8 1.4 1.2 0.9 1.5 1.3 Other 0.2 0.4 0.3 0.2 0.4 0.3 Missing 0.1 0.3 0.2 0.0 0.4 0.3 No facility/bush/field 2.3 35.7 25.3 2.4 33.3 23.8 Total 12.4 68.7 51.2 12.9 65.7 49.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,413 11,938 17,351 35,523 80,220 115,743 1 Facilities that would be considered improved if they were not shared by two or more households. 10 • Housing Characteristics and Household Population Over half of Yemeni households (51 percent) have nonimproved toilet facilities. Overall, about one in five households uses either a pit or a latrine, and another 8 percent use buckets. One in four households has no toilet facility at all. There are large differences in sanitation facilities by urban-rural residence; 12 percent of urban households have nonimproved toilet facilities, compared with 69 percent of rural households. Although the questions and coding categories differed between surveys, the results from the 2013 YNHDS show that 47 percent of the household population use improved toilet facilities, which is similar to the 52 percent found in the 2006 YMICS survey. 2.1.3 Housing Characteristics Table 2.3 presents information on characteristics of the dwelling in which households live. In addition to reflecting the household’s socioeconomic situation, these characteristics show environmental conditions in which the household lives. For example, use of biomass fuels exposes the household members to indoor pollution, which has a direct bearing on their health and welfare. The type of material used to build a dwelling is a basic indicator of socioeconomic status. One-third of Yemeni households have earthen floors (made of dirt or clay), while 42 percent have cement floors and 17 percent have tile floors. Large differences exist between rural and urban households; earth flooring is most common in rural areas (45 percent of households), while tile floors are most common in urban areas (42 percent of households). The vast majority of households have roofs made with wood. One-third have roofs made of wood and dirt, while another one-third have roofs made of wood and cement, and 10 percent have Table 2.3 Household characteristics Percent distribution of households by housing characteristics, according to residence, Yemen 2013 Residence Total Housing characteristic Urban Rural Flooring material Dirt, clay 6.2 44.9 32.9 Cement 37.8 44.1 42.1 Plain tile 41.6 5.4 16.7 Plaster 1.7 2.6 2.3 Stone 2.3 1.8 2.0 Marble 10.3 1.0 3.9 Missing 0.0 0.2 0.1 Total 100.0 100.0 100.0 Main roof material Wood and cement 37.9 28.9 31.7 Wood and dirt 13.8 40.9 32.5 Wood 7.8 10.4 9.6 Straw, cane 0.8 6.0 4.4 Cane and mud 1.0 4.5 3.4 Metal plates 0.8 0.7 0.7 Metal plates and mud 0.2 0.5 0.4 Concrete roof, cement 37.6 7.7 17.0 Other 0.1 0.3 0.2 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Main wall material Straw, cane 0.5 2.7 2.0 Cloth, wool 0.0 0.3 0.2 Dirt 6.0 13.2 11.0 Carved stone 17.2 11.5 13.3 Plain stone 16.7 44.4 35.7 Cement blocks 55.9 25.5 35.0 Local adobe 2.4 0.6 1.2 Covered adobe 1.0 1.2 1.1 Other 0.3 0.6 0.5 Missing 0.1 0.1 0.1 Source of light Electricity 98.5 65.2 75.6 Public electric network 95.3 45.9 61.3 Coop. electric network 0.7 2.4 1.9 Private electric network 1.6 9.9 7.3 Special generator 0.8 6.1 4.5 Solar energy 0.1 0.8 0.5 Other 1.5 33.6 23.6 Gas (Kerosene) 1.4 28.9 20.3 Other 0.1 4.6 3.2 No source of light 0.0 1.1 0.8 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Rooms used for sleeping None 0.0 0.2 0.2 One 27.6 42.4 37.8 Two 36.7 31.1 32.9 Three or more 35.2 25.9 28.8 Missing 0.4 0.4 0.4 Total 100.0 100.0 100.0 Place for cooking In the house 92.1 60.2 70.1 In a separate building 3.7 25.2 18.5 Other 3.8 14.1 10.9 Missing 0.4 0.6 0.5 Total 100.0 100.0 100.0 Cooking fuel Electricity 1.0 0.3 0.5 LPG/natural gas/biogas 92.5 43.1 58.5 Kerosene 3.0 4.7 4.2 Charcoal 0.1 0.3 0.2 Wood 2.3 49.3 34.7 Animal dung 0.0 0.2 0.1 No food cooked in household 0.3 1.2 0.9 Missing 0.7 0.8 0.8 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 2.4 49.8 35.0 Number 5,412.5 11,938.5 17,351.0 LPG = Liquefied petroleum gas 1 Includes charcoal, wood, and animal dung Housing Characteristics and Household Population • 11 roofs of wood alone. Seventeen percent of households have cement or concrete roofs. Urban households are much more likely to have cement or concrete roofs than rural households. Most households in Yemen live in dwellings with substantial walls. Over one-third of households have walls made of plain stone, and more than one-third have walls made of cement blocks. Thirteen percent of households have walls made of carved stone. Only 13 percent of Yemeni households have walls made from dirt, straw, or cane. The main difference by residence is that urban households are more likely to have walls made from cement blocks or carved stone, while rural households are more likely to have walls made of plain stone. Use of electricity usually goes hand in hand with improved housing structures and a better standard of living. In Yemen, just over three-quarters of households have electricity, mostly supplied through the public network. Households with no electricity mainly rely on kerosene gas for lighting. There is a large difference in access to electricity between urban and rural households (99 percent in urban areas compared with 65 percent in rural areas). The number of rooms used for sleeping indicates the extent of crowding. Overcrowding increases the risk of contracting diseases. Overall, 38 percent of Yemeni households use one room for sleeping, 33 percent use two rooms, and 29 percent use three or more rooms for sleeping. Urban households generally have more rooms for sleeping than rural households. Cooking and heating with solid fuels can lead to high levels of indoor smoke, a complex mix of health-damaging pollutants that could increase the risk of contracting diseases (WHO, 2011a). Solid fuels include fire coal/charcoal and wood. In the 2013 YNHDS, households were asked about their primary source of fuel for cooking. The results show that only 35 percent of households use solid fuel (wood) for cooking, with the majority of households (59 percent) using liquefied petroleum gas (LPG) or natural gas/biogas. There are large differentials in cooking fuel between urban and rural areas. Although 49 percent of households in the rural areas use wood for cooking, only 2 percent of urban households do so. By far, the main source of cooking fuel in the urban areas is LPG/natural gas/biogas (93 percent). The potential for exposure to harmful effects of smoke from using solid fuels for cooking increases if cooking occurs within the home itself rather than outdoors or in a separate building. Seventy percent of households in Yemen cook in the house, and 19 percent cook in a separate building. Ninety-two percent of urban households cook in the house, compared with 60 percent of rural households. 2.1.4 Household Possessions The availability of durable goods is an indicator of a household’s socioeconomic status. Moreover, each particular item has specific benefits. For instance, having access to a radio or a television exposes household members to innovative ideas; a refrigerator prolongs the wholesomeness of foods; and a means of transport allows greater access to services away from the local area. Table 2.4 shows the ownership of selected household possessions by residence. The most common items to be owned by households are a mobile telephone (80 percent), and a television (67 percent). Additionally, 40 percent of households own a radio, 40 percent own a refrigerator, 35 percent own a washer; 25 percent own a fan; 17 percent own a nonmobile telephone, 17 percent own a generator; 14 percent own a water heater; and 12 percent own an air conditioner. Urban households are more likely than rural households to own each of the items. For many of these items, ownership has increased substantially over time. For example, in 1997, only 8 percent of households owned a telephone of any kind, compared with 80 percent of households owning a mobile phone in 2013. Similarly, the proportion of households owning a washing machine has doubled, growing from 16 percent in 1997 to 35 percent in 2013, and the proportion owning a refrigerator has also doubled, increasing from 20 percent in 1997 to 40 percent in 2013 (CSO and MI, 1998). 12 • Housing Characteristics and Household Population With regard to means of transportation, 21 percent of households own a car or truck, 13 percent own a motorcycle or scooter, 11 percent own a bicycle, and 1 percent each owns an animal-drawn cart or a boat. Ownership of cars and trucks has increased from 13 percent of households in 1997 to 21 percent in 2013; in 1997, only 2 percent of households owned a motorcycle or scooter. Ownership of property is common in Yemen, with 63 percent of households owning real estate and 42 percent owning agricultural land. Only 3 percent of households have commercial or industrial property. More than half of households (52 percent) own farm animals. As might be expected, ownership of agricultural land, real estate, and farm animals is considerably higher among rural households than urban households. 2.2 HOUSEHOLD WEALTH Information on household assets was used to create an index that is used throughout this report to represent the wealth of the households interviewed in the 2013 YNHDS. This method for calculating a country-specific wealth index was developed and tested in a large number of countries in relation to inequalities in household income, use of health services, and health outcomes (Rutstein and Johnson, 2004). It has been shown to be consistent with expenditure and income measures. The wealth index is constructed using household asset data, including ownership of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities, and type of building materials. In its current form, which takes account urban-rural differences in these items and their characteristics, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. For purposes of creating scores, categorical variables are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators (Rutstein, 2008). The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are formed by assigning the household score to each de jure household member, ranking each person in the population by that score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Thus, throughout this report, wealth quintiles are expressed in terms of quintiles of individuals in the overall population rather than quintiles of individuals at risk for any one health or population indicator. For example, quintile rates for infant mortality refer to infant mortality rates per 1,000 live births among all people in the population quintile concerned, as distinct from quintiles of live births or newly born infants, who constitute the only members of the population at risk of mortality during infancy. Table 2.5 presents wealth quintiles by residence and governorate. Also included in the table is the Gini Coefficient for each residence and governorate, which indicates the level of concentration of wealth, with zero being an equal distribution and one a totally unequal distribution. Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land and livestock/farm animals by residence, Yemen 2013 Residence Total Possession Urban Rural Household effects Radio 41.2 39.4 39.9 Television 93.9 54.5 66.8 Mobile telephone 93.5 74.0 80.0 Non-mobile telephone 37.0 7.8 16.9 Refrigerator 77.3 22.7 39.7 Washer 74.7 17.6 35.4 Air conditioner 28.4 4.9 12.2 Fan 49.2 13.7 24.7 Generator 23.2 13.9 16.8 Water heater 31.6 6.4 14.3 Means of transport Bicycle 18.1 7.0 10.5 Animal drawn cart 0.7 1.6 1.3 Motorcycle/scooter 13.2 12.4 12.7 Car/truck 28.5 17.4 20.9 Boat with a motor 0.7 0.8 0.8 Ownership of fixed assets Agricultural land 15.5 54.1 42.0 Real state 51.9 68.5 63.3 Commercial or industrial property 5.4 2.4 3.3 Ownership of farm animals1 12.3 69.3 51.5 Number 5,413 11,938 17,351 1 Cattle, cows, horses, donkeys, mules, camels, goats, sheep, or chickens Housing Characteristics and Household Population • 13 Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and governorate, Yemen 2013 Wealth quintile Total Number of persons Gini coefficient Residence/ Governorate Lowest Second Middle Fourth Highest Residence Urban 1.1 1.5 5.6 36.5 55.3 100.0 35,523 0.11 Rural 28.4 28.2 26.4 12.7 4.4 100.0 80,220 0.20 Governorate Ibb 15.7 26.7 28.0 17.5 12.1 100.0 12,687 0.25 Abyan 6.4 13.0 30.3 36.6 13.6 100.0 2,463 0.18 Sana’a City 0.0 0.1 0.2 26.1 73.6 100.0 10,256 0.12 Al-Baidha 10.9 13.9 22.4 31.4 21.4 100.0 4,600 0.22 Taiz 21.3 19.6 24.0 14.0 21.1 100.0 15,012 0.26 Al-Jawf 26.4 39.2 29.6 4.8 0.0 100.0 937 0.25 Hajjah 49.9 21.6 14.7 10.1 3.6 100.0 7,072 0.29 Al-Hodiedah 32.8 24.5 14.0 14.6 14.1 100.0 14,252 0.26 Hadramout 3.8 7.6 11.9 45.3 31.4 100.0 6,541 0.15 Dhamar 25.6 29.3 27.5 11.7 5.9 100.0 8,300 0.28 Shabwah 3.3 5.6 23.5 42.2 25.5 100.0 2,443 0.12 Sadah 11.0 37.7 42.7 8.4 0.3 100.0 3,638 0.14 Sana’a 19.0 27.0 25.9 24.0 4.1 100.0 6,038 0.24 Aden 0.0 0.5 2.4 25.1 72.0 100.0 3,727 0.11 Lahj 19.8 19.6 25.2 26.0 9.5 100.0 3,223 0.27 Mareb 17.6 19.3 20.3 27.4 15.3 100.0 838 0.22 Al-Mhweit 31.1 29.9 23.6 11.2 4.2 100.0 3,071 0.25 Al-Mhrah 6.2 2.4 10.6 46.9 33.9 100.0 450 0.13 Amran 27.0 24.3 25.8 19.6 3.3 100.0 4,515 0.26 Aldhalae 10.4 23.3 29.3 26.2 10.8 100.0 3,001 0.22 Reimah 57.8 32.1 8.8 0.8 0.5 100.0 2,680 0.24 Total 20.0 20.0 20.0 20.0 20.0 100.0 115,743 0.23 Although by definition, 20 percent of the population falls into each of the five categories of the index, there are large differentials across residence and governorate. More than 9 in 10 urban residents fall in the fourth and highest quintiles, whereas more than half of the rural population (57 percent) falls in the lowest two quintiles. Similarly, the more urbanized governorates of Sana’a City and Aden have the largest proportions of households in the highest wealth quintile (74 percent and 72 percent, respectively). Reimah has the largest proportion in the lowest wealth quintile (58 percent). 2.3 HAND WASHING Hand washing with soap and water is ideal. However, hand washing with a nonsoap cleansing agent such as ash or sand is preferred over not using any cleansing agent. To obtain hand-washing information, interviewers asked to see the place where members of the household most often washed their hands; information on the availability of water, cleansing agents, or both was recorded only for households where the hand washing place was observed. As shown in Table 2.6, interviewers observed the place most often used for hand washing in 72 percent of households. Among those households where the hand washing place was observed, 62 percent had soap and water, 22 percent had only water, 5 percent had soap but no water, and 8 percent had no water, soap, or any other cleansing agent at the place for hand washing. The proportion of households with soap and water is higher in urban than rural areas and ranges from a low of 31 percent in Hajjah Governorate to a high of 88 percent in Aden Governorate. The proportion with soap and water increases steadily as wealth increases. 14 • Housing Characteristics and Household Population Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Yemen 2013 Percentage of households where place for washing hands was observed Number of house- holds Among households where place for hand washing was observed, percentage with: Number of households with place for hand washing observed Background characteristic Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Missing Total Residence Urban 87.5 5,413 76.7 0.1 13.1 4.9 0.1 3.3 1.8 100.0 4,735 Rural 64.8 11,938 52.8 0.2 27.2 4.9 0.1 10.8 4.1 100.0 7,740 Governorate Ibb 63.2 1,827 49.1 0.0 33.6 4.3 0.2 12.2 0.5 100.0 1,154 Abyan 57.5 374 74.9 0.4 15.5 1.7 0.0 4.7 2.7 100.0 215 Sana’a City 93.5 1,640 70.7 0.0 16.7 6.5 0.0 4.9 1.1 100.0 1,534 Al-Baidha 82.7 533 68.0 0.1 22.1 1.1 0.0 8.5 0.2 100.0 441 Taiz 62.0 2,306 84.6 0.0 7.4 6.5 0.0 1.0 0.5 100.0 1,429 Al-Jawf 67.6 142 73.7 2.0 21.3 0.6 0.0 2.1 0.2 100.0 96 Hajjah 77.8 1,094 31.4 0.2 19.0 6.0 0.0 15.7 27.7 100.0 851 Al-Hodiedah 86.1 2,487 59.9 0.3 31.5 3.9 0.0 3.5 1.0 100.0 2,141 Hadramout 43.5 822 85.4 0.0 10.7 0.6 0.0 1.0 2.3 100.0 357 Dhamar 82.1 1,246 35.3 0.4 32.5 2.9 0.0 26.2 2.7 100.0 1,023 Shabwah 39.1 271 65.2 0.0 8.3 0.4 0.0 2.7 23.4 100.0 106 Sadah 61.4 493 58.4 0.5 19.0 10.1 2.1 9.3 0.6 100.0 302 Sana’a 62.5 779 46.5 0.0 40.4 7.8 0.0 3.9 1.4 100.0 487 Aden 89.5 620 87.9 0.3 9.1 1.0 0.0 0.3 1.3 100.0 555 Lahj 60.0 601 73.4 0.0 9.1 7.3 0.3 8.4 1.3 100.0 360 Mareb 32.8 103 33.7 0.0 24.0 1.7 0.0 10.7 29.9 100.0 34 Al-Mhweit 42.6 488 41.1 0.0 29.3 5.2 0.0 23.0 1.4 100.0 208 Al-Mhrah 80.8 85 86.8 0.0 6.0 2.5 1.1 0.1 3.4 100.0 68 Amran 83.9 622 52.0 0.0 25.4 9.3 0.1 12.0 1.1 100.0 522 Aldhalae 95.0 397 81.0 0.0 8.2 7.5 0.0 2.6 0.7 100.0 377 Reimah 50.8 423 70.6 0.6 16.6 2.2 0.0 9.4 0.6 100.0 215 Wealth quintile Lowest 59.0 3,849 30.8 0.4 33.7 6.1 0.2 19.9 9.0 100.0 2,270 Second 63.5 3,493 47.9 0.4 31.5 6.2 0.1 11.4 2.5 100.0 2,219 Middle 68.2 3,286 65.2 0.1 23.8 3.9 0.0 5.4 1.5 100.0 2,242 Fourth 79.1 3,220 70.5 0.0 17.9 4.1 0.1 4.5 2.9 100.0 2,548 Highest 91.3 3,503 84.4 0.0 8.5 4.6 0.0 1.5 1.0 100.0 3,197 Total 71.9 17,351 61.9 0.2 21.8 4.9 0.1 7.9 3.2 100.0 12,475 1Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent 2.4 HOUSEHOLD POPULATION BY AGE, SEX, AND RESIDENCE Age and sex are important demographic variables that are the primary basis for demographic classification in vital statistics, censuses, and surveys. They are also very important variables in the study of mortality, fertility, and marriage. The distribution of the de facto household population in the 2013 YNHDS is shown in Table 2.7 by five-year age groups, according to sex and residence. A total of 109,215 individuals resided in the 17,351 households successfully interviewed; the female population (56,593) exceeds that of males (52,621). Housing Characteristics and Household Population • 15 Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Yemen 2013 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 12.9 11.6 12.3 15.9 14.0 14.9 15.0 13.3 14.1 5-9 12.8 12.8 12.8 17.1 15.2 16.1 15.7 14.5 15.1 10-14 14.8 12.8 13.7 16.6 14.5 15.5 16.0 13.9 14.9 15-19 11.4 11.7 11.5 11.6 11.8 11.7 11.5 11.8 11.6 20-24 10.0 10.6 10.3 7.3 9.0 8.2 8.1 9.5 8.9 25-29 8.0 9.8 8.9 5.7 7.9 6.9 6.5 8.5 7.5 30-34 6.5 7.1 6.8 4.5 5.4 5.0 5.2 5.9 5.6 35-39 5.1 5.6 5.4 4.0 4.8 4.4 4.4 5.0 4.7 40-44 4.3 3.5 3.9 3.0 3.2 3.1 3.4 3.3 3.3 45-49 3.0 3.0 3.0 2.5 2.5 2.5 2.6 2.7 2.7 50-54 3.1 4.5 3.8 2.5 3.9 3.3 2.7 4.1 3.4 55-59 2.1 2.3 2.2 1.8 2.2 2.0 1.9 2.2 2.1 60-64 2.1 1.7 1.9 2.4 1.8 2.1 2.3 1.7 2.0 65-69 1.2 0.8 1.0 1.3 1.0 1.2 1.3 1.0 1.1 70-74 1.4 1.0 1.2 1.6 1.0 1.3 1.5 1.0 1.3 75-79 0.5 0.5 0.5 0.8 0.6 0.7 0.7 0.5 0.6 80 + 0.8 0.9 0.9 1.3 1.2 1.2 1.2 1.1 1.1 Don’t know/missing 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 16,976 17,461 34,437 35,646 39,132 74,778 52,621 56,593 109,215 The age-sex structure of the population is shown in the population pyramid in Figure 2.1. The broad base of the pyramid indicates that Yemen’s population is young, a scenario typical of countries with high fertility rates. The proportion of persons under age 15 is 44 percent, while the proportion of individuals age 65 and older is 4 percent. This pattern is similar to the one observed in the 1997 YDMCHS, although the proportion under age 15 has declined from 49 percent to 44 percent. There appears to be some displacement of women age 45-49 to age 50-54; interviewers may have intentionally overestimated the respondents’ ages as older than the age cut-off of 49 so as to make them ineligible for the individual interview. Figure 2.1 Population pyramid -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 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 + Percentage Age Male Female 8 7 6 5 4 3 2 1 YNHDS 2013 16 • Housing Characteristics and Household Population 2.5 HOUSEHOLD COMPOSITION Information on the composition of households, including the sex of the head of the household and the size of the household, is presented in Table 2.8. These characteristics are important because they are associated with the welfare of the household. Female-headed households are, for example, typically poorer than male-headed households. In larger households, economic resources are often more limited. Moreover, where the household size is large, crowding can lead to health problems. Table 2.8 shows that 92 percent of the households in Yemen are headed by men. This proportion is almost identical to the 91 percent found in the 1997 YDMCHS. Households in Yemen are large, with almost one-quarter consisting of 9 or more members. The overall average household size of 6.7 is only slightly lower than that reported in the 1997 YDMCHS (7.0). Variation in household size by residence is small. The mean size of households in urban areas is 6.6, which compares with 6.7 in rural areas. Information was also collected on the living arrangements of all children under age 18 residing in households and on the survival status of their parents. These data can be used to assess the extent to which households face a need to care for orphaned or foster children. Orphans include children whose mother or father has died (single orphans) as well as children who have lost both parents (double orphans). In the case of foster children, both parents are alive but the children are living in a household where neither their natural mother nor their natural father resides. Overall, 9 percent of households in Yemen are caring for foster or orphaned children, or both. 2.6 BIRTH REGISTRATION The registration of births is the inscription of the facts of each birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration, or later, as proof of the registration of the birth. Birth registration is basic to ensuring a child’s legal status and, thus, basic rights and services (UNICEF, 2006; United Nations General Assembly, 2002). Information on the registration of births was collected in the household interview. Respondents were asked whether children under age 5 residing in the household had a birth certificate. If not, interviewers asked if the child’s birth had ever been registered with the civil authority. Table 2.9 shows the percentage of de jure children under age 5 whose births were registered at the time of the survey. Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Yemen 2013 Residence Total Characteristic Urban Rural Household headship Male 91.4 92.6 92.2 Female 8.6 7.4 7.8 Total 100.0 100.0 100.0 Number of usual members 1 1.2 2.2 1.9 2 5.6 7.3 6.8 3 7.8 7.9 7.9 4 13.4 10.2 11.2 5 14.1 11.8 12.5 6 14.5 12.8 13.3 7 11.9 12.1 12.0 8 9.8 10.2 10.1 9+ 21.8 25.5 24.4 Total 100.0 100.0 100.0 Mean size of households 6.6 6.7 6.7 Percentage of households with orphans and foster children under 18 years of age Foster children1 4.2 4.2 4.2 Double orphans 0.2 0.2 0.2 Single orphans2 4.8 5.3 5.1 Foster and/or orphan children 8.5 8.6 8.6 Number of households 5,413 11,938 17,351 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent. Housing Characteristics and Household Population • 17 Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Yemen 2013 Children whose births are registered Number of children Background characteristic Percentage who had a birth certificate Percentage who did not have birth certificate Percentage registered Age <2 13.4 15.5 28.9 6,340 2-4 17.0 14.9 31.9 9,260 Sex Male 15.8 15.2 31.1 7,980 Female 15.3 15.0 30.3 7,620 Residence Urban 36.0 12.2 48.2 4,267 Rural 7.9 16.2 24.1 11,332 Governorate Ibb 10.6 8.4 19.0 1,665 Abyan 40.5 11.8 52.4 315 Sana’a City 39.6 5.5 45.1 1,259 Al-Baidha 20.0 5.1 25.1 651 Taiz 12.0 20.0 32.0 1,907 Al-Jawf 6.1 6.1 12.2 143 Hajjah 3.1 26.9 29.9 1,022 Al-Hodiedah 7.3 26.2 33.6 2,008 Hadramout 47.0 12.0 59.0 733 Dhamar 6.9 11.2 18.2 1,283 Shabwah 17.3 25.4 42.7 298 Sadah 3.0 10.5 13.6 462 Sana’a 7.9 7.8 15.7 898 Aden 65.4 7.3 72.7 391 Lahj 16.0 22.5 38.4 403 Mareb 7.5 41.1 48.6 118 Al-Mhweit 8.1 10.2 18.3 506 Al-Mhrah 28.6 25.3 53.9 61 Amran 3.1 21.5 24.6 667 Aldhalae 19.6 4.5 24.0 390 Reimah 6.2 15.9 22.1 420 Wealth quintile Lowest 1.9 14.9 16.7 3,507 Second 4.5 15.6 20.2 3,302 Middle 9.4 17.4 26.9 3,189 Fourth 24.2 16.3 40.6 2,907 Highest 44.8 10.9 55.7 2,694 Total 15.6 15.1 30.7 15,600 Survey results show that the births of less than one-third of Yemeni children under age 5 have been registered. Of these, roughly half (16 percent of all children) have a birth certificate, while the other half (15 percent) do not have a certificate, but the birth was registered. There is little variation by age or sex in the proportion of children registered. Births of children in urban households are more likely to have been registered than those of children in rural households (48 percent and 24 percent, respectively). By governorate, the proportion of children with registered births is highest in Aden (73 percent) and lowest in Al-Jawf (12 percent) and Sadah (14 percent) governorates. The percentage of children whose births are registered correlates positively with wealth, ranging from 17 percent of children in the lowest wealth quintile to 56 percent of children in the highest wealth quintile. A comparison of the 2013 YNHDS with the 2006 YMICS reveals that the percentage of children under 5 with registered births has increased from 22 percent in 2006 to 31 percent in 2013 (MOHP and UNICEF, 2008). 2.7 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Information was collected on the living arrangements and survival status of parents of all children under age 18 residing in the YNHDS sample households to assess the potential burden on households of the need to provide for orphaned or foster children. These data were also used to assess the situation from the perspective of the children themselves. Table 2.10 presents the proportion of children under age 18 who are not living with one or both parents, either because the parent(s) died or for other reasons. 18 • H ou si ng C ha ra ct er is tic s an d H ou se ho ld P op ul at io n Ta bl e 2. 10 C hi ld re n’ s liv in g ar ra ng em en ts a nd o rp ha nh oo d P er ce nt d is tri bu tio n of d e ju re c hi ld re n un de r ag e 18 b y liv in g ar ra ng em en ts a nd s ur vi va l s ta tu s of p ar en ts , t he p er ce nt ag e of c hi ld re n no t l iv in g w ith a b io lo gi ca l p ar en t, an d th e pe rc en ta ge o f c hi ld re n w ith o ne o r bo th p ar en ts d ea d, a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, Y em en 2 01 3 Li vi ng w ith bo th p ar en ts Li vi ng w ith m ot he r b ut no t w ith fa th er Li vi ng w ith fa th er b ut no t w ith m ot he r N ot li vi ng w ith e ith er p ar en t To ta l P er ce nt ag e no t l iv in g w ith a bi ol og ic al pa re nt P er ce nt ag e w ith o ne o r bo th p ar en ts de ad 1 N um be r o f ch ild re n B ac kg ro un d ch ar ac te ris tic Fa th er al iv e Fa th er de ad M ot he r al iv e M ot he r de ad B ot h al iv e O nl y fa th er al iv e O nl y m ot he r al iv e B ot h de ad M is si ng in fo rm at io n on fa th er /m ot he r A ge 0- 4 93 .5 4. 6 1. 0 0. 4 0. 2 0. 3 0. 0 0. 1 0. 0 0. 1 10 0. 0 0. 4 1. 2 15 ,6 00 <2 93 .9 5. 0 0. 6 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 10 0. 0 0. 1 0. 6 6, 34 0 2- 4 93 .2 4. 3 1. 2 0. 4 0. 2 0. 4 0. 0 0. 1 0. 0 0. 0 10 0. 0 0. 6 1. 6 9, 26 0 5- 9 90 .6 4. 6 2. 2 1. 1 0. 5 0. 6 0. 1 0. 1 0. 0 0. 1 10 0. 0 0. 9 3. 0 16 ,7 08 10 -1 4 87 .3 4. 0 4. 0 1. 5 1. 2 1. 2 0. 1 0. 2 0. 2 0. 3 10 0. 0 1. 7 5. 7 16 ,5 65 15 -1 7 80 .9 3. 8 5. 7 1. 4 1. 8 3. 6 0. 2 0. 5 0. 2 1. 9 10 0. 0 4. 5 8. 4 8, 08 6 Se x M al e 89 .6 4. 1 2. 9 1. 1 0. 8 0. 7 0. 1 0. 2 0. 1 0. 2 10 0. 0 1. 1 4. 1 29 ,0 65 Fe m al e 88 .4 4. 5 2. 8 1. 0 0. 7 1. 5 0. 1 0. 2 0. 1 0. 6 10 0. 0 1. 9 4. 0 27 ,8 93 R es id en ce U rb an 88 .5 4. 4 3. 1 1. 2 0. 8 1. 3 0. 1 0. 1 0. 1 0. 4 10 0. 0 1. 6 4. 2 15 ,9 47 R ur al 89 .3 4. 3 2. 8 1. 0 0. 8 1. 0 0. 1 0. 3 0. 1 0. 4 10 0. 0 1. 5 4. 0 41 ,0 12 G ov er no ra te Ib b 86 .0 7. 0 3. 0 0. 7 0. 8 1. 7 0. 0 0. 2 0. 2 0. 4 10 0. 0 2. 1 4. 2 6, 31 0 A by an 88 .3 3. 6 4. 1 0. 8 1. 0 1. 5 0. 0 0. 1 0. 0 0. 8 10 0. 0 1. 6 5. 2 1, 05 2 S an a’ a C ity 91 .7 3. 2 1. 5 1. 6 0. 6 0. 8 0. 1 0. 0 0. 1 0. 4 10 0. 0 1. 1 2. 4 4, 61 1 A l-B ai dh a 82 .9 9. 8 4. 8 0. 5 0. 4 1. 1 0. 0 0. 3 0. 1 0. 1 10 0. 0 1. 5 5. 6 2, 28 1 Ta iz 86 .4 6. 2 2. 5 1. 4 0. 4 2. 2 0. 2 0. 3 0. 0 0. 5 10 0. 0 2. 7 3. 4 7, 05 9 A l-J aw f 84 .1 5. 9 4. 9 1. 9 1. 0 1. 4 0. 3 0. 2 0. 1 0. 3 10 0. 0 1. 9 6. 5 49 3 H aj ja h 94 .1 0. 8 2. 6 0. 6 1. 3 0. 4 0. 1 0. 1 0. 0 0. 1 10 0. 0 0. 6 4. 0 3, 87 0 A l-H od ie da h 88 .8 4. 7 2. 9 0. 9 1. 2 0. 7 0. 2 0. 0 0. 0 0. 5 10 0. 0 0. 9 4. 4 6, 98 1 H ad ra m ou t 90 .6 3. 8 2. 6 1. 3 0. 4 0. 6 0. 0 0. 1 0. 0 0. 6 10 0. 0 0. 7 3. 2 3, 03 5 D ha m ar 88 .5 3. 7 3. 6 1. 0 0. 6 1. 4 0. 0 0. 5 0. 2 0. 6 10 0. 0 2. 1 4. 8 4, 57 4 S ha bw ah 92 .8 1. 6 3. 6 0. 5 0. 4 0. 4 0. 0 0. 3 0. 1 0. 3 10 0. 0 0. 9 4. 4 1, 17 8 S ad ah 91 .3 1. 3 3. 8 0. 9 0. 6 0. 8 0. 0 0. 6 0. 1 0. 6 10 0. 0 1. 5 5. 1 1, 88 7 S an a’ a 91 .4 1. 4 3. 0 1. 5 1. 1 0. 7 0. 1 0. 4 0. 1 0. 4 10 0. 0 1. 3 4. 7 3, 02 7 A de n 85 .9 6. 5 2. 8 1. 2 1. 9 1. 1 0. 0 0. 0 0. 3 0. 2 10 0. 0 1. 5 5. 1 1, 47 4 La hj 90 .3 5. 1 1. 7 0. 8 0. 4 0. 9 0. 1 0. 1 0. 0 0. 5 10 0. 0 1. 1 2. 3 1, 47 4 M ar eb 88 .0 3. 1 4. 8 1. 0 0. 6 1. 0 0. 1 0. 4 0. 3 0. 7 10 0. 0 1. 7 6. 2 42 9 A l-M hw ei t 90 .7 3. 6 1. 9 1. 0 1. 0 1. 0 0. 1 0. 4 0. 1 0. 2 10 0. 0 1. 6 3. 5 1, 62 7 A l-M hr ah 93 .6 2. 6 1. 8 0. 1 0. 7 0. 4 0. 2 0. 1 0. 0 0. 7 10 0. 0 0. 6 2. 7 21 6 A m ra n 91 .8 1. 5 2. 9 1. 6 1. 0 0. 7 0. 1 0. 1 0. 1 0. 3 10 0. 0 1. 0 4. 2 2, 39 0 A ld ha la e 88 .1 4. 9 2. 7 1. 3 0. 8 1. 4 0. 1 0. 1 0. 2 0. 3 10 0. 0 1. 8 3. 9 1, 52 1 R ei m ah 90 .8 3. 0 2. 2 1. 2 0. 8 1. 2 0. 3 0. 2 0. 2 0. 2 10 0. 0 1. 8 3. 7 1, 47 1 C on tin ue d… 18 • Housing Characteristics and Household Population H ou si ng C ha ra ct er is tic s an d H ou se ho ld P op ul at io n • 1 9 Ta bl e 2. 10 — C on tin ue d Li vi ng w ith bo th p ar en ts Li vi ng w ith m ot he r b ut no t w ith fa th er Li vi ng w ith fa th er b ut no t w ith m ot he r N ot li vi ng w ith e ith er p ar en t To ta l P er ce nt ag e no t l iv in g w ith a bi ol og ic al pa re nt P er ce nt ag e w ith o ne o r bo th p ar en ts de ad 1 N um be r o f ch ild re n B ac kg ro un d ch ar ac te ris tic Fa th er al iv e Fa th er de ad M ot he r al iv e M ot he r de ad B ot h al iv e O nl y fa th er al iv e O nl y m ot he r al iv e B ot h de ad M is si ng in fo rm at io n on fa th er /m ot he r W ea lth q ui nt ile Lo w es t 91 .0 2. 5 3. 1 1. 1 0. 8 0. 6 0. 2 0. 2 0. 1 0. 4 10 0. 0 1. 1 4. 4 12 ,3 88 S ec on d 88 .7 4. 1 3. 3 0. 8 0. 9 1. 1 0. 2 0. 3 0. 2 0. 4 10 0. 0 1. 7 4. 8 11 ,8 46 M id dl e 87 .8 5. 5 2. 4 1. 3 0. 8 1. 4 0. 0 0. 3 0. 0 0. 4 10 0. 0 1. 7 3. 5 11 ,6 49 Fo ur th 88 .9 4. 8 2. 6 0. 8 0. 8 1. 3 0. 1 0. 1 0. 1 0. 3 10 0. 0 1. 6 3. 8 10 ,9 86 H ig he st 88 .7 4. 7 2. 8 1. 4 0. 6 1. 2 0. 1 0. 1 0. 1 0. 5 10 0. 0 1. 4 3. 6 10 ,0 89 To ta l < 15 90 .4 4. 4 2. 4 1. 0 0. 6 0. 7 0. 1 0. 1 0. 1 0. 2 10 0. 0 1. 0 3. 3 48 ,8 72 To ta l < 18 89 .1 4. 3 2. 9 1. 1 0. 8 1. 1 0. 1 0. 2 0. 1 0. 4 10 0. 0 1. 5 4. 1 56 ,9 58 N ot e: T ab le is b as ed o n de ju re m em be rs , i .e ., us ua l r es id en ts . 1 I nc lu de s ch ild re n w ith fa th er d ea d, m ot he r d ea d, b ot h de ad a nd o ne p ar en t d ea d bu t m is si ng in fo rm at io n on s ur vi va l s ta tu s of th e ot he r p ar en t. Housing Characteristics and Household Population • 19 20 • Housing Characteristics and Household Population Almost 90 percent of children under 18 in Yemen are living with both their natural parents (89 percent). Seven percent of children are living with their mothers but not their fathers, and 2 percent are living with their fathers but not their mothers. Only 2 percent of children are not living with either parent. Four percent of children under age 18 are orphaned, that is, one or both parents are dead. The percentage of orphaned children increases rapidly with age, from 1 percent of children under 5 to 8 percent of children age 15-17. Differences in orphanhood by other characteristics are not large. 2.8 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 factors that have a significant impact on health-seeking behavior, reproductive behavior, use of contraception, and the health of children. Under the current Yemeni school system, there are 9 years of Fundamental school (grades 1-9) for children age 6-14, after which students receive a school certificate. In the previous school system, “Fundamental” corresponded to a combination of either Primary (grades 1-6) and Preparatory (grades 1-3) or Unified (grades 1-8). The category of “Fundamental” used in this report corresponds to the current Fundamental, the two previous levels, and “diploma before secondary.” There are three years of secondary education for children age 15-17. In the report, the category of higher education includes university and higher levels, as well as diploma after secondary. 2.8.1 Educational Attainment Tables 2.11.1 and 2.11.2 show the distribution of female and male household members age 6 and above by the highest level of schooling ever attended (even if they did not complete that level) according to age, residence, governorate, and wealth quintile. A comparison of the two tables reveals that there is a substantial gap in educational attainment between women and men. Although a majority of the household population age 6 and older has some education, 43 percent of females have never attended school; this compares with only 21 percent of males. At the other end of the education spectrum, only 12 percent of females age 6 and above have reached secondary school or higher, compared with 23 percent of males. As expected, the proportion of those who have never been to school is higher among older women and men than among those who are younger. For example, the proportion with no education decreases steadily from 96 percent of women age 65 and over to only 14 percent of girls age 10-14. Rural females and males are about twice as likely as their urban counterparts to have no education. Educational attainment also differs markedly among governorates. For example, the largest proportion of the household population age 6 and over that has never been to school is found in Hajjah for both females (61 percent) and males (39 percent). The governorates with the lowest proportions of household members who have never attended school are Aden (23 percent) and Sana’a City (24 percent) for females and Sana’a City (11 percent) and Shabwah (12 percent) for males. For both sexes, the percentage with no education decreases steadily as wealth quintile rises. Comparison of data from the 2013 YNHDS with the 1997 YDMCHS shows some improvement in educational attainment. For example, between 1997 and 2013 the proportion of those age 6 and over with no education declined from 67 percent to 43 percent for females and from 33 percent to 21 percent for males (CSO and MI, 1998). Housing Characteristics and Household Population • 21 Table 2.11.1 Educational attainment of the female household population Percent distribution of the de facto female household population age six and over by highest level of schooling attended, according to background characteristics, Yemen 2013 Background characteristic No education Fundamental1 Secondary Higher Don’t know/ missing Total Number Age 6-9 30.7 68.0 0.0 0.0 1.3 100.0 6,931 10-14 13.9 85.1 0.8 0.0 0.2 100.0 7,893 15-19 18.0 55.7 24.9 1.3 0.1 100.0 6,651 20-24 30.3 39.7 20.2 9.6 0.2 100.0 5,390 25-29 43.4 33.2 13.0 10.2 0.3 100.0 4,801 30-34 52.2 28.8 9.7 9.2 0.1 100.0 3,342 35-39 63.2 26.3 4.2 6.1 0.3 100.0 2,837 40-44 73.6 19.4 3.6 3.2 0.2 100.0 1,853 45-49 79.1 16.1 2.6 2.0 0.1 100.0 1,512 50-54 87.9 8.6 1.6 1.1 0.7 100.0 2,324 55-59 94.5 3.1 1.0 0.9 0.4 100.0 1,273 60-64 95.9 2.0 0.2 0.4 1.6 100.0 982 65+ 96.1 0.7 0.1 0.0 3.0 100.0 2,042 Don’t know/missing * * * * * 100.0 6 Residence Urban 26.2 48.7 15.5 9.1 0.5 100.0 15,099 Rural 50.2 43.0 5.2 1.0 0.6 100.0 32,737 Governorate Ibb 40.0 51.5 7.0 1.2 0.3 100.0 5,328 Abyan 36.6 50.4 7.7 4.9 0.4 100.0 1,010 Sana’a City 24.0 46.1 17.5 12.0 0.4 100.0 4,420 Al-Baidha 35.9 57.3 5.9 0.7 0.2 100.0 1,872 Taiz 37.4 43.7 13.3 5.4 0.1 100.0 6,313 Al-Jawf 42.7 44.7 10.2 1.2 1.3 100.0 357 Hajjah 60.9 32.1 5.2 1.0 0.9 100.0 2,883 Al-Hodiedah 48.7 40.6 6.8 3.3 0.6 100.0 5,970 Hadramout 36.9 52.3 7.8 2.5 0.4 100.0 2,671 Dhamar 54.5 40.4 3.4 1.1 0.6 100.0 3,315 Shabwah 40.5 52.9 4.3 0.5 1.8 100.0 982 Sadah 56.1 39.7 2.2 0.3 1.6 100.0 1,531 Sana’a 50.1 43.4 5.6 0.4 0.5 100.0 2,401 Aden 22.6 47.4 16.3 13.2 0.6 100.0 1,601 Lahj 42.0 43.3 9.1 4.8 0.7 100.0 1,337 Mareb 36.4 50.0 10.2 2.7 0.8 100.0 338 Al-Mhweit 49.5 42.3 6.3 1.3 0.6 100.0 1,215 Al-Mhrah 35.4 52.0 9.2 1.2 2.2 100.0 181 Amran 53.1 40.4 4.9 1.1 0.5 100.0 1,807 Aldhalae 40.3 49.7 7.8 1.5 0.6 100.0 1,251 Reimah 52.4 43.0 3.7 0.2 0.8 100.0 1,055 Wealth quintile Lowest 69.4 28.6 1.6 0.0 0.4 100.0 9,409 Second 51.0 44.1 4.0 0.3 0.6 100.0 9,450 Middle 40.7 50.0 7.5 1.3 0.6 100.0 9,397 Fourth 32.0 52.9 10.7 3.7 0.7 100.0 9,545 Highest 21.5 48.4 17.8 11.9 0.4 100.0 10,035 Total 42.6 44.8 8.4 3.6 0.5 100.0 47,836 1 Fundamental includes Primary, Unified, Preparatory, and Diploma before secondary 22 • Housing Characteristics and Household Population Table 2.11.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended, according to background characteristics, Yemen 2013 Background characteristic No education Fundamental1 Secondary Higher Don’t know/ missing Total Number Age 6-9 24.7 74.3 0.0 0.0 1.0 100.0 6,975 10-14 5.0 93.9 1.0 0.0 0.1 100.0 8,404 15-19 5.1 59.3 33.7 1.7 0.2 100.0 6,070 20-24 6.3 42.2 32.3 19.1 0.2 100.0 4,287 25-29 9.5 42.8 29.4 17.9 0.4 100.0 3,398 30-34 11.2 40.5 26.8 21.2 0.3 100.0 2,729 35-39 14.2 41.4 21.0 22.8 0.5 100.0 2,291 40-44 20.6 36.5 17.9 24.5 0.5 100.0 1,802 45-49 31.8 36.9 13.3 17.0 0.9 100.0 1,394 50-54 51.6 27.3 9.3 11.4 0.4 100.0 1,419 55-59 63.0 20.8 7.1 8.3 0.9 100.0 1,015 60-64 75.9 14.0 4.3 4.8 1.0 100.0 1,204 65+ 89.5 5.9 1.8 1.6 1.2 100.0 2,455 Don’t know/missing * * * * * 100.0 11 Residence Urban 12.5 52.8 19.7 14.6 0.4 100.0 14,425 Rural 24.7 56.7 12.7 5.4 0.5 100.0 29,028 Governorate Ibb 20.1 59.2 15.1 5.3 0.2 100.0 4,534 Abyan 14.4 56.1 22.0 7.3 0.2 100.0 966 Sana’a City 10.5 46.3 22.5 20.5 0.2 100.0 4,221 Al-Baidha 19.5 59.2 16.0 5.2 0.1 100.0 1,668 Taiz 18.3 56.3 15.5 9.5 0.3 100.0 5,033 Al-Jawf 18.1 54.5 18.0 8.6 0.9 100.0 353 Hajjah 39.0 47.6 9.1 4.0 0.3 100.0 2,765 Al-Hodiedah 28.3 56.5 9.7 5.1 0.4 100.0 5,406 Hadramout 13.4 61.6 15.6 8.9 0.5 100.0 2,680 Dhamar 24.4 56.9 12.3 5.8 0.6 100.0 3,030 Shabwah 12.3 60.9 19.9 5.1 1.9 100.0 919 Sadah 28.7 54.0 11.0 5.0 1.3 100.0 1,517 Sana’a 18.9 55.6 15.8 8.8 1.0 100.0 2,297 Aden 12.7 49.8 20.1 16.7 0.6 100.0 1,546 Lahj 18.3 53.7 17.6 9.7 0.6 100.0 1,243 Mareb 14.4 56.3 19.1 9.3 1.0 100.0 301 Al-Mhweit 23.2 56.6 11.7 7.9 0.5 100.0 1,017 Al-Mhrah 20.0 63.3 11.8 3.0 2.0 100.0 175 Amran 21.8 58.0 13.6 6.5 0.1 100.0 1,656 Aldhalae 15.2 53.5 20.6 10.2 0.6 100.0 1,195 Reimah 21.6 63.0 10.3 4.5 0.6 100.0 931 Wealth quintile Lowest 39.0 52.9 5.9 1.7 0.4 100.0 8,280 Second 24.5 58.7 12.1 4.1 0.7 100.0 8,259 Middle 17.7 58.7 16.3 6.8 0.5 100.0 8,558 Fourth 15.1 58.1 17.6 8.7 0.5 100.0 9,107 Highest 9.0 49.0 22.1 19.5 0.4 100.0 9,250 Total 20.7 55.4 15.0 8.4 0.5 100.0 43,453 1 Fundamental includes Primary, Unified, Preparatory, and Diploma before secondary 2.8.2 School Attendance Rates Age-specific attendance rates (ASARs) for the population age 5 to 24—i.e., the percentage of a given age cohort that attends school, regardless of the level attended—are shown in Figure 2.2. Attendance rates peak at 85 percent for girls age 9 and at 93 percent for boys age 11. Whereas the percentage of girls in school is slightly higher than boys at age 5, from then on, the percentage of boys in school greatly exceeds girls at every age. Housing Characteristics and Household Population • 23 Figure 2.2 Age-specific attendance rates of the de facto population 5 to 24 years 2.9 CHILD DISCIPLINE The manner in which parents and caretakers discipline children can have long-term consequences on their physical and psychological development and well-being. In an effort to identify the types of child discipline methods used in Yemen, the 2013 YNHDS included questions on this topic. The questions were aimed at only one randomly selected child age 2-14 in the household. Interviewers were instructed how to use the “Kish” grid in the Household Questionnaire to randomly select one child in households with two or more eligible children. Interviewers then posed questions to the child’s mother/caretaker about whether the respondent or anyone else in the household used any of a list of methods to discipline the child in the previous month. Responses were weighted to properly represent all children 2-14 living in households. Responses were grouped into three categories: (1) only non-violent discipline (e.g., taking away privileges, explaining to the child why his/her behavior is wrong); (2) any physical punishment (hitting the child either with or without a tool); and (3) severe physical punishment (e.g., hitting the child on the face or head, hitting the child very hard with a tool). Data in Table 2.12 show that a large majority of children age 2-14 in Yemen received some sort of physical punishment in the month before the survey (79 percent); 42 percent of children received severe physical punishment in the previous month. Sixteen percent of children received only non-violent discipline such as taking away privileges or explaining why something the child did was wrong. Differences in the use of the various types of child discipline by the sex and age of the child and by education of the head of the household are not large. However, the use of severe physical discipline is more common among rural than urban children and declines steadily as wealth quintile increases. It is also more common in Amran Governorate, where over two-thirds of children 2-14 were severely disciplined in the month before the survey. Despite some differences in the wording of questions, the 2006 YMICS survey found almost identical results to the 2013 YNHDS, with 83 percent of children 2-14 having received any physical punishment in the month before the survey (compared with 79 in 2013) and 41 percent receiving severe physical punishment (compared with 42 percent in 2013) (MOHP and UNICEF, 2008). 0 10 20 30 40 50 60 70 80 90 100 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percentage Age Male Female YNHDS 2013 24 • Housing Characteristics and Household Population Table 2.12 Child discipline Percentage of children age 2-14 by child discipline methods experienced during the last one month, Yemen 2013 Percentage of children age 2-14 years who experienced: Number of children age 2-14 years4 Background characteristic Only non-violent discipline1 Physical punishment Any2 Severe3 Child’s sex Male 14.2 81.2 44.6 6,923 Female 18.2 77.1 39.6 6,689 Age 2 18.1 73.5 35.1 1,036 3-4 14.0 81.8 40.8 1,956 5-9 12.1 84.4 46.2 5,193 10-14 20.5 74.2 40.0 5,427 Residence Urban 19.7 76.4 33.9 3,805 Rural 14.8 80.2 45.3 9,807 Governorate Ibb 17.3 78.1 41.8 1,520 Abyan 32.1 63.5 33.8 241 Sana’a City 18.1 78.4 39.7 1,102 Al-Baidha 16.3 81.5 44.4 547 Taiz 13.8 82.5 47.3 1,668 Al-Jawf 15.5 80.8 36.4 120 Hajjah 11.5 84.1 58.7 965 Al-Hodiedah 17.1 76.5 25.5 1,675 Hadramout 28.7 62.5 12.8 722 Dhamar 9.1 85.3 51.9 1,068 Shabwah 9.5 77.8 34.4 274 Sadah 14.1 80.3 50.9 456 Sana’a 12.8 84.9 58.4 710 Aden 14.5 82.7 36.7 351 Lahj 23.0 71.8 28.7 346 Mareb 15.1 77.6 51.3 104 Al-Mhweit 14.2 83.3 55.7 388 Al-Mhrah 26.7 66.3 21.1 50 Amran 12.5 84.8 67.1 588 Aldhalae 29.1 68.8 13.5 360 Reimah 13.7 81.8 48.0 356 Education of the head of household No education 16.0 78.9 45.9 5,404 Fundamental 15.1 80.1 42.7 4,486 Secondary 16.6 80.0 39.6 1,902 Higher 19.0 77.0 31.8 1,738 Missing 19.2 75.5 41.2 82 Wealth quintile Lowest 13.2 81.6 49.8 3,042 Second 12.0 84.2 48.4 2,829 Middle 15.8 79.2 43.8 2,742 Fourth 19.5 75.9 35.9 2,613 Highest 21.8 73.6 29.7 2,386 Total 16.2 79.2 42.1 13,612 Note: Random selection of one child age 2-14 years per household is carried out during fieldwork. Household sample weight is multiplied by the total number of children age 2-14 in each household to take the random selection into account. Child disciplining methods in this table should be considered as lower bounds of the actual discipline methods used by the household members, since children who may have been separated from the household members (e.g. at boarding school) during the past month are considered not to have been subjected to any disciplining method. 1 Only non-violent discipline: “taking away privileges” or “explaining to the child that his/her behavior is wrong” and no other form of discipline. 2 Any physical punishment: “hitting the child on the shoulder or spanking on the rear” or “hitting on the rear or at any other place of the child’s body using something such as a belt, hair brush, a stick or something solid” or “hitting the child in the face or head or ear” or “hitting the child’s hand, arm, or leg” or “punishing the child by using a tool and then continued to hit the child very hard.” 3 Severe physical punishments: “hitting the child in the face or head or ear” or “punishing the child by using a tool and then continued to hit the child very hard.” 4 Columns 1-3 are based on children age 2-14 years selected for the child discipline module, weighted by the total number of children age 2-14 years in each household where at least one child in this age range is currently living. Housing Characteristics and Household Population • 25 Table 2.13 shows that almost four in ten mothers/caretakers of children believe that children must be physically punished in order to be raised in an appropriate way. Belief in physical punishment is more prevalent among respondents in rural areas and in Dhamar Governorate. It declines with increasing education of the household head and increasing wealth. Table 2.13 Attitudes toward physical punishment Percentage of respondents to the child discipline module who believe that physical punishment is needed to bring up, raise, or educate a child properly, by background characteristics, Yemen 2013 Background characteristic Respondent believes that a child needs to be physically punished Number of respondents to the child discipline module Sex of the respondent Male 31.1 286 Female 39.3 13,311 Missing 18.4 15 Age < 25 42.0 1,217 25-39 39.2 8,325 40-59 38.3 3,823 60+ 38.5 232 Don’t know, missing, inconsistent 18.4 15 Residence Urban 26.9 3,805 Rural 43.9 9,807 Governorate Ibb 45.5 1,520 Abyan 31.7 241 Sana’a City 30.3 1,102 Al-Baidha 23.3 547 Taiz 45.7 1,668 Al-Jawf 30.9 120 Hajjah 42.1 965 Al-Hodiedah 33.8 1,675 Hadramout 16.6 722 Dhamar 66.7 1,068 Shabwah 33.5 274 Sadah 41.3 456 Sana’a 42.4 710 Aden 18.2 351 Lahj 29.7 346 Mareb 38.5 104 Al-Mhweit 48.4 388 Al-Mhrah 12.8 50 Amran 39.8 588 Aldhalae 24.4 360 Reimah 53.7 356 Education of the head of household No education 42.6 5,404 Fundamental 40.7 4,486 Secondary 35.1 1,902 Higher 29.3 1,738 Missing 32.1 82 Wealth quintile Lowest 51.6 3,042 Second 48.5 2,829 Middle 38.8 2,742 Fourth 28.8 2,613 Highest 23.9 2,386 Total1 39.2 13,612 Note: The question is asked to a single respondent in all households where a child age 2-14 was randomly selected for the child discipline module. The respondent is not necessarily a parent or caretaker of such a child and may not necessarily have responded to the child discipline module about his/her own child. 1 Total includes 15 cases with inconsistent/missing information on sex and age of the respondent in the child discipline module. Characteristics of Respondents • 27 CHARACTERISTICS OF RESPONDENTS 3 his chapter presents information on demographic and socioeconomic characteristics of the survey respondents such as age, education, place of residence, marital status, employment, and wealth status. This information is useful for understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviors, as they provide a context for the interpretation of demographic and health indices. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Information on background characteristics of the 25,434 women age 15-49 interviewed in the 2013 YNHDS is presented in Table 3.1. The distribution is presented separately for ever-married women and never-married women, as well as for both combined. For all women, the proportion in each age group declines with increasing age, as expected. Of course, among never-married women, the proportion declines with age, as women marry. Among ever- married women, the proportion in each age group rises with age until age 25-29, after which it declines. Just over one-third of all women have never married, while 61 percent are currently married, and 4 percent are either divorced or widowed. About one-third of all women live in urban areas and two-thirds live in rural areas. By contrast, according to the 1997 YDMCHS, only one-quarter of female respondents resided in urban areas; however, by 2006, 31 percent of ever-married women were living in urban areas (CSO and MI, 1998; MOHP and UNICEF, 2008), almost identical to the 32 percent found in the 2013 YNHDS. The largest proportions of women live in Taiz Governorate, followed by Al-Hodiedah and Ibb Governorates. The smallest proportions live in Al-Mhrah, Mareb, and Al-Jawf Governorates. Education influences an individual’s attitude and outlook on life. Generally, educational attainment in Yemen is low; only 21 percent of all women age 15-49 have attended at least some secondary school. Thirty-seven percent of women have attended only Fundamental school, and 42 percent have no education. Because never-married women are generally younger than all women, a higher proportion of never-married women have been to school and have reached secondary school. T Key Findings • A total of 25,434 women age 15-49 were interviewed as part of the 2013 YNHDS—16,656 ever-married women and 8,778 never-married women. • Forty-two percent of all women age 15-49 have no education, and only 21 percent have attended secondary school. • Female literacy rates are low; just over half of all women are literate. • Twenty percent of all women read a newspaper at least once a week, while 73 percent watch television and 28 percent listen to the radio at least once a week. • Only 10 percent of ever-married women age 15-49 are currently employed. • Among ever-married women who were employed in the past 12 months, half worked in agriculture. 28 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of ever-married women, never-married women, and all women age 15-49 by selected background characteristics, Yemen 2013 Ever-married women Never-married women All women Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 6.7 1,112 1,112 59.0 5,231 5,303 24.9 6,342 6,415 20-24 18.7 3,099 3,096 23.6 2,098 2,049 20.4 5,197 5,145 25-29 22.5 3,731 3,724 10.2 903 842 18.2 4,634 4,566 30-34 17.0 2,824 2,816 4.5 401 345 12.7 3,225 3,161 35-39 15.8 2,612 2,611 1.7 149 149 10.9 2,761 2,760 40-44 10.5 1,744 1,755 0.7 63 66 7.1 1,807 1,821 45-49 8.7 1,442 1,542 0.3 26 24 5.8 1,468 1,566 Marital status Never married 0.0 0 0 100.0 8,870 8,778 34.9 8,870 8,778 Married 94.0 15,566 15,649 0.0 0 0 61.2 15,566 15,649 Divorced 3.5 577 584 0.0 0 0 2.3 577 584 Widowed 2.5 421 423 0.0 0 0 1.7 421 423 Residence Urban 32.1 5,322 4,548 37.2 3,297 2,720 33.9 8,619 7,268 Rural 67.9 11,242 12,108 62.8 5,573 6,058 66.1 16,815 18,166 Governorate Ibb 10.8 1,791 977 10.7 948 517 10.8 2,739 1,494 Abyan 2.1 345 741 2.3 206 428 2.2 551 1,169 Sana’a City 9.6 1,587 989 10.2 901 589 9.8 2,487 1,578 Al-Baidha 4.6 768 1,099 3.8 333 486 4.3 1,101 1,585 Taiz 13.3 2,196 983 14.8 1,316 578 13.8 3,512 1,561 Al-Jawf 0.9 141 492 0.5 40 162 0.7 181 654 Hajjah 5.4 895 814 5.4 479 422 5.4 1,374 1,236 Al-Hodiedah 12.2 2,023 845 14.0 1,238 521 12.8 3,261 1,366 Hadramout 5.8 958 863 5.3 468 420 5.6 1,427 1,283 Dhamar 7.2 1,188 887 5.4 482 360 6.6 1,670 1,247 Shabwah 1.9 315 816 2.4 213 549 2.1 528 1,365 Sadah 3.2 532 764 3.3 291 426 3.2 823 1,190 Sana’a 5.2 867 943 4.5 398 426 5.0 1,265 1,369 Aden 3.2 534 655 4.4 387 490 3.6 921 1,145 Lahj 2.6 425 587 2.9 253 361 2.7 678 948 Mareb 0.7 123 672 0.7 59 334 0.7 183 1,006 Al-Mhweit 2.7 445 770 2.0 178 309 2.5 623 1,079 Al-Mhrah 0.4 62 372 0.4 33 198 0.4 95 570 Amran 3.7 614 838 2.7 238 326 3.4 852 1,164 Aldhalae 2.4 404 824 2.7 237 504 2.5 641 1,328 Reimah 2.1 350 725 1.9 170 372 2.0 520 1,097 Education No education 53.7 8,887 9,109 20.5 1,817 1,819 42.1 10,705 10,928 Fundamental1 32.7 5,416 5,470 44.2 3,923 4,145 36.7 9,339 9,615 Secondary 9.4 1,564 1,497 24.8 2,204 2,065 14.8 3,767 3,562 Higher 4.2 697 580 10.4 926 749 6.4 1,623 1,329 Wealth quintile Lowest 18.2 3,010 2,969 16.1 1,424 1,297 17.4 4,435 4,266 Second 19.6 3,248 3,368 17.6 1,561 1,582 18.9 4,808 4,950 Middle 20.1 3,330 3,625 19.3 1,716 1,951 19.8 5,046 5,576 Fourth 20.5 3,394 3,654 21.7 1,927 2,062 20.9 5,320 5,716 Highest 21.6 3,582 3,040 25.3 2,243 1,886 22.9 5,825 4,926 Total 15-49 100.0 16,564 16,656 100.0 8,870 8,778 100.0 25,434 25,434 1 Fundamental includes Primary, Unified, Preparatory, and Diploma before secondary Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents • 29 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Table 3.2 presents an overview of female respondents’ educational attainment, according to background demographic characteristics. As mentioned, a low level of education exists in Yemen among women, with 42 percent never having attended school at all. Table 3.2 Educational attainment Percent distribution of all women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Yemen 2013 Highest level of schooling Total Number of women Background characteristic No education Funda- mental1 Secondary More than secondary Age 15-24 23.4 48.2 23.0 5.5 100.0 11,539 15-19 17.3 55.2 25.8 1.7 100.0 6,342 20-24 30.8 39.6 19.5 10.1 100.0 5,197 25-29 43.8 33.6 12.8 9.8 100.0 4,634 30-34 52.4 28.9 9.7 9.0 100.0 3,225 35-39 64.2 26.1 4.0 5.7 100.0 2,761 40-44 74.4 18.7 3.6 3.3 100.0 1,807 45-49 79.8 15.6 2.5 2.0 100.0 1,468 Residence Urban 20.5 39.5 24.8 15.2 100.0 8,619 Rural 53.2 35.3 9.7 1.9 100.0 16,815 Governorate Ibb 41.1 43.4 12.8 2.7 100.0 2,739 Abyan 28.8 49.0 13.5 8.6 100.0 551 Sana’a City 18.6 33.2 28.4 19.8 100.0 2,487 Al-Baidha 34.0 55.5 9.4 1.2 100.0 1,101 Taiz 34.0 33.9 22.6 9.5 100.0 3,512 Al-Jawf 44.0 33.8 19.7 2.4 100.0 181 Hajjah 67.1 20.8 10.4 1.7 100.0 1,374 Al-Hodiedah 50.1 32.3 11.5 6.1 100.0 3,261 Hadramout 30.8 51.3 13.1 4.8 100.0 1,427 Dhamar 60.1 32.3 5.8 1.9 100.0 1,670 Shabwah 37.1 54.3 7.4 1.1 100.0 528 Sadah 64.5 31.0 4.0 0.5 100.0 823 Sana’a 50.2 39.2 10.0 0.6 100.0 1,265 Aden 14.6 39.4 25.5 20.6 100.0 921 Lahj 38.5 33.1 18.9 9.4 100.0 678 Mareb 37.1 38.9 19.3 4.7 100.0 183 Al-Mhweit 53.7 31.9 11.8 2.6 100.0 623 Al-Mhrah 33.8 48.5 15.7 2.0 100.0 95 Amran 58.5 29.5 10.0 2.1 100.0 852 Aldhalae 44.9 37.6 14.8 2.7 100.0 641 Reimah 64.4 28.4 6.9 0.3 100.0 520 Wealth quintile Lowest 76.6 20.0 3.2 0.1 100.0 4,435 Second 57.6 34.2 7.5 0.6 100.0 4,808 Middle 42.6 41.8 13.4 2.3 100.0 5,046 Fourth 28.3 47.2 18.0 6.5 100.0 5,320 Highest 15.2 37.5 27.9 19.3 100.0 5,825 Total 42.1 36.7 14.8 6.4 100.0 25,434 1 Fundamental includes Primary, Unified, Preparatory, and Diploma before secondary. Results imply a huge improvement in education coverage over time, since younger women are far more likely than older women to have attended school. For example, the proportion of women with no education drops from 80 percent of those age 45-49 to only 17 percent among women age 15-19. Rural respondents generally have attained less education than their urban counterparts; 53 percent of all rural women have no education compared with 21 percent of urban women. Of the 20 governorates and Sana’a City, attainment of more than secondary education is concentrated in only two areas: Aden Governorate (21 percent) and Sana’a City (20 percent). In Hajjah, Sadah, and Reimah Governorates, about two-thirds of all women age 15-49 have never been to school. Wealth status is associated with educational attainment. The proportion of women with no education is five times higher among those in the lowest wealth quintile (77 percent) than among those in the highest 30 • Characteristics of Respondents wealth quintile (15 percent), and the proportion of women who have attended more than secondary school varies from less than 1 percent in the lowest two wealth quintiles to 19 percent in the highest quintile. 3.3 LITERACY The ability to read and write is an important personal asset, allowing individuals increased opportunities in life. Knowing the distribution of the literate population can help program managers, especially for health programs, know how to reach women and men with their messages. In the 2013 YNHDS, the literacy status of respondents who had not attended school or had attended only primary school was determined by their ability to read all or part of a sentence. Those with grades 6-9, diploma before secondary, or secondary education or higher were assumed to be literate. Table 3.3 shows the percent distribution of all women age 15-49 by level of schooling attended and level of literacy, along with the percentage of respondents who are literate, according to background characteristics. Female literacy rates in Yemen are low; overall, just over half of women (53 percent) are literate. Literacy correlates inversely with age; 73 percent of women age 15-19 are literate compared with only 20 percent of women age 45-49. Table 3.3 Literacy Percent distribution of all women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Yemen 2013 Secondary school or higher Grades 6-9, diploma before secondary No schooling, primary school (less than grade 6) Total Percentage literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Missing Age 15-24 28.4 17.3 9.7 13.0 29.0 0.0 2.6 100.0 68.4 11,539 15-19 27.5 21.8 10.4 13.7 23.9 0.0 2.7 100.0 73.4 6,342 20-24 29.6 11.8 8.9 12.2 35.2 0.0 2.4 100.0 62.4 5,197 25-29 22.5 7.6 8.2 12.9 46.6 0.0 2.2 100.0 51.2 4,634 30-34 18.8 6.2 7.7 12.2 53.6 0.0 1.6 100.0 44.8 3,225 35-39 9.7 6.0 7.2 12.0 64.0 0.1 1.0 100.0 34.9 2,761 40-44 6.9 4.6 5.7 9.8 72.6 0.1 0.3 100.0 27.0 1,807 45-49 4.5 3.9 4.2 7.6 78.6 0.2 0.9 100.0 20.3 1,468 Residence Urban 40.0 15.6 8.7 11.8 21.4 0.0 2.5 100.0 76.1 8,619 Rural 11.6 9.0 8.0 12.5 57.2 0.0 1.7 100.0 41.1 16,815 Governorate Ibb 15.5 10.9 12.9 14.5 45.5 0.0 0.6 100.0 53.9 2,739 Abyan 22.1 15.4 8.9 16.4 35.0 0.1 2.2 100.0 62.7 551 Sana’a City 48.2 11.1 6.6 14.7 17.0 0.0 2.4 100.0 80.6 2,487 Al-Baidha 10.5 13.1 20.0 15.2 37.8 0.0 3.4 100.0 58.8 1,101 Taiz 32.1 12.4 8.0 6.6 40.3 0.1 0.5 100.0 59.1 3,512 Al-Jawf 22.1 11.8 3.6 13.6 44.2 0.0 4.7 100.0 51.1 181 Hajjah 12.1 6.7 4.0 6.2 68.6 0.0 2.5 100.0 28.9 1,374 Al-Hodiedah 17.7 8.4 3.6 12.2 57.4 0.0 0.8 100.0 41.8 3,261 Hadramout 17.9 25.2 6.4 16.0 30.4 0.0 4.2 100.0 65.4 1,427 Dhamar 7.6 5.3 7.9 14.1 62.9 0.0 2.1 100.0 35.0 1,670 Shabwah 8.6 12.5 18.8 22.9 34.8 0.1 2.3 100.0 62.8 528 Sadah 4.5 5.8 9.6 13.6 62.8 0.0 3.7 100.0 33.5 823 Sana’a 10.6 12.0 13.4 12.4 50.3 0.3 1.0 100.0 48.4 1,265 Aden 46.1 17.9 7.8 8.2 17.9 0.1 2.0 100.0 80.0 921 Lahj 28.3 11.1 6.2 9.0 42.3 0.1 3.1 100.0 54.5 678 Mareb 24.0 10.7 12.6 12.2 37.8 0.0 2.6 100.0 59.6 183 Al-Mhweit 14.4 7.5 5.0 12.2 54.0 0.0 6.9 100.0 39.2 623 Al-Mhrah 17.7 19.6 2.7 14.1 36.3 0.0 9.5 100.0 54.2 95 Amran 12.0 8.6 5.4 13.0 58.5 0.0 2.5 100.0 39.0 852 Aldhalae 17.6 12.4 8.2 13.3 46.6 0.2 1.8 100.0 51.5 641 Reimah 7.2 7.7 3.8 10.7 69.8 0.0 0.8 100.0 29.4 520 Wealth quintile Lowest 3.3 3.8 2.8 6.6 82.6 0.1 0.7 100.0 16.6 4,435 Second 8.2 7.3 5.9 12.8 64.1 0.0 1.8 100.0 34.2 4,808 Middle 15.6 11.6 10.1 15.7 45.1 0.0 1.9 100.0 53.0 5,046 Fourth 24.5 16.3 12.2 14.4 30.0 0.0 2.5 100.0 67.4 5,320 Highest 47.3 15.2 9.3 11.1 14.5 0.0 2.6 100.0 82.9 5,825 Total 21.2 11.2 8.3 12.2 45.1 0.0 1.9 100.0 52.9 25,434 1 Refers to women who attended grades 6-9, diploma before secondary, secondary school or higher and women who can read a whole sentence or part of a sentence Characteristics of Respondents • 31 Women in urban areas have much higher literacy rates (76 percent) than their rural counterparts (41 percent). Sana’a City and Aden Governorate have the highest literacy rates (81 percent and 80 percent, respectively), while Hajjah Governorate has the lowest (29 percent). Literacy closely correlates with increasing wealth quintile, rising from 17 percent in the lowest quintile to 83 percent in the highest quintile. 3.4 EXPOSURE TO MASS MEDIA The 2013 YNHDS collected information on respondents’ exposure to common print and electronic media. Respondents were asked how often they read a newspaper, watch television, or listen to the radio. This information indicates the extent to which women are regularly exposed to mass media, often used to convey messages on family planning, health education, sanitation, and other health topics. Table 3.4 shows the percentages of women who were exposed to different types of mass media by age, residence, governorate, level of education, and wealth quintile. Twenty percent of women read a newspaper at least once a week, 73 percent watch television at least once a week, and 28 percent listen to the radio at least once a week. Overall, only 7 percent of women are exposed to all three media at least once per week; 19 percent are not exposed to any of the three media on a regular basis. Table 3.4 Exposure to mass media Percentage of all women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Yemen 2013 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 28.4 76.3 31.1 10.0 15.0 6,342 20-24 24.6 74.3 28.5 9.0 17.2 5,197 25-29 19.2 71.1 27.0 7.4 21.8 4,634 30-34 16.3 72.8 25.4 5.6 20.3 3,225 35-39 11.8 69.3 24.8 3.8 22.5 2,761 40-44 10.0 72.1 25.8 3.7 21.8 1,807 45-49 6.1 70.6 22.8 2.1 22.7 1,468 Residence Urban 32.7 94.4 26.5 11.9 3.5 8,619 Rural 13.5 62.2 28.1 4.8 27.1 16,815 Governorate Ibb 26.9 80.1 19.5 5.4 14.1 2,739 Abyan 33.4 77.1 24.5 11.4 17.3 551 Sana’a City 45.0 96.8 39.6 23.1 1.7 2,487 Al-Baidha 16.0 75.3 23.0 7.1 21.1 1,101 Taiz 14.5 72.4 19.0 3.6 21.4 3,512 Al-Jawf 20.0 47.2 21.9 3.9 36.9 181 Hajjah 9.8 43.4 40.5 5.9 41.1 1,374 Al-Hodiedah 8.4 64.7 29.2 2.9 23.0 3,261 Hadramout 17.5 80.8 30.2 9.1 14.5 1,427 Dhamar 14.5 59.9 41.9 6.2 24.1 1,670 Shabwah 31.5 89.9 13.6 3.6 7.5 528 Sadah 7.8 73.0 15.1 3.1 24.4 823 Sana’a 23.0 73.9 46.9 14.2 15.6 1,265 Aden 33.6 97.4 8.5 3.6 1.8 921 Lahj 28.0 63.1 24.2 8.0 26.1 678 Mareb 31.8 74.3 26.5 8.0 14.1 183 Al-Mhweit 10.5 68.8 30.1 4.7 23.3 623 Al-Mhrah 14.6 73.0 8.5 1.7 24.3 95 Amran 14.8 64.6 23.5 3.7 25.4 852 Aldhalae 16.0 77.0 15.4 3.9 18.9 641 Reimah 6.8 45.2 34.2 1.5 38.0 520 Education No education 1.3 55.5 23.9 0.3 34.0 10,705 Fundamental 25.4 81.9 29.8 8.8 11.1 9,339 Secondary 44.2 91.8 30.9 16.3 3.9 3,767 Higher 56.0 95.3 30.6 21.8 2.2 1,623 Wealth quintile Lowest 3.7 17.5 28.1 0.8 60.5 4,435 Second 10.3 60.4 29.3 3.3 27.1 4,808 Middle 17.1 86.1 26.5 6.1 9.8 5,046 Fourth 26.3 93.2 27.7 9.8 4.4 5,320 Highest 37.2 96.3 26.5 13.8 2.4 5,825 Total 20.0 73.1 27.6 7.2 19.1 25,434 32 • Characteristics of Respondents Younger women are more likely to access all three media than older women, though the differences by age are largest for reading newspapers. Urban women are more likely to read newspapers and watch television than rural women; however, the proportions of urban and rural women who listen to the radio at least once a week are almost identical. Women in Sana’a City are more likely to read newspapers than women who live elsewhere, while women in Aden and Sana’a City are most likely to watch television, and women in Sana’a Governorate are most likely to listen to the radio. Women in Reimah Governorate are the least likely to access all three media and the most likely to report having no exposure to any of the three media. Not surprisingly, media exposure is related to education. For example, 34 percent of women with no education report that they are not exposed to any media on at least a weekly basis, compared with 2 percent of women with higher than secondary education. Media exposure also relates to wealth status. For example, 37 percent of women in the highest wealth quintile read a newspaper at least once a week, compared with 4 percent of women in the lowest wealth quintile. Ninety-six percent of women in the highest wealth quintile watch television at least once a week, in contrast with 18 percent of those in the lowest wealth quintile. 3.5 EMPLOYMENT STATUS The 2013 YNHDS asked ever-married women several questions about their current employment status and continuity of employment in the 12 months prior to the survey. Table 3.5 presents the proportion of ever-married women who were currently employed (i.e., who were working in the seven days preceding the survey), the proportion who were not currently employed but had been employed at some time during the 12 months before the survey, and the proportion who had not been employed at any time during the 12-month period. Overall, only 10 percent of ever-married women reported that they were currently employed. An additional 1 percent were not currently employed but had worked in the 12 months preceding the survey. The proportion of women in the 15-19 and 20-24 age groups who are currently employed is lower than in older age groups, a finding that may be partially due to the fact that some in this age cohort are students. Women who are divorced or widowed are more likely to be currently employed (20 percent) than women who are currently married (9 percent). Differences in current employment levels by number of living children and urban-rural residence are small. By governorate, there are substantial differentials in women’s employment status. Ever-married women in Sana’a Governorate are most likely to be currently employed (32 percent), while those in Ibb Governorate are the least likely (3 percent). Ever-married women with higher education are far more likely to be currently employed (43 percent) than women who have less education (7-9 percent). Interestingly, women’s employment status does not vary very much by wealth quintile. Characteristics of Respondents • 33 Table 3.5 Employment status Percent distribution of ever-married women age 15-49 by employment status, according to background characteristics, Yemen 2013 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/don’t know Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 4.2 1.0 94.8 0.0 100.0 1,112 20-24 5.5 0.7 93.6 0.1 100.0 3,099 25-29 8.9 1.3 89.7 0.1 100.0 3,731 30-34 11.0 1.9 86.9 0.1 100.0 2,824 35-39 12.0 1.0 86.9 0.1 100.0 2,612 40-44 12.6 1.9 85.4 0.2 100.0 1,744 45-49 13.8 1.1 85.0 0.0 100.0 1,442 Marital status Married 8.9 1.2 89.7 0.1 100.0 15,566 Divorced/widowed 20.2 2.3 77.4 0.1 100.0 998 Number of living children 0 7.3 1.7 90.9 0.0 100.0 2,075 1-2 9.4 1.0 89.6 0.1 100.0 4,890 3-4 10.9 1.1 87.9 0.1 100.0 4,145 5+ 9.8 1.5 88.6 0.1 100.0 5,454 Residence Urban 9.9 0.8 89.2 0.1 100.0 5,322 Rural 9.5 1.5 88.9 0.1 100.0 11,242 Governorate Ibb 2.5 0.2 97.0 0.3 100.0 1,791 Abyan 17.5 2.2 80.3 0.0 100.0 345 Sana’a City 8.7 0.7 90.6 0.0 100.0 1,587 Al-Baidha 14.7 1.2 83.9 0.1 100.0 768 Taiz 9.9 4.4 85.6 0.1 100.0 2,196 Al-Jawf 13.6 0.5 85.9 0.0 100.0 141 Hajjah 5.7 0.3 93.9 0.0 100.0 895 Al-Hodiedah 6.5 0.8 92.6 0.1 100.0 2,023 Hadramout 6.5 0.2 93.2 0.1 100.0 958 Dhamar 8.0 0.1 91.8 0.1 100.0 1,188 Shabwah 6.1 0.6 93.1 0.1 100.0 315 Sadah 6.1 0.0 93.9 0.0 100.0 532 Sana’a 31.8 2.9 65.3 0.0 100.0 867 Aden 16.2 1.3 82.5 0.0 100.0 534 Lahj 16.0 1.3 82.5 0.2 100.0 425 Mareb 10.8 1.5 87.7 0.0 100.0 123 Al-Mhweit 3.7 0.7 95.6 0.0 100.0 445 Al-Mhrah 7.6 1.2 91.2 0.0 100.0 62 Amran 15.1 2.2 82.5 0.2 100.0 614 Aldhalae 6.5 0.4 92.9 0.2 100.0 404 Reimah 6.9 0.3 92.8 0.0 100.0 350 Education No education 8.4 1.2 90.3 0.1 100.0 8,887 Fundamental 7.4 1.3 91.2 0.2 100.0 5,416 Secondary 9.4 1.9 88.7 0.0 100.0 1,564 Higher 42.7 1.2 56.1 0.0 100.0 697 Wealth quintile Lowest 9.2 1.0 89.9 0.0 100.0 3,010 Second 9.1 1.6 89.1 0.3 100.0 3,248 Middle 8.6 1.8 89.5 0.1 100.0 3,330 Fourth 9.7 1.3 88.9 0.1 100.0 3,394 Highest 11.4 0.8 87.8 0.0 100.0 3,582 Total 9.6 1.3 89.0 0.1 100.0 16,564 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 34 • Characteristics of Respondents 3.6 OCCUPATION Ever-married women who were currently employed or who had worked in the 12 months preceding the survey were asked to specify their occupation. Information on the current occupation of employed women is shown in Table 3.6. Women are most likely to be employed in agriculture (50 percent), followed by professional, technical, and managerial positions (21 percent), and skilled manual jobs (13 percent). Table 3.6 Occupation Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Yemen 2013 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 8.9 0.0 0.0 17.5 1.6 70.6 1.5 100.0 58 20-24 10.8 1.0 2.5 16.0 6.3 62.7 0.8 100.0 194 25-29 19.4 1.5 7.1 14.2 6.1 50.9 0.8 100.0 381 30-34 28.4 4.3 7.4 12.6 4.4 42.3 0.6 100.0 367 35-39 29.5 1.3 10.3 13.7 4.4 40.4 0.5 100.0 340 40-44 17.0 4.0 10.5 6.0 3.6 58.6 0.2 100.0 251 45-49 15.1 5.8 9.2 11.5 8.7 49.7 0.0 100.0 216 Marital status Married 21.3 2.5 7.0 12.1 5.3 51.2 0.6 100.0 1,582 Divorced/widowed 19.1 4.6 13.1 16.3 5.2 41.3 0.4 100.0 225 Number of living children 0 28.9 7.1 5.6 11.2 2.1 44.7 0.3 100.0 188 1-2 28.1 5.1 5.2 12.9 6.5 41.8 0.3 100.0 508 3-4 25.5 0.8 11.3 12.0 4.3 45.7 0.4 100.0 496 5+ 9.1 1.2 7.6 13.3 6.0 61.9 0.9 100.0 614 Residence Urban 48.6 8.4 13.7 17.8 7.8 2.9 0.8 100.0 572 Rural 8.2 0.2 5.0 10.2 4.1 71.8 0.4 100.0 1,234 Governorate Ibb (17.1) (0.0) (16.8) (14.7) (10.7) (36.3) (4.4) 100.0 49 Abyan 13.8 3.4 9.6 9.3 3.3 60.0 0.7 100.0 68 Sana’a City 55.5 5.1 9.4 23.4 5.2 1.4 0.0 100.0 150 Al-Baidha 9.4 0.0 6.5 9.7 0.5 73.9 0.0 100.0 122 Taiz 32.7 2.5 8.9 5.5 4.9 45.5 0.0 100.0 313 Al-Jawf 10.2 1.0 4.8 13.4 0.0 70.5 0.0 100.0 20 Hajjah 9.1 0.0 3.1 0.0 0.0 87.8 0.0 100.0 54 Al-Hodiedah 29.0 5.0 16.3 10.2 7.8 31.7 0.0 100.0 148 Hadramout 53.0 3.4 6.2 7.3 4.4 24.6 1.3 100.0 64 Dhamar 1.4 1.5 7.7 33.5 1.5 54.5 0.0 100.0 97 Shabwah 18.4 2.3 11.7 54.6 3.7 6.5 2.8 100.0 21 Sadah (8.9) (0.0) (3.4) (40.9) (3.9) (43.0) (0.0) 100.0 33 Sana’a 0.6 0.0 0.6 10.6 4.7 83.2 0.3 100.0 301 Aden 36.3 18.7 15.7 11.1 16.8 0.0 1.5 100.0 93 Lahj 16.8 1.7 8.7 4.1 7.1 61.6 0.0 100.0 74 Mareb 28.5 0.0 8.5 49.4 2.8 10.8 0.0 100.0 15 Al-Mhweit (17.9) (2.7) (14.9) (16.1) (3.2) (45.2) (0.0) 100.0 19 Al-Mhrah (20.2) (8.7) (3.1) (6.7) (19.0) (42.3) (0.0) 100.0 6 Amran 9.0 0.7 1.5 9.3 6.6 71.1 1.8 100.0 107 Aldhalae 17.6 0.0 12.0 12.4 2.8 49.0 6.2 100.0 28 Reimah 5.6 0.9 6.0 4.5 6.1 76.8 0.0 100.0 25 Education No education 1.0 0.2 6.2 10.6 7.0 74.3 0.8 100.0 853 Fundamental 10.8 1.9 10.2 20.5 7.1 49.1 0.4 100.0 470 Secondary 36.5 6.2 15.2 18.9 1.1 21.4 0.7 100.0 177 Higher 83.5 9.4 4.0 2.6 0.2 0.2 0.0 100.0 306 Wealth quintile Lowest 0.5 0.7 5.0 7.2 5.9 80.8 0.0 100.0 305 Second 3.6 0.4 4.5 9.2 4.5 76.9 0.8 100.0 346 Middle 6.8 0.1 6.3 11.1 4.8 69.8 1.1 100.0 346 Fourth 23.0 2.6 9.4 20.0 8.5 35.8 0.7 100.0 372 Highest 58.6 8.4 12.0 13.9 3.1 3.8 0.2 100.0 438 Total 21.0 2.8 7.8 12.6 5.3 50.0 0.5 100.0 1,806 Characteristics of Respondents • 35 Almost half of the ever-married urban women who are employed have professional, technical, or managerial jobs, while 72 percent of working women in rural areas are employed in the agricultural sector. There are similar patterns by education and wealth of the woman. For example, among ever-married women who are employed, the proportion in professional, technical, and managerial jobs varies from 1 percent of those with no education to 84 percent of those with higher education and the proportion in agricultural jobs varies from 74 percent of those with no education to less than 1 percent of those with higher education. Similarly, employed women in the lowest wealth quintile are concentrated in agricultural occupations (81 percent), while 59 percent of those in the highest wealth quintile are employed in professional, technical, or managerial positions. 3.7 TYPE OF EMPLOYMENT Table 3.7 shows the percent distribution of ever-married women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural). Half of working women are paid in cash only, while 4 percent are paid in cash and in kind, another 4 percent are paid only in kind, and 42 percent are not paid at all. As expected, unpaid work is far more common in agricultural occupations; three-quarters of women working in agriculture are not paid. Table 3.7 Type of employment Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Yemen 2013 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 11.7 88.5 49.9 Cash and in-kind 4.4 3.4 3.9 In-kind only 7.8 1.0 4.4 Not paid 75.9 6.7 41.5 Missing 0.2 0.3 0.3 Total 100.0 100.0 100.0 Type of employer Employed by family member 66.4 22.6 44.7 Employed by nonfamily member 14.3 20.1 17.1 Self-employed 18.0 54.7 36.2 Other 1.0 2.3 1.6 Missing 0.4 0.3 0.3 Total 100.0 100.0 100.0 Continuity of employment All year 32.1 63.0 47.4 Seasonal 55.6 14.7 35.2 Occasional 12.2 22.0 17.2 Missing 0.1 0.3 0.2 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 903 893 1,806 Note: Total includes women with missing information on type of employment who are not shown separately. Overall, 45 percent of working women are employed by a family member, while 36 percent are self- employed and 17 percent work for a non-family member. Those employed in agricultural occupations are far more likely to be employed by a family member than those employed in nonagricultural occupations, more than half of whom are self-employed. Less than half of employed women work throughout the year. As expected, women working in agriculture are more likely than average to be employed seasonally (56 percent), while women in non- agricultural occupations are far more likely to be employed all year (63 percent). Marriage • 37 MARRIAGE 4 arriage is a primary indication of the exposure of women to the risk of pregnancy and therefore is important to the understanding of fertility. Populations in which women marry at a young age tend to initiate childbearing early and have high fertility. 4.1 MARITAL STATUS Table 4.1 presents the percent distribution of women age 15-49 by current marital status. The proportion of women who have never married declines sharply with age, from 83 percent of women age 15-19 to 2 percent of women age 45-49 (Figure 4.1). Marriage is thus nearly universal in Yemen. Sixty-one percent of women age 15-49 are currently married. Two percent of women age 15-49 are divorced and 2 percent are widowed. As expected the proportions currently married, divorced, and widowed all increase with age. Table 4.1 Current marital status Percent distribution of all women age 15-49 by current marital status, according to age, Yemen 2013 Marital status Total Number of respondents Age Never married Married Divorced Widowed 15-19 82.5 17.1 0.4 0.0 100.0 6,342 20-24 40.4 57.1 2.2 0.3 100.0 5,197 25-29 19.5 77.1 2.6 0.8 100.0 4,634 30-34 12.4 83.0 2.8 1.8 100.0 3,225 35-39 5.4 87.2 3.8 3.5 100.0 2,761 40-44 3.5 87.4 3.7 5.4 100.0 1,807 45-49 1.8 87.0 3.7 7.6 100.0 1,468 Total 15-49 34.9 61.2 2.3 1.7 100.0 25,434 M Key Findings • Sixty-one percent of women age 15-49 are currently married. • Most women in Yemen are married by the time they reach age 18. Among women age 25-49, the median age at first marriage is 18.2 years • There has been a trend towards later marriage for women. For example, in 1997, the median age at marriage for women was 16.0. • Polygyny is not common in Yemen; only 6 percent of currently married women say their husbands have other wives. 38 • Marriage Figure 4.1 Percent distribution of women age 15-49 by current marital status 4.2 POLYGYNY Polygyny (the practice of having more than one wife) has implications for the frequency of exposure to the risk of pregnancy and, therefore, fertility. The extent of polygyny in Yemen was measured by asking all currently married women the question: “Does your husband have other wives?” If the answer was yes, the woman was asked: “Including yourself, in total, how many wives does he have?” Table 4.2 shows the distribution of currently married women by the number of co-wives, according to selected background characteristics. A large majority of married women report their husbands have no other wives (93 percent). Six percent of women report their husbands have other wives, mostly only one other wife. This percentage is almost identical to the 7 percent reported in 1997 and the 6 percent reported in 2003 (CSO and MI, 1998; MOPHP, CSO, and PAPFAM, 2004). The proportion of women in polygynous marriages increases with age, from 2 percent among married women age 15-19 to 13 percent among women age 40-44 and 11 percent among women age 45-49. The proportions of women who report having co-wives is lowest in Hadramout Governorate (3 percent) and highest in Al-Jawf Governorate (16 percent). There is no consistent relationship between polygyny and either education or wealth quintile. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Never married Married Divorced Widowed YNHDS 2013 Marriage • 39 Table 4.2 Number of women’s co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Yemen 2013 Number of co-wives Total Number of women Background characteristic 0 1 2+ Don’t know, missing Age 15-19 98.1 1.6 0.0 0.4 100.0 1,084 20-24 97.0 2.3 0.4 0.3 100.0 2,968 25-29 95.0 4.0 0.5 0.5 100.0 3,574 30-34 93.0 5.9 0.6 0.5 100.0 2,675 35-39 91.0 7.6 0.9 0.5 100.0 2,409 40-44 86.8 10.9 1.7 0.6 100.0 1,579 45-49 88.8 8.9 1.9 0.4 100.0 1,277 Residence Urban 92.9 5.9 0.8 0.4 100.0 4,949 Rural 93.5 5.3 0.7 0.5 100.0 10,617 Governorate Ibb 92.8 5.6 0.9 0.6 100.0 1,678 Abyan 96.2 3.4 0.1 0.3 100.0 326 Sana’a City 93.2 5.6 1.0 0.2 100.0 1,510 Al-Baidha 90.6 8.0 1.1 0.2 100.0 702 Taiz 93.6 5.1 1.1 0.1 100.0 2,053 Al-Jawf 81.7 13.4 2.9 2.0 100.0 124 Hajjah 92.3 6.3 0.8 0.6 100.0 867 Al-Hodiedah 93.6 5.6 0.5 0.3 100.0 1,891 Hadramout 97.1 2.3 0.2 0.3 100.0 884 Dhamar 95.6 3.7 0.2 0.6 100.0 1,106 Shabwah 93.3 5.7 0.2 0.8 100.0 293 Sadah 88.6 9.7 0.7 0.9 100.0 504 Sana’a 94.2 4.7 0.8 0.4 100.0 831 Aden 96.2 3.6 0.0 0.2 100.0 487 Lahj 93.7 4.2 0.4 1.6 100.0 405 Mareb 88.8 8.9 1.7 0.5 100.0 111 Al-Mhweit 91.9 7.0 1.0 0.1 100.0 425 Al-Mhrah 91.2 6.7 1.5 0.7 100.0 61 Amran 93.4 5.6 0.3 0.8 100.0 595 Aldhalae 89.3 8.5 1.4 0.8 100.0 384 Reimah 92.4 5.6 1.4 0.6 100.0 330 Education No education 91.8 6.7 1.0 0.5 100.0 8,336 Fundamental 94.8 4.3 0.4 0.4 100.0 5,090 Secondary 96.5 2.9 0.3 0.3 100.0 1,511 Higher 92.7 5.8 1.1 0.5 100.0 629 Wealth quintile Lowest 94.0 4.9 0.6 0.5 100.0 2,840 Second 93.8 5.1 0.6 0.4 100.0 3,076 Middle 93.0 5.7 0.9 0.5 100.0 3,141 Fourth 92.5 6.5 0.5 0.5 100.0 3,147 Highest 93.4 5.2 1.1 0.3 100.0 3,362 Total 93.3 5.5 0.7 0.5 100.0 15,566 4.3 AGE AT FIRST MARRIAGE For most societies, marriage marks the point in a woman’s life when childbearing first becomes socially acceptable. Women who marry early will, on average, have longer exposure to pregnancy and a greater number of lifetime births. Information on age at first marriage was obtained by asking all ever- married women the month and year they started living together with their first husband. Table 4.3 presents the percentages of all women age 15-49 who first married by specific exact ages and their median age at first marriage. Overall, almost half of women age 25-49 married by the time they were 18, and six in ten married by age 20. The median age at marriage is 18.2. There is evidence that age at first marriage has been increasing among women in Yemen. The median age at marriage among women has risen by about two years, from 17.0 years among women age 5-49 to 19.0 years among women age 25-29. The proportion of women married by age 15 declined from 27 percent among those age 45-49 to 3 percent among women age 15-19. Additional evidence comes from prior surveys. For example, the median age at first marriage among women age 25-49 has increased from 16.0 in 1997 to 18.2 in 2013 (CSO and MI, 1998). 40 • Marriage Table 4.3 Age at first marriage Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Yemen 2013 Percentage first married by exact age: Percentage never married Number of women Median age at first marriage Current age 15 18 20 22 25 15-19 3.3 na na na na 82.5 6,342 a 20-24 9.4 31.9 48.1 na na 40.4 5,197 a 25-29 14.0 41.6 56.5 68.5 77.8 19.5 4,634 19.0 30-34 17.2 46.9 61.4 71.4 80.7 12.4 3,225 18.4 35-39 19.3 51.7 68.3 79.7 87.5 5.4 2,761 17.8 40-44 20.8 53.5 68.4 80.6 88.3 3.5 1,807 17.6 45-49 26.7 58.0 70.5 79.5 86.1 1.8 1,468 17.0 20-49 15.7 43.7 59.0 na na 19.1 19,092 18.7 25-49 18.0 48.1 63.0 74.1 82.6 11.1 13,895 18.2 Note: The age at first marriage is defined as the age at which the woman began living with her first husband. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women began living with their husband for the first time before reaching the beginning of the age group Table 4.4 presents the median age at first marriage among women by background characteristics. Among women age 25-49, the median age at marriage is one year older among urban women (18.9) than among rural women (17.9). The lowest median ages at marriage are observed in Al-Jawf (16.6) and Al-Baidha (16.8) Governorates, while the highest is seen in Aden Governorate (21.7). There is a marked relationship among women’s level of education and median age at marriage. The median age at first marriage among women age 25-49 with no formal education is 17.4 years, and it rises to 20.5 years among those with at least some secondary education. There is a generally positive correlation between wealth and age at marriage. Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20- 49 and age 25-49, according to background characteristics, Yemen 2013 Women age Background characteristic 20-49 25-49 Residence Urban 19.6 18.9 Rural 18.3 17.9 Governorate Ibb 17.9 17.0 Abyan a 21.1 Sana’a City 19.4 18.7 Al-Baidha 17.6 16.8 Taiz 19.1 18.6 Al-Jawf 17.0 16.6 Hajjah 18.7 18.0 Al-Hodiedah 18.9 18.5 Hadramout 18.8 18.5 Dhamar 17.6 17.4 Shabwah 18.6 17.9 Sadah 18.2 17.6 Sana’a 18.4 17.9 Aden a 21.7 Lahj a 20.4 Mareb 18.2 17.4 Al-Mhweit 17.5 17.0 Al-Mhrah 18.3 17.9 Amran 18.5 18.3 Aldhalae 18.0 17.5 Reimah 17.6 17.1 Education No education 17.6 17.4 Fundamental 18.6 18.1 Secondary a 20.5 Wealth quintile Lowest 18.3 17.9 Second 18.3 17.9 Middle 18.2 17.7 Fourth 18.8 18.3 Highest 19.9 19.1 Total 18.7 18.2 Note: The age at first marriage is defined as the age at which the woman began living with her first husband. a = Omitted because less than 50 percent of the women began living with their husbands for the first time before reaching the beginning of the age group Fertility • 41 FERTILITY 5 n the 2013 YNHDS, data were collected on current and completed fertility. The birth histories of ever- married women interviewed in the survey are used in this chapter to provide a description of levels and differentials in current fertility. Trends in fertility are explored, including examination of age-specific fertility rates for periods 15 to 20 years before the survey. Measures of several proximate determinants of fertility that influence exposure to the risk of pregnancy are also presented, including duration of postpartum amenorrhea and menopause. The chapter also gives information on the age of women at their first birth and on patterns of teenage childbearing. The fertility indicators presented in this chapter are based on reports of reproductive histories provided by ever-married women age 15-49. To obtain the total number of live births, each woman was asked to provide information on the total number of sons and daughters to whom she had given birth and who were living with her, the number living elsewhere, and the number who had died. In the birth history, women reported the details of each live birth separately, including such information as the child’s name and month and year of birth, in addition to sex and survival status. For children who had died, age at death was recorded. 5.1 CURRENT FERTILITY Measures of current fertility include age-specific fertility rates (ASFRs), the total fertility rate (TFR), the general fertility rate (GFR), and the crude birth rate (CBR). These rates are presented for the three-year period preceding the survey, a period that corresponds roughly to calendar years 2011-2013. The three-year period (rather than a longer or a shorter period) was chosen as a balance among providing the most current information, reducing sampling errors, and avoiding potential problems with displacement of births occurring four to five years before the survey. Age-specific fertility rates are expressed as the number of births per 1,000 women in a certain age group. They are useful in understanding the age pattern of fertility. Numerators of ASFRs are calculated by identifying live births that occurred in the period 1 to 36 months preceding the survey (determined from the date of interview and date of birth of the child); they are then classified by the age of the mother (in five- year groups) at the time of the child’s birth. The denominators of these rates are the number of woman-years lived by the survey respondents in each of the five-year age groups during the specified period. Although in the YNHDS, only women who had ever married were asked about their births, the denominators of the rates were based on all women, including those who never married. Never-married women are presumed not to have given birth. I Key Findings • The total fertility rate for Yemen is 4.4 children per woman, a large decrease since 1997, when the rate was 6.5 children per woman. • Fertility among urban women (3.2 children per woman) is markedly lower than among rural women (5.1 children per woman). • Births in Yemen are too closely spaced; 30 percent occur within 24 months after a previous birth. • The median age at first birth among women age 25-49 is 20.8. • Only 11 percent of girls age 15-19 have either given birth or are pregnant with their first child. 42 • Fertility The TFR is a common measure of current fertility and is defined as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the current age-specific fertility rates. The GFR represents the number of live births per 1,000 women of reproductive age. The CBR is the number of live births per 1,000 population. The latter two measures are based on birth history data for the three-year period before the survey and on the age-sex distribution of the household population. Despite efforts to ensure accurate reporting, data from the YNHDS are subject to the same types of errors that are inherent in all retrospective sample surveys: the possibility of omitting some births (especially births of children who died at a very young age) and the difficulty of accurately determining each child’s date of birth. These errors can bias estimates of fertility trends, which therefore have to be interpreted within the context of data quality and sample sizes. A summary of the quality of the YNHDS data appears in the tables in Appendix C. Table 5.1 shows the age-specific and aggregate fertility measures calculated from the 2013 YNHDS. The total fertility rate for Yemen is 4.4 children per woman. Childbearing peaks during age 25-29 and drops sharply after age 39. Fertility among urban women is markedly lower (3.2 children per woman) than among rural women (5.1 children per woman). This pattern of lower fertility in urban areas is evident in every age group. 5.2 FERTILITY BY BACKGROUND CHARACTERISTICS Table 5.2 shows differentials in fertility by residence, governorate, level of education, and wealth quintile. As mentioned, women in urban areas have a distinctly lower TFR (3.2) than those in rural areas (5.1). The TFR ranges from a low of 2.9 children per woman in Aden Governorate to a high of 6.2 in Dhamar Governorate. Education and wealth are closely linked to a woman’s fertility. The TFRs decrease uniformly as education increases, from 5.3 for women with no formal education to 2.2 for women who have higher education. The TFR also decreases with each increase in wealth quintile, ranging from 6.1 children per woman in the lowest wealth quintile to 2.9 children per woman in the highest wealth quintile. Table 5.2 also allows for a general assessment of differential trends in fertility over time among population subgroups. The mean number of children ever born to women age 40-49 is a measure of past fertility. The mean number of children ever born to older women who are nearing the end of their reproductive period is an indicator of average completed fertility of women who began childbearing during the three decades preceding the survey. If fertility were to remain constant over time, and the reported data on children ever born and births during the three years preceding the survey were reasonably accurate, the TFR and the mean number of children ever born for women age 40-49 would be similar. If fertility levels have fallen, the TFR will be substantially lower than the mean number of children ever born among women age 40-49. Overall, a comparison of past (completed) and current (TFR) fertility indicators suggests a decline from 6.7 to 4.4 children per woman. There have been substantial but variable declines in both urban and rural areas, and across education levels and wealth quintiles. The largest declines have occurred among women in urban areas, women with no education or fundamental education, and women in the three highest wealth quintiles. Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Yemen 2013 Residence Total Age group Urban Rural 15-19 51 75 67 20-24 145 216 191 25-29 162 232 208 30-34 135 202 177 35-39 104 162 142 40-44 35 90 71 45-49 8 41 29 TFR(15-49) 3.2 5.1 4.4 GFR 111 163 146 CBR 27.4 36.2 33.4 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population Fertility • 43 Table 5.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by background characteristics, Yemen 2013 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 3.2 6.2 5.8 Rural 5.1 9.5 7.1 Governorate Ibb 4.8 8.8 7.7 Abyan 4.0 6.1 4.8 Sana’a City 3.1 6.6 6.2 Al-Baidha 3.9 8.4 6.8 Taiz 4.0 7.8 6.5 Al-Jawf 5.8 8.2 7.3 Hajjah 5.5 9.3 7.3 Al-Hodiedah 4.4 8.2 6.8 Hadramout 3.4 6.9 5.5 Dhamar 6.2 10.1 8.0 Shabwah 4.0 7.8 6.8 Sadah 4.0 9.9 6.8 Sana’a 4.9 9.3 7.0 Aden 2.9 5.6 4.1 Lahj 4.5 6.4 5.4 Mareb 4.7 8.6 7.8 Al-Mhweit 5.8 11.0 7.5 Al-Mhrah 4.3 8.3 6.8 Amran 6.1 12.3 7.7 Aldhalae 4.5 8.3 7.2 Reimah 5.9 11.2 8.2 Education No education 5.3 9.9 7.2 Fundamental 4.1 8.1 5.6 Secondary 3.1 5.8 4.0 Higher 2.2 5.5 2.8 Wealth quintile Lowest 6.1 10.5 7.3 Second 5.3 10.0 7.1 Middle 4.5 9.5 7.1 Fourth 3.8 7.1 6.8 Highest 2.9 5.5 5.4 Total 4.4 8.4 6.7 Note: Total fertility rates are for the period 1-36 months prior to interview. At the time of the survey, 8 percent of women reported that they were pregnant. This percentage is an underestimate because many women will not yet know for sure that they are pregnant, and other women may not want to declare that they are pregnant. 5.3 FERTILITY TRENDS The data in Table 5.3.1 provide evidence of fluctuations in fertility in Yemen over the past 20 years. The table uses information from the retrospective birth histories obtained from YNHDS respondents to examine trends in age-specific fertility rates for successive five-year periods before the survey. To calculate these rates, births were classified according to the period of time in which the birth occurred and the mother’s age at the time of birth. Because women age 50 and above were not interviewed in the survey, the rates are successively truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 35-39 for the period Table 5.3.1 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother’s age at the time of the birth, Yemen 2013 Number of years preceding survey Mother’s age at birth 0-4 5-9 10-14 15-19 15-19 70 116 147 157 20-24 194 242 285 312 25-29 209 261 322 324 30-34 185 234 296 328 35-39 140 177 272 * 40-44 75 114 * * 45-49 31 * * * Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 44 • Fertility 15 to 19 years before the survey because these women would have been over the age of 50 at the time of the 2013 YNHDS and not interviewed. Fertility has fallen steadily among women in all age groups over the past two decades. Substantial declines in age-specific fertility rates were observed from the period 10 to 14 years before the survey to the period 5-9 years before the survey and also from 5-9 to 0 to 4 years before the survey. Table 5.3.2 and Figure 5.1 show trends in current fertility rates based on previous surveys in Yemen. Overall, the TFR declined by just over 2 births between the 1997 and 2013 surveys. The decline in TFR has been consistent across surveys: 6.5 children per woman in 1997, 6.2 children per woman in 2003, 5.2 children per woman in 2006, and 4.4 children per woman in 2013. Table 5.3.2 Trends in age-specific and total fertility rates Age-specific and total fertility rates (TFR) for several surveys, Yemen Mother’s age at birth YDMCHS 1997 YFHS 2003 YMICS 2006 YNHDS 2013 15-19 105 83 80 67 20-24 279 245 211 191 25-29 301 286 247 208 30-34 258 255 221 177 35-39 196 182 156 142 40-44 105 111 78 71 45-49 54 69 39 29 TFR 15-49 6.5 6.2 5.2 4.4 Note: Age-specific fertility rates are per 1,000 women. Rates refer to the three-year period preceding each survey except for the 2003 YFHS, which utilized a five-year period. Figure 5.1 Trends in fertility 0 50 100 150 200 250 300 350 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Births per 1,000 women Age YNHDS 2013 YFHS 2003 YMICS 2006 YDMCHS 1997 Fertility • 45 5.4 CHILDREN EVER BORN AND LIVING The distribution of women by the number of children ever born is presented in Table 5.4 for all women and for currently married women. The table also shows the mean number of children ever born to women in each five-year age group. These distributions reflect the accumulation of births among YNHDS respondents over the past 30 years and, therefore, their relevance to the current situation is limited. However, the information on children ever born is useful for observing how average family size varies across age groups and for observing the level of primary infertility. On average, women in their late twenties have given birth to more than two children, women in their late thirties have had more than five children, and women at the end of their childbearing years have had more than seven children. Of the 7.2 children ever born to women age 45-49, 6.4 survived to the time of the survey. Table 5.4 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Yemen 2013 Number of children ever born Total Number of women Mean number of children ever born Mean number of living children Age 0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN Age 15-19 91.9 6.2 1.7 0.2 0.0 0.1 0.0 0.0 0.0 0.0 0.0 100.0 6,342 0.10 0.10 20-24 53.5 19.5 15.7 7.6 2.6 0.8 0.3 0.0 0.0 0.0 0.0 100.0 5,197 0.90 0.84 25-29 26.6 10.4 19.0 17.5 14.3 6.9 3.5 1.2 0.4 0.2 0.0 100.0 4,634 2.27 2.12 30-34 17.2 5.6 10.2 15.3 15.5 12.8 11.0 6.6 3.6 1.4 0.7 100.0 3,225 3.60 3.38 35-39 9.0 3.5 4.6 8.3 10.9 15.3 15.0 11.9 9.6 5.2 6.8 100.0 2,761 5.26 4.82 40-44 7.2 3.3 3.4 5.5 7.1 12.9 12.8 12.0 10.4 9.5 16.0 100.0 1,807 6.26 5.65 45-49 4.2 2.2 2.8 4.8 6.3 8.7 12.0 11.3 11.6 11.3 24.7 100.0 1,468 7.20 6.36 Total 42.6 8.9 9.3 8.3 7.2 6.1 5.3 3.9 3.0 2.1 3.4 100.0 25,434 2.51 2.30 CURRENTLY MARRIED WOMEN Age 15-19 53.1 35.8 9.6 1.0 0.1 0.3 0.0 0.0 0.0 0.0 0.0 100.0 1,084 0.60 0.56 20-24 21.1 32.4 27.0 13.2 4.5 1.3 0.4 0.1 0.0 0.0 0.0 100.0 2,968 1.54 1.44 25-29 7.9 12.4 23.5 22.3 18.2 8.9 4.5 1.5 0.5 0.2 0.0 100.0 3,574 2.88 2.69 30-34 4.7 5.3 11.7 17.6 18.1 15.1 13.0 7.7 4.3 1.6 0.9 100.0 2,675 4.20 3.95 35-39 3.2 2.6 4.1 8.3 11.6 16.3 16.4 13.3 10.9 5.8 7.7 100.0 2,409 5.76 5.28 40-44 3.5 2.2 2.7 5.0 7.0 12.7 13.9 13.1 11.6 10.4 17.9 100.0 1,579 6.74 6.09 45-49 2.0 1.8 2.7 4.1 6.3 8.5 12.2 11.1 12.4 12.0 27.0 100.0 1,277 7.54 6.65 Total 11.4 13.2 14.3 12.9 11.2 9.4 8.3 6.0 4.8 3.3 5.4 100.0 15,566 3.91 3.59 Note: Questions on reproduction were not asked to never-married women. Children ever born to these women is assumed to be 0 for this table. Results at younger ages for currently married women differ from those for all women because of the large number of unmarried women who have not given birth. Differences at older ages generally reflect the impact of marital dissolution (either divorce or widowhood). Only 2 percent of currently married women age 45-49 have never had a child. If the desire for children is universal in Yemen, this percentage represents a rough measure of primary infertility or the inability to bear children. Another indication of the decline in fertility in Yemen is the fact that the mean number of children ever born to older women has declined. For example, in 1997, women age 45-49 had given birth to an average of 8.8 children, compared with 7.2 in 2013 (CSO and MI, 1998). 5.5 BIRTH INTERVALS Information on the length of birth intervals provides insight into birth spacing patterns, which affect fertility as well as infant and child mortality. Research has shown that children born too soon after a previous birth are at increased risk of poor health, particularly when the interval is less than 24 months. Table 5.5 shows the distribution of births in the five years before the survey by the interval since the preceding birth, according to various background and demographic characteristics. 46 • Fertility Table 5.5 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Yemen 2013 Months since preceding birth Total Number of nonfirst births Median number of months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 34.5 23.9 32.5 7.5 1.6 0.0 100.0 137 22.1 20-29 18.1 18.8 30.8 17.0 8.4 6.9 100.0 5,899 27.9 30-39 11.0 13.6 28.3 18.4 10.6 18.1 100.0 5,241 35.0 40-49 5.5 11.8 23.7 18.5 12.2 28.3 100.0 1,320 41.1 Sex of preceding birth Male 13.6 16.0 28.6 17.6 9.6 14.7 100.0 6,472 32.3 Female 14.5 15.9 29.5 17.7 9.7 12.7 100.0 6,125 31.3 Survival of preceding birth Living 12.9 15.8 29.2 18.2 9.8 14.2 100.0 11,879 32.5 Dead 32.8 18.4 26.4 8.9 7.3 6.1 100.0 719 23.6 Birth order 2-3 17.2 17.8 28.0 17.4 9.3 10.3 100.0 5,374 29.5 4-6 12.3 13.6 30.2 17.3 9.7 16.9 100.0 4,594 33.3 7+ 10.6 16.3 29.0 18.8 10.3 15.0 100.0 2,629 33.5 Residence Urban 11.8 13.5 25.3 18.3 11.2 19.9 100.0 3,266 35.7 Rural 14.8 16.8 30.3 17.4 9.1 11.5 100.0 9,332 30.6 Governorate Ibb 13.5 13.8 27.9 20.0 10.0 14.9 100.0 1,387 33.2 Abyan 11.2 13.3 30.2 18.4 13.1 13.8 100.0 226 33.2 Sana’a City 12.2 12.2 25.4 18.5 11.7 20.0 100.0 966 36.1 Al-Baidha 12.9 15.2 23.7 22.6 12.0 13.6 100.0 474 35.1 Taiz 16.7 15.8 28.2 16.5 9.1 13.6 100.0 1,572 30.3 Al-Jawf 11.5 20.9 29.8 18.3 9.5 10.0 100.0 111 31.6 Hajjah 12.2 19.6 32.8 15.6 8.9 10.9 100.0 880 30.7 Al-Hodiedah 14.5 20.8 30.9 16.6 7.6 9.7 100.0 1,640 28.2 Hadramout 7.4 12.4 28.2 19.9 12.4 19.7 100.0 578 37.2 Dhamar 16.9 17.1 31.5 15.5 8.8 10.2 100.0 1,078 28.9 Shabwah 8.9 13.6 25.8 20.6 13.6 17.5 100.0 221 36.6 Sadah 15.7 13.4 32.9 16.8 7.4 13.9 100.0 382 31.9 Sana’a 17.9 16.4 24.7 15.6 9.5 15.9 100.0 695 30.7 Aden 10.8 9.1 27.8 18.3 9.7 24.4 100.0 280 37.2 Lahj 12.9 16.5 26.2 16.8 11.1 16.5 100.0 322 33.6 Mareb 13.6 20.8 28.1 14.1 8.0 15.4 100.0 96 29.8 Al-Mhweit 17.2 17.2 33.6 16.5 7.5 8.1 100.0 422 28.7 Al-Mhrah 9.4 14.8 29.9 23.3 12.1 10.4 100.0 51 33.4 Amran 11.2 14.1 29.5 20.9 10.1 14.2 100.0 541 33.9 Aldhalae 13.2 12.2 29.4 18.5 12.8 13.9 100.0 317 34.5 Reimah 18.1 19.0 32.2 15.7 6.8 8.3 100.0 358 28.0 Education No education 14.2 16.3 29.9 17.6 9.3 12.8 100.0 7,605 31.2 Fundamental 14.2 16.5 26.7 17.6 9.9 15.1 100.0 3,684 32.4 Secondary 13.8 12.6 32.2 17.9 10.6 12.9 100.0 947 32.6 Higher 10.4 13.3 25.5 18.3 11.8 20.7 100.0 361 36.5 Wealth quintile Lowest 14.8 19.1 32.2 17.7 8.0 8.2 100.0 3,046 28.8 Second 18.1 16.5 30.3 17.0 8.3 9.9 100.0 2,763 29.0 Middle 13.8 16.9 28.4 16.9 10.3 13.7 100.0 2,498 32.1 Fourth 12.1 13.6 29.4 16.9 10.0 18.0 100.0 2,276 33.4 Highest 9.9 11.9 22.8 20.3 12.6 22.5 100.0 2,015 39.2 Total 14.0 16.0 29.0 17.6 9.6 13.7 100.0 12,597 31.8 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. The data show that 30 percent of children in Yemen are born after too short an interval (less than 24 months after a preceding birth). This proportion is particularly high for children of young mothers age 15-19, 58 percent of whom are born less than 24 months after a prior birth. The median birth interval in Yemen is 32 months. The median interval is shorter among births to women under age 30 than among births to older mothers. The length of the birth interval varies by survival status of the previous birth. For births whose prior sibling survived, the median birth interval is 33 months; for those with a non-surviving previous birth, the birth interval is 24 months. The difference is likely due to the absence of the fertility-inhibiting effects of breastfeeding as well as a desire to replace a dead child as soon as possible. Fertility • 47 The median birth interval in urban areas (36 months) is slightly higher than in rural areas (31 months). Women with higher education have a longer median birth interval (37 months) than women with no education (31 months). Median birth interval increases with each wealth quintile, ranging from 29 months in the lowest quintile to 39 months in the highest quintile. Comparison with the 1997 YDMCHS shows that the median birth interval has increased slightly, from 28 to 32 months (CSO and MI, 1998). 5.6 POSTPARTUM AMENORRHEA Postpartum amenorrhea refers to the interval between childbirth and the return of menstruation. During this period, the risk of pregnancy is greatly reduced. The duration of this protection from conception after childbirth depends on the duration and intensity of breastfeeding. In the 2013 YNHDS, women who gave birth in the five years prior to the survey were asked if their menstrual period had returned. Table 5.6 shows results for births in the three years before the survey according to time since the birth. As expected, the proportion of births for which the mother is still amenorrheic declines rapidly from 88 percent for births occurring in the two months before the survey to 14 percent and less for births occurring 12 months or more before the survey. The median duration of amenorrhea is less than 4 months, while the mean duration is 7 months. 5.7 MENOPAUSE Fecundity refers to the ability to have children. The risk of pregnancy declines with age as increasing proportions of women become infecund. Although the onset of infecundity is difficult to determine for an individual woman, there are ways of estimating it for a population. Table 5.7 presents data on menopause, an indicator of decreasing exposure to the risk of pregnancy for women age 30 and older. The percentage of women who have reached menopause refers to the population of women who are neither pregnant nor postpartum amenorrheic and have not had a menstrual period in the six months preceding the survey, or women who report being menopausal. Table 5.7 shows that overall, 6 percent of women age 30-49 are menopausal. The proportion of menopausal women increases with age, from 2 percent among women age 30-34 to 23 percent among women age 48-49. 5.8 AGE AT FIRST BIRTH The age at which childbearing begins has an impact on the health and welfare of a mother and her children. In many countries, the postponement of first births has contributed to an overall fertility decline. Table 5.8 shows the distribution of women by age at first birth, according to their current age. The median age at first birth in Yemen is around 21 for most age groups, with no clear trend by age. The median age at first birth for women age 25-49 (20.8) is higher than that of 19.5 found in the 1997 YDMCHS (CSO and MI, 1998). Table 5.6 Postpartum amenorrhea Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, by number of months since birth, and median and mean durations, Yemen 2013 Percentage of births for which the mother is amenorrheic Number of births Months since birth < 2 88.1 464 2-3 51.6 662 4-5 38.6 579 6-7 34.6 521 8-9 26.6 636 10-11 20.8 447 12-13 14.0 620 14-15 11.0 706 16-17 10.4 525 18-19 5.4 441 20-21 5.7 457 22-23 5.7 392 24-25 3.2 652 26-27 2.2 693 28-29 2.2 529 30-31 2.7 451 32-33 3.3 429 34-35 1.4 406 Total 18.6 9,609 Median 3.5 na Mean 6.9 na Note: Estimates are based on status at the time of the survey. na = Not applicable Table 5.7 Menopause Percentage of ever-married women age 30-49 who are menopausal, by age, Yemen 2013 Age Percentage menopausal1 Number of women 30-34 2.3 2,824 35-39 2.7 2,612 40-41 5.8 911 42-43 5.7 662 44-45 12.8 754 46-47 14.7 387 48-49 22.5 471 Total 5.6 8,622 1 Percentage of all women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey 48 • Fertility Table 5.8 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, percentage never married, and median age at first birth, according to current age, Yemen 2013 Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth Current age 15 18 20 22 25 15-19 0.7 na na na na 91.9 6,342 a 20-24 3.1 16.9 31.3 na na 53.5 5,197 a 25-29 4.3 22.6 40.2 54.6 68.6 26.6 4,634 21.4 30-34 6.6 27.2 45.5 58.1 71.3 17.2 3,225 20.7 35-39 6.3 29.0 45.5 62.2 77.8 9.0 2,761 20.4 40-44 6.7 28.9 45.7 60.8 77.9 7.2 1,807 20.6 45-49 9.3 27.2 42.7 57.5 73.0 4.2 1,468 20.9 20-49 5.3 23.7 40.2 na na na 19,092 a 25-49 6.1 26.3 43.5 58.0 72.7 16.0 13,895 20.8 na = Not applicable due to censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group 5.9 MEDIAN AGE AT FIRST BIRTH BY BACKGROUND CHARACTERISTICS Table 5.9 summarizes the median age at first birth for women age 25-49 across residential, educational, and wealth status subgroups. The results show that median age at first birth does not vary much by these background characteristics, being only slightly higher in urban areas than in rural areas (21.1 versus 20.7 years) and among women with secondary education (22.5) than among women with less education. Childbearing appears to start later among women in Abyan and Aden governorates than for women in other areas. 5.10 TEENAGE PREGNANCY AND MOTHERHOOD The issue of adolescent fertility is important for both health and social reasons. Children born to very young mothers are at increased risk of sickness and death. Teenage mothers are more likely to experience adverse pregnancy outcomes and are also more constrained in their ability to pursue educational opportunities than young women who delay childbearing. Table 5.10 shows the percentage of women age 15-19 who have given birth or were pregnant with their first child at the time of the survey, according to selected background characteristics. Overall, only 11 percent of women age 15-19 have begun childbearing, a sizeable drop from the 16 percent reported in 1997 (CSO and MI, 1998), but an increase from the 9 percent reported in 2003 (MOPHP, CSO, and PAPFAM 2004). The proportion of teenagers who have started childbearing rises rapidly with age, increasing from less than 1 percent at age 15 to 25 percent at age 19 (Figure 5.2). Teenagers with no education tend to start childbearing earlier than their better educated peers. Table 5.9 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Yemen 2013 Background characteristic Women age 25-49 Residence Urban 21.1 Rural 20.7 Governorates Ibb 19.7 Abyan 24.3 Sana’a City 20.8 Al-Baidha 19.7 Taiz 21.2 Al-Jawf 20.8 Hajjah 21.1 Al-Hodiedah 21.4 Hadramout 21.0 Dhamar 20.4 Shabwah 20.8 Sadah 20.4 Sana’a 19.8 Aden 23.8 Lahj 23.4 Mareb 20.2 Al-Mhweit 19.9 Al-Mhrah 20.6 Amran 20.7 Aldhalae 20.0 Reimah 20.3 Education No education 20.3 Fundamental 20.3 Secondary 22.5 Higher a Wealth quintile Lowest 20.9 Second 20.9 Middle 20.5 Fourth 20.6 Highest 21.1 Total 20.8 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group Fertility • 49 Table 5.10 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child, and percentage who have begun childbearing, by background characteristics, Yemen 2013 Percentage of women age 15-19 who: Percentage never married Number of women Background characteristic Have had a live birth Are pregnant with first child Have begun childbearing Age 15 0.3 0.2 0.5 97.4 1,345 16 2.6 1.9 4.4 91.0 1,218 17 6.1 2.7 8.7 84.3 1,208 18 10.9 5.0 15.9 73.7 1,452 19 22.3 3.1 25.4 64.7 1,119 Residence Urban 7.2 1.3 8.5 86.2 1,977 Rural 8.6 3.2 11.8 80.8 4,365 Governorate Ibb 10.8 3.9 14.7 77.8 762 Abyan 6.8 3.8 10.5 77.9 115 Sana’a City 7.1 1.1 8.2 84.5 512 Al-Baidha 12.7 2.6 15.3 79.4 299 Taiz 6.4 2.9 9.4 83.3 900 Al-Jawf 11.1 1.0 12.2 75.0 40 Hajjah 4.8 1.8 6.6 89.8 322 Al-Hodiedah 7.2 1.8 9.0 83.5 795 Hadramout 5.6 3.0 8.6 85.2 334 Dhamar 9.6 3.8 13.4 76.8 447 Shabwah 5.6 1.5 7.1 87.9 161 Sadah 9.9 4.8 14.7 80.8 217 Sana’a 10.3 2.9 13.1 82.4 329 Aden 9.0 1.8 10.8 86.9 201 Lahj 7.6 1.0 8.6 86.0 158 Mareb 6.6 1.5 8.1 85.1 47 Al-Mhweit 8.8 2.4 11.2 79.8 154 Al-Mhrah 9.2 0.8 10.0 83.6 23 Amran 7.4 2.1 9.5 82.6 219 Aldhalae 7.3 1.8 9.0 85.3 167 Reimah 10.4 2.7 13.1 81.2 139 Education No education 13.9 3.8 17.7 73.2 1,100 Fundamental 8.4 2.9 11.3 81.3 3,500 Secondary 4.1 1.4 5.5 90.6 1,636 Higher 1.1 0.5 1.6 91.5 108 Wealth quintile Lowest 8.4 2.3 10.7 82.6 1,080 Second 8.9 4.2 13.1 77.9 1,255 Middle 9.7 2.9 12.7 80.3 1,372 Fourth 7.5 1.9 9.5 85.6 1,313 Highest 6.2 1.6 7.8 85.8 1,322 Total 8.1 2.6 10.7 82.5 6,342 50 • Fertility Figure 5.2 Percentage of women age 15-19 who have begun childbearing 1 3 7 14 25 1 4 9 16 25 15 16 17 18 19 Percentage Age YFHS 2003 YNHDS 2013 Fertility Preferences • 51 FERTILITY PREFERENCES 6 nformation on fertility preferences is of considerable importance to managers of family planning programs, who must assess the need for contraception (whether to space births or childbearing) (limiting), and the extent of unwanted and mistimed pregnancies. Data on fertility preferences also can be used to predict the direction that future fertility patterns may take. In the 2013 YNHDS, women were asked whether they wanted more children and, if so, how long they would prefer to wait before the next child. They were also asked, if they could start afresh, how many children they would want. 6.1 FERTILITY PREFERENCES BY NUMBER OF LIVING CHILDREN Table 6.1 presents fertility preferences among currently married women by number of living children. When classifying people according to their fertility preferences, the desired timing of the next birth is taken into account. Forty-five percent of currently married women in Yemen would like to have another child; 20 percent want another child soon (within the next two years), while 24 percent want to have another child later (in two or more years), and 1 percent want another child but are undecided as to when. Nearly four in ten married women (39 percent) want no more children, while almost 1 in 10 (10 percent) are undecided. An additional 2 percent have been sterilized. Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women age 15-49 by desire for children, according to number of living children, Yemen 2013 Number of living children1 Total Desire for children 0 1 2 3 4 5 6+ Have another soon2 76.9 31.7 20.7 14.1 10.1 7.2 3.3 19.5 Have another later3 7.4 47.0 42.9 34.7 23.8 13.7 4.8 24.2 Have another, undecided when 1.2 2.0 1.5 1.8 1.8 0.9 0.4 1.3 Undecided 4.0 8.3 12.0 11.6 13.0 11.3 7.5 9.6 Want no more 1.4 8.4 20.5 34.1 46.5 61.0 71.7 39.0 Sterilized4 0.1 0.3 0.7 1.0 2.0 2.3 6.3 2.3 Declared infecund 7.7 1.7 1.2 2.2 1.8 2.8 5.0 3.2 Missing 1.4 0.6 0.5 0.6 0.9 0.8 0.9 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,445 2,186 2,397 2,149 1,930 1,632 3,827 15,566 1 Number of living children includes the current pregnancy 2 Wants next birth within two years 3 Wants to delay next birth for two or more years 4 Includes both female and male sterilization I Key Findings • Currently married women in Yemen are roughly evenly split between those who want to have another child (45 percent) and those who either want no more children or are sterilized (41 percent). • Ever-married women report that the ideal number of children is 4.3. • One in seven births in Yemen (14 percent) was reported by the mother to have been unwanted at the time of conception, and 21 percent were mistimed (wanted later); only 63 percent of births were wanted at the time of conception. • If all unwanted births could be prevented, women would have an average of 3.1 births (total wanted fertility rate) instead of the actual fertility rate of 4.4 children per woman. 52 • Fertility Preferences As expected, the desire to have children depends on the number of living children a woman already has. More than three out of four married women with no living children (77 percent) want to have a child soon (within two years), compared with only 3 percent of women with six or more children. The desire to stop childbearing increases dramatically among women who already have several living children. The proportion reporting that they do not want another child or have been sterilized increases from 2 percent among married women with no children to 78 percent among women with six or more children. Fertility preferences have changed somewhat over time. The proportion of currently married women who either want no more children or have been sterilized has declined from 49 percent in 1997 to 41 percent in 2013, while the proportion who want to have more children has increased slightly over the same period, from 42 to 45 percent (CSO and MI, 1998). 6.2 DESIRE TO STOP CHILDBEARING BY BACKGROUND CHARACTERISTICS Table 6.2 shows the percentage of currently married women who want no more children by number of living children and selected background characteristics. Overall, four in ten married women want no more children or are sterilized. The desire to stop childbearing is slightly higher among rural women (42 percent) than among urban women (39 percent), although this varies by the number of living children. The proportion wanting no more children varies substantially by governorate, from a low of 20 percent of married women in Hadramout Governorate to a high of 56 percent in Hajjah Governorate. Table 6.2 Desire to stop childbearing Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Yemen 2013 Number of living children1 Total Background characteristic 0 1 2 3 4 5 6+ Residence Urban 1.6 9.4 20.7 32.3 52.7 68.1 78.8 39.2 Rural 1.4 8.3 21.5 36.7 46.4 61.2 77.8 42.3 Governorate Ibb 2.3 10.4 23.0 32.8 38.0 58.5 79.3 40.1 Abyan 0.0 2.2 14.2 32.1 42.9 56.9 76.9 31.6 Sana’a City 3.3 8.1 17.4 34.4 60.8 73.2 79.2 38.8 Al-Baidha 2.2 12.8 18.7 30.2 37.0 76.0 84.0 42.0 Taiz 0.9 12.1 23.9 36.7 49.6 64.5 77.4 40.8 Al-Jawf (3.5) 2.1 18.9 (18.6) 33.1 (28.1) 77.2 34.0 Hajjah 2.4 13.7 27.8 47.5 66.4 70.9 83.2 55.8 Al-Hodiedah 0.0 6.2 20.7 39.6 54.4 65.3 84.0 44.2 Hadramout 1.6 2.2 10.1 15.4 18.3 30.5 42.6 19.8 Dhamar 1.4 5.8 18.2 29.3 39.8 56.0 76.1 40.4 Shabwah 0.0 2.7 6.8 12.4 26.8 41.6 69.2 29.7 Sadah (5.7) 11.0 19.0 35.9 44.7 60.3 66.5 41.1 Sana’a 3.8 12.3 27.9 47.9 57.4 79.2 89.1 48.4 Aden 0.0 8.3 31.5 42.5 62.7 75.1 84.4 42.8 Lahj 0.0 14.7 40.0 47.2 63.9 63.3 82.4 47.4 Mareb 1.9 10.2 19.1 12.5 44.9 38.6 59.4 31.8 Al-Mhweit 0.0 12.4 19.5 39.7 50.7 68.0 87.2 49.8 Al-Mhrah (0.0) (5.9) 9.8 11.4 29.7 (33.0) 52.2 24.9 Amran 0.0 0.9 19.2 38.1 62.7 76.7 87.7 45.8 Aldhalae 3.7 5.0 16.6 33.3 53.4 62.6 81.3 47.3 Reimah 0.0 8.1 26.1 27.3 41.2 49.5 72.3 42.6 Education No education 1.5 9.4 22.7 36.8 48.7 62.0 78.8 50.3 Fundamental 1.5 7.3 18.7 34.1 45.5 64.4 74.7 32.4 Secondary 1.9 9.5 24.1 30.9 50.8 69.4 76.9 26.4 Higher 0.0 12.3 21.5 35.7 68.9 * * 29.2 Wealth quintile Lowest 2.3 9.3 23.6 42.0 51.0 62.6 78.4 47.6 Second 2.1 10.2 19.7 32.0 47.7 62.1 79.6 41.5 Middle 0.5 7.6 23.6 41.4 45.6 63.1 79.9 42.8 Fourth 1.0 7.3 22.5 29.9 46.8 55.6 76.0 38.5 Highest 1.5 9.0 18.3 32.1 51.3 71.7 75.2 37.1 Total 1.5 8.7 21.2 35.1 48.5 63.3 78.0 41.3 Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The number of living children includes the current pregnancy. Fertility Preferences • 53 Overall, married women with no education are far more likely to want no more children (50 percent) than women with some education (26 to 32 percent); however among women with any given number of children, the relationship weakens or even disappears. Similarly, the association between wealth and the desire to stop childbearing is inconsistent. 6.3 IDEAL NUMBER OF CHILDREN Ever-married women were asked what number of children they would consider to be the ideal number. Respondents who had no children were asked, “If you could choose exactly the number of children to have in your whole life, how many would that be?” For respondents who had children, the question was rephrased as follows: “If you could go back to the time when you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” Responses to these questions are summarized in Table 6.3 for ever-married women age 15-49. Table 6.3 Ideal number of children by number of living children Percent distribution of ever-married women age 15-49 by ideal number of children, and mean ideal number of children for ever- married women and for currently married women, according to the number of living children, Yemen 2013 Number of living children1 Total Ideal number of children 0 1 2 3 4 5 6+ 0 2.9 2.7 2.8 3.8 3.9 6.1 6.7 4.3 1 2.6 4.8 1.3 1.7 1.4 0.6 0.5 1.7 2 25.9 21.2 19.4 11.0 10.6 11.0 8.8 14.7 3 7.8 12.3 11.7 16.8 4.2 5.4 5.3 9.0 4 29.4 30.7 36.8 32.5 35.1 20.5 19.0 28.4 5 6.5 7.0 6.1 9.8 10.0 16.0 6.3 8.3 6+ 17.3 14.3 14.1 16.5 24.7 27.1 37.7 23.1 Non-numeric responses 7.6 7.0 7.7 8.0 10.2 13.2 15.8 10.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,653 2,399 2,540 2,260 2,022 1,718 3,973 16,564 Mean ideal number of children for:2 Ever-married women 3.9 3.7 3.8 4.1 4.5 4.7 5.2 4.3 Number of ever-married 1,527 2,230 2,345 2,079 1,817 1,490 3,347 14,834 Currently married women 4.0 3.8 3.9 4.1 4.5 4.7 5.2 4.4 Number of currently married 1,354 2,043 2,218 1,981 1,741 1,416 3,231 13,984 1 The number of living children includes current pregnancy 2 Means are calculated excluding respondents who gave non-numeric responses. The data in the top portion of Table 6.3 indicate that a large majority of women were able to give a numeric answer to this hypothetical question. Only 10 percent of ever-married women gave a non-numeric answer such as “It is up to God,” “any number,” or “I do not know.” The mean ideal number of children is 4.3 for ever-married women and 4.4 for currently married women. More women report four children as ideal (28 percent) than any other number of children, although almost as many women (23 percent) report six or more children as ideal. Overall, 58 percent of women ideally would want four or fewer children. When interpreting the findings in Table 6.3, it is important to remember that the actual and stated ideal number of children tend to be related. There are several reasons for this. First, to the extent that women are able to fulfil their fertility desires, women who want large families will achieve large families. Second, because women with large families are, on average, older women, they may prefer a greater number of children because of the attitudes towards childbearing to which they were exposed during the early stages of their reproductive lives. Finally, some women may have difficulty admitting that they would prefer fewer children than they currently have if they could begin childbearing again. Such women are likely to report their actual number as their preferred number. Indeed, women who have fewer children do report a smaller ideal number of children than women with more children. The mean ideal number of children among ever- married women with one child is 3.7, compared with 5.2 among women with six or more children. It is also interesting that a substantial number of women reported ideal family sizes smaller than their actual number of children. For example, 47 percent of women with 6 or more children reported that if 54 • Fertility Preferences they could start over, they would have five or fewer children. Similarly, 44 percent of women with 5 children said ideally they would want four or fewer children. Over time, the mean ideal number of children reported by ever-married women has fluctuated from 4.5 children in 1997 up to 4.6 in 2003 and down to 4.3 in 2013 (CSO and MI, 1998; POPHP, CSO, PAPFAM, 2004). 6.4 IDEAL NUMBER OF CHILDREN BY BACKGROUND CHARACTERISTICS Table 6.4 shows the mean ideal number of children among ever-married women age 15-49, by background characteristics. The mean ideal number of children increases consistently with age, from 3.8 among women age 15-19 to 5.2 among women age 45-49. Women in rural areas have higher family size norms than those in urban areas (4.5 and 4.0 children, respectively). The mean ideal number of children varies substantially by governorate, from a low of 3.5 children for women in Sana’a Governorate to a high of 6.5 children for women in Al-Mhrah Governorate. The mean ideal number of children consistently decreases with increasing education, differing by slightly over one child between the lowest and highest education categories. The mean ideal number of children also decreases with increasing wealth quintile. 6.5 FERTILITY PLANNING STATUS The issue of unplanned and unwanted fertility was investigated in the 2013 YNHDS by asking women who had births during the five years before the survey whether the births were wanted at the time (planned), wanted at a later time (mistimed), or not wanted at all (unwanted). The responses to those questions provide a measure of the degree to which Yemeni couples have been successful in controlling childbearing. In addition, the information can be used to estimate the effect on fertility if unwanted pregnancies had been prevented. Questions pertaining to the planning status of recent births require the respondent to recall accurately her wishes at one or more points in the past five years and report them honestly. These questions are subject to recall and accuracy bias in remembering how she felt about a particular pregnancy. She also may not be willing to admit that she had not wanted a child at its conception. Conversely, if the child has become an economic or health burden, she may now claim that the pregnancy was unwanted. Despite these potential problems of comprehension, recall, and truthfulness, results from previous surveys have yielded plausible responses, with the most probable effect of biases in the answers being net underestimation of the level of unwanted fertility. Table 6.5 shows the distribution of births in the five years before the survey by whether a birth was wanted then, wanted later, or not wanted. Overall, 63 percent of all births were wanted at the time of conception, 21 percent were reported as mistimed (wanted later), and 14 percent were unwanted. The proportion of unwanted births is much greater for births that are fourth order or more (29 percent) than for first births (less than 1 percent). Similarly, a much larger proportion of births to older women are unwanted than are those to younger women. Whereas only 1 percent of births to women under age 20 are unwanted, 54 percent of births to women age 45-49 are unwanted. Table 6.4 Mean ideal number of children Mean ideal number of children for ever- married women age 15-49 by background characteristics, Yemen 2013 Background characteristic Mean Number of women1 Age 15-19 3.8 1,029 20-24 4.0 2,901 25-29 4.1 3,402 30-34 4.3 2,544 35-39 4.6 2,275 40-44 4.9 1,473 45-49 5.2 1,210 Residence Urban 4.0 4,871 Rural 4.5 9,963 Governorate Ibb 4.1 1,333 Abyan 4.6 312 Sana’a City 3.7 1,562 Al-Baidha 4.1 567 Taiz 4.6 2,148 Al-Jawf 5.2 132 Hajjah 4.1 870 Al-Hodiedah 4.6 1,852 Hadramout 5.2 794 Dhamar 4.1 991 Shabwah 5.2 200 Sadah 5.8 491 Sana’a 3.5 788 Aden 3.9 523 Lahj 4.4 407 Mareb 5.3 113 Al-Mhweit 4.0 417 Al-Mhrah 6.5 57 Amran 4.1 590 Aldhalae 5.0 371 Reimah 4.3 315 Education No education 4.6 7,757 Fundamental 4.1 4,935 Secondary 3.9 1,470 Higher 3.5 672 Wealth quintile Lowest 4.6 2,695 Second 4.4 2,907 Middle 4.4 2,937 Fourth 4.4 2,962 Highest 4.0 3,333 Total 4.3 14,834 1 Number of women who gave a numeric response Fertility Preferences • 55 Table 6.5 Fertility planning status Percent distribution of births to ever-married women age 15-49 in the five years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother’s age at birth, Yemen 2013 Planning status of birth Total Number of births Birth order and mother’s age at birth Wanted then Wanted later Wanted no more Missing Birth order 1 86.7 11.4 0.5 1.5 100.0 3,673 2 72.9 24.5 1.3 1.2 100.0 3,310 3 66.5 28.0 4.2 1.3 100.0 2,820 4+ 48.1 22.0 28.6 1.4 100.0 8,205 Mother’s age at birth <20 79.5 17.8 1.3 1.5 100.0 2,328 20-24 69.8 25.2 3.6 1.4 100.0 5,383 25-29 64.0 23.5 11.3 1.1 100.0 4,716 30-34 54.5 19.7 24.0 1.8 100.0 3,003 35-39 45.9 15.7 37.1 1.4 100.0 1,801 40-44 42.9 9.1 47.4 0.7 100.0 663 45-49 40.3 5.2 54.4 0.2 100.0 113 Total 63.4 21.2 14.0 1.4 100.0 18,008 6.6 WANTED FERTILITY RATES Responses to the question on the ideal number of children are used to calculate a total “wanted” fertility rate. This measure is calculated in the same manner as the conventional total fertility rate, except that unwanted births are excluded from the numerator. A birth is considered wanted if the number of living children at the time of conception are fewer than the ideal number of children currently reported by the respondent. Wanted fertility rates express the level of fertility that theoretically would result if all unwanted births were prevented. Comparison of the actual fertility rate with the wanted rate indicates the potential demographic impact of eliminating unwanted births. Table 6.6 and Figure 6.1 show that the wanted fertility rate is 3.1 children, compared with the actual fertility rate of 4.4 children (rates calculated over the three years prior to the survey). In other words, Yemeni women are currently having an average of 1.3 children more than they actually want. The table also shows that regardless of place of residence, level of education, and wealth quintile, the wanted fertility rate is lower than the actual total fertility rate. The total wanted fertility rate has declined enormously since 1997, when it was 4.6 children per woman (CSO and MI, 1998). Women in rural areas have a much larger gap between their actual and wanted fertility (1.6 children) than do women in urban areas (0.8). Women with higher levels of education as well as those in the higher wealth quintiles seem to be the most successful in achieving their fertility goals; that is, the gap between wanted and actual fertility narrows as education and wealth quintile increase. For example, women in the poorest wealth quintile have an average of about two children more than they want, while women in the highest wealth quintile have less than one child more than they want. Table 6.6 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Yemen 2013 Background characteristic Total wanted fertility rates Total fertility rate Residence Urban 2.4 3.2 Rural 3.5 5.1 Governorate Ibb 3.4 4.8 Abyan 3.0 4.0 Sana’a City 2.2 3.1 Al-Baidha 3.2 3.9 Taiz 3.2 4.0 Al-Jawf 4.3 5.8 Hajjah 3.0 5.5 Al-Hodiedah 3.0 4.4 Hadramout 3.1 3.4 Dhamar 4.1 6.2 Shabwah 3.5 4.0 Sadah 2.9 4.0 Sana’a 3.0 4.9 Aden 2.3 2.9 Lahj 3.3 4.5 Mareb 3.7 4.7 Al-Mhweit 3.3 5.8 Al-Mhrah 3.7 4.3 Amran 3.6 6.1 Aldhalae 2.9 4.5 Reimah 3.5 5.9 Education No education 3.6 5.3 Fundamental 3.1 4.1 Secondary 2.5 3.1 Higher 1.9 2.2 Wealth quintile Lowest 3.8 6.1 Second 3.7 5.3 Middle 3.2 4.5 Fourth 2.9 3.8 Highest 2.3 2.9 Total 3.1 4.4 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 5.2. 56 • Fertility Preferences Figure 6.1 Total fertility rates and wanted total fertility rates 4.4 3.2 5.1 6.1 5.3 4.5 3.8 2.9 3.1 2.4 3.5 3.8 3.7 3.2 2.9 2.3 Number of Births TFR Wanted TFR YNHDS 2013 Family Planning • 57 FAMILY PLANNING 7 amily planning refers to a conscious effort by a couple to stop childbearing (limiting) or space the number of children they want to have through the use of contraceptives. This chapter presents results from the 2013 YNHDS on a number of aspects of contraception: knowledge of specific contraceptive methods, current use, sources of current contraceptive methods, contraceptive discontinuation, unmet need for family planning services, and exposure to family planning messages and providers. The focus of this chapter is on currently married women because these women have the greatest risk of exposure to pregnancy. 7.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Information about contraceptive methods was collected by asking ever-married women if they had heard of various methods that a couple can use to delay or avoid a pregnancy. Specifically, the interviewer named a method, described it, and then asked whether the respondent had heard of it. In all, the interviewer asked about thirteen different contraceptive methods. Provision was also made in the questionnaire to record any additional methods the respondent had heard of but was not asked about by the interviewer. Contraceptive methods are classified into two broad categories, namely modern methods and traditional methods. Modern methods include female and male sterilization, the pill, the intrauterine device (IUD), injectables, implants, the male and the female condom, the diaphragm, the lactational amenorrhea method (LAM), and emergency contraception. Traditional methods include rhythm (periodic abstinence) and withdrawal. Table 7.1 shows that knowledge of contraceptive methods is almost universal in Yemen, with 98 percent of both ever-married and currently married women having heard of at least one method of contraception. Modern methods are more widely known than traditional methods; 98 percent of currently married women know of a modern method, while only 75 percent know of a traditional method. F Key Findings • Knowledge about contraception is nearly universal in Yemen: 98 percent of married women have heard of at least one method. • The contraceptive prevalence rate has increased to 34 percent among married women; in 1997, this rate was only 21 percent. • The birth control pill is the most widely used method of contraception, the IUD and injectables are the next most popular methods. • Just over half (53 percent) of modern contraceptive users obtain their methods from the public sector. • Among women who started using a family planning method in the five years before the survey, 43 percent stopped using the method within 12 months. Discontinuation rates are highest for injectables and the pill. • Twenty-nine percent of currently married women have an unmet need for family planning services (15 percent for spacing births and 14 percent for stopping childbearing), with just over half of the demand being satisfied. • Overall, 92 percent of nonusers did not discuss family planning with a fieldworker or a staff member at a health facility. 58 • Family Planning Table 7.1 Knowledge of contraceptive methods Percentage of ever-married women and currently married women age 15-49 who know a contraceptive method, by specific method, Yemen 2013 Method Ever-married women Currently married women Any method 98.2 98.3 Any modern method 98.2 98.3 Female sterilization 72.2 72.2 Male sterilization 30.0 29.8 Pill 96.9 97.1 IUD 89.9 90.0 Injectables 92.2 92.5 Implants 84.0 84.0 Male condom 55.3 55.5 Female condom 14.4 14.3 Diaphragm 10.2 10.2 Lactational amenorrhea (LAM) 80.5 80.6 Emergency contraception 11.4 11.5 Any traditional method 74.6 74.7 Rhythm 65.6 65.7 Withdrawal 57.6 58.0 Other 7.7 7.5 Mean number of methods known by respondents 15-49 7.7 7.7 Number of respondents 16,564 15,566 The pill, injectables, the IUD, and implants are the contraceptive methods most widely known among women in Yemen. Among currently married women age 15-49, 97 percent have heard of the pill, 93 percent have heard of injectables, 90 percent have heard of the IUD, and 84 percent have heard of implants. Each of these figures is markedly higher than those reported in the 1997 YDMCHS (76 percent, 56 percent, 64 percent, and 6 percent, respectively). Knowledge of several other modern methods has also dramatically increased. For example, the proportion of currently married women who have heard of female sterilization has increased from 48 percent in 1997 to 72 percent in 2013, while the proportion who have heard of the male condom has doubled from 24 percent in 1997 to 56 percent in 2013. Over four in five women have heard of the lactational amenorrhea method (LAM). The least well known modern methods are the diaphragm (known by 10 percent of currently married women), emergency contraception (12 percent), female condom (14 percent), and male sterilization (30 percent). With regard to traditional methods, two- thirds of women have heard of the rhythm method, while 58 percent know about withdrawal. Overall, women in Yemen have heard of an average of 7.7 contraceptive methods. As shown in Table 7.2, knowledge of some method of family planning is almost universal among currently married women in Yemen. Across all categories of age, residence, governorate, education, and wealth, more than 95 percent of currently married women have heard of at least one contraceptive method and at least one modern method with only three exceptions: women age 15-19, women in Al-Mhrah Governorate, and women in the lowest wealth quintile. Even in these three categories, however, more than 90 percent of women have heard of a modern method of contraception. Table 7.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women age 15-49 who have heard of at least one contraceptive method and who have heard of at least one modern method, by background characteristics, Yemen 2013 Background characteristic Heard of any method Heard of any modern method1 Number Age 15-19 94.2 94.2 1,084 20-24 98.7 98.7 2,968 25-29 98.1 98.1 3,574 30-34 98.9 98.8 2,675 35-39 99.1 99.1 2,409 40-44 98.6 98.5 1,579 45-49 98.0 98.0 1,277 Continued… Family Planning • 59 Table 7.2—Continued Background characteristic Heard of any method Heard of any modern method1 Number Residence Urban 99.8 99.8 4,949 Rural 97.6 97.5 10,617 Governorate Ibb 98.8 98.8 1,678 Abyan 99.0 99.0 326 Sana’a City 100.0 100.0 1,510 Al-Baidha 98.3 98.3 702 Taiz 98.4 98.4 2,053 Al-Jawf 98.2 98.2 124 Hajjah 96.0 95.9 867 Al-Hodiedah 98.5 98.5 1,891 Hadramout 97.2 97.2 884 Dhamar 97.0 96.9 1,106 Shabwah 99.2 99.2 293 Sadah 95.5 95.5 504 Sana’a 99.4 99.4 831 Aden 100.0 100.0 487 Lahj 98.0 97.6 405 Mareb 99.7 99.7 111 Al-Mhweit 96.1 96.0 425 Al-Mhrah 91.4 90.4 61 Amran 98.9 98.9 595 Aldhalae 99.0 99.0 384 Reimah 98.0 98.0 330 No education 97.1 97.1 8,336 Fundamental 99.5 99.5 5,090 Secondary 99.9 99.9 1,511 Higher 100.0 100.0 629 Wealth quintile Lowest 94.1 93.9 2,840 Second 98.1 98.0 3,076 Middle 99.3 99.3 3,141 Fourth 99.6 99.5 3,147 Highest 100.0 100.0 3,362 Total 15-49 98.3 98.3 15,566 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception 7.2 CURRENT USE OF CONTRACEPTION Contraceptive use is one of the principal determinants of the level of fertility. Changes in contraceptive prevalence that have occurred over time can indicate the overall success of family plannin

View the publication

You are currently offline. Some pages or content may fail to load.