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 planning programs in Yemen. Contraceptive use among currently married women age 15-49 is presented in Table 7.3 by age group. The contraceptive prevalence rate (CPR), or the percentage of currently married women who use a contraceptive method of any sort, is 34 percent, while the CPR for modern methods is 29 percent; only 4 percent of currently married women use a traditional method. The contraceptive methods most commonly used are the pill (12 percent) and the IUD (6 percent) (Figure 7.1). Four percent of currently married women reported using injectables, another 4 percent use LAM, and 2 percent have been sterilized. Less than one percent of married women are using implants, male condoms, or male sterilization. As for traditional methods, 3 percent of married women reported using withdrawal, while 2 percent are using the rhythm method. The contraceptive prevalence rate increases with age, reaching a peak of 40 percent at age 30-39, after which it declines to 37 percent at age 40-44 and to 29 percent among women age 45-49. The pill is the most popular method among women at every age group except 45-49 when it is overtaken by female sterilization. 60 • F am ily P la nn in g Ta bl e 7. 3 C ur re nt u se o f c on tra ce pt io n by a ge P er ce nt d is tri bu tio n of c ur re nt ly m ar rie d w om en a ge 1 5- 49 b y co nt ra ce pt iv e m et ho d cu rre nt ly u se d, a cc or di ng to a ge , Y em en 2 01 3 A ny m et ho d A ny m od er n m et ho d M od er n m et ho d A ny tr ad i- tio na l m et ho d Tr ad iti on al m et ho d N ot cu rr en tly us in g To ta l N um be r o f w om en A ge Fe m al e st er ili - za tio n M al e st er ili - za tio n P ill IU D In je ct - ab le s Im pl an ts M al e co nd om LA M O th er R hy th m W ith - dr aw al O th er 15 -1 9 13 .2 12 .1 0. 0 0. 0 6. 2 1. 2 1. 8 0. 2 0. 2 2. 6 0. 0 1. 1 0. 5 0. 6 0. 0 86 .8 10 0. 0 1, 08 4 20 -2 4 25 .4 23 .0 0. 0 0. 0 11 .5 3. 7 2. 8 0. 6 0. 2 4. 3 0. 0 2. 5 0. 7 1. 8 0. 0 74 .6 10 0. 0 2, 96 8 25 -2 9 36 .4 32 .8 0. 4 0. 0 13 .9 7. 0 4. 8 0. 8 0. 5 5. 3 0. 1 3. 6 1. 0 2. 4 0. 1 63 .6 10 0. 0 3, 57 4 30 -3 4 40 .2 35 .6 1. 6 0. 0 13 .8 8. 8 5. 8 0. 6 0. 8 4. 2 0. 0 4. 6 2. 2 2. 4 0. 0 59 .8 10 0. 0 2, 67 5 35 -3 9 40 .5 34 .5 3. 2 0. 0 12 .3 7. 8 5. 2 0. 5 1. 1 4. 4 0. 0 6. 0 2. 6 3. 2 0. 2 59 .5 10 0. 0 2, 40 9 40 -4 4 37 .4 30 .6 7. 8 0. 1 9. 4 5. 6 4. 5 0. 4 0. 4 2. 3 0. 1 6. 8 2. 5 4. 0 0. 3 62 .6 10 0. 0 1, 57 9 45 -4 9 29 .2 22 .9 7. 7 0. 8 7. 0 3. 1 2. 4 0. 4 0. 3 1. 2 0. 0 6. 4 1. 9 4. 4 0. 1 70 .8 10 0. 0 1, 27 7 To ta l 33 .5 29 .2 2. 3 0. 1 11 .6 5. 9 4. 2 0. 6 0. 5 4. 0 0. 0 4. 3 1. 6 2. 6 0. 1 66 .5 10 0. 0 15 ,5 66 N ot e: If m or e th an o ne m et ho d is u se d, o nl y th e m os t e ffe ct iv e m et ho d is c on si de re d in th is ta bu la tio n. LA M = L ac ta tio na l a m en or rh ea m et ho d 60 • Family Planning Family Planning • 61 Figure 7.1 Percentage of currently married women using specific contraceptive methods Figure 7.2 shows trends in contraceptive use among currently married women from 1997 to 2013. Data from four surveys conducted in Yemen over the past 16 years show an impressive increase in the use of contraceptive methods from 21 percent in 1997 to 34 percent in 2013. The increase in the use of contraceptives is due mainly to increased use of modern methods (from 10 percent in 1997 to 29 percent in 2013), while use of traditional methods has decreased from 11 percent in 1997 to 4 percent in 2013. The figure shows that the proportion of currently married women who are using a modern method of contraception has increased by 50 percent in the past 7 years (from 19 percent in 2006 to 29 percent in 2013), while use of traditional methods has decreased by 50 percent (from 8 percent in 2006 to 4 percent in 2013). Figure 7.2 Trends in contraceptive prevalence, Yemen 1997-2013 7.3 CURRENT USE OF CONTRACEPTION BY BACKGROUND CHARACTERISTICS Table 7.4 shows that there are large variations in contraceptive use among currently married women age 15-49 by background characteristics. For example, very few married women without children use any contraceptive method (1 percent), compared with over 40 percent of women with three or more children. 2 3 4 1 1 2 4 4 6 12 29 Rhythm Withdrawal Any traditional method Male condons Implants Female sterilization LAM Injectables IUD Pill Any modern method YNHDS 2013 Percentage 10 11 21 13 10 23 19 8 28 29 4 34 Any modern method Any traditional method Any method 1997 YDMCHS 2003 YFHS 2006 YMICS 2013 YNHDS Percentage 62 • F am ily P la nn in g Ta bl e 7. 4 C ur re nt u se o f c on tra ce pt io n by b ac kg ro un d ch ar ac te ris tic s P er ce nt d is tri bu tio n of c ur re nt ly m ar rie d w om en a ge 1 5- 49 b y co nt ra ce pt iv e m et ho d cu rre nt ly u se 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 A ny m et ho d A ny m od er n m et ho d M od er n m et ho d A ny tr ad i- tio na l m et ho d Tr ad iti on al m et ho d N ot cu rr en tly us in g To ta l N um be r o f w om en B ac kg ro un d ch ar ac te ris tic Fe m al e st er ili - za tio n M al e st er ili - za tio n P ill IU D In je ct - ab le s Im pl an ts M al e co nd om LA M O th er R hy th m W ith - dr aw al O th er N um be r o f l iv in g ch ild re n 0 1. 1 0. 8 0. 1 0. 0 0. 6 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 3 0. 0 0. 2 0. 0 98 .9 10 0. 0 1, 86 4 1- 2 30 .9 27 .3 0. 5 0. 0 13 .4 4. 9 2. 6 0. 6 0. 4 4. 8 0. 0 3. 6 1. 5 2. 1 0. 0 69 .1 10 0. 0 4, 53 8 3- 4 41 .5 36 .8 1. 4 0. 1 15 .0 8. 7 5. 1 0. 8 0. 6 5. 0 0. 0 4. 7 1. 8 2. 9 0. 1 58 .5 10 0. 0 3, 94 1 5+ 41 .3 35 .2 5. 2 0. 1 11 .4 6. 8 6. 4 0. 6 0. 7 3. 8 0. 1 6. 1 2. 1 3. 7 0. 2 58 .7 10 0. 0 5, 22 3 R es id en ce U rb an 47 .5 40 .2 3. 1 0. 1 17 .2 11 .0 3. 3 0. 9 1. 2 3. 2 0. 1 7. 3 2. 9 4. 3 0. 1 52 .5 10 0. 0 4, 94 9 R ur al 27 .0 24 .0 1. 9 0. 1 9. 0 3. 5 4. 6 0. 4 0. 2 4. 3 0. 0 2. 9 1. 0 1. 9 0. 1 73 .0 10 0. 0 10 ,6 17 G ov er no ra te Ib b 32 .7 30 .7 2. 8 0. 4 12 .0 6. 6 6. 9 0. 4 0. 3 1. 4 0. 0 2. 0 0. 9 1. 0 0. 2 67 .3 10 0. 0 1, 67 8 A by an 32 .4 29 .5 0. 7 0. 0 15 .5 3. 8 2. 8 0. 7 0. 3 5. 9 0. 0 2. 9 1. 2 1. 7 0. 0 67 .6 10 0. 0 32 6 S an a’ a C ity 56 .2 48 .1 3. 4 0. 0 19 .6 16 .9 1. 9 0. 8 1. 6 3. 7 0. 1 8. 1 2. 2 5. 9 0. 0 43 .8 10 0. 0 1, 51 0 A l-B ai dh a 33 .9 30 .2 1. 2 0. 0 12 .2 6. 7 5. 9 0. 3 0. 4 3. 5 0. 0 3. 7 0. 2 3. 5 0. 1 66 .1 10 0. 0 70 2 Ta iz 31 .4 27 .7 1. 3 0. 2 8. 9 4. 3 4. 4 0. 7 0. 3 7. 4 0. 1 3. 7 2. 0 1. 7 0. 1 68 .6 10 0. 0 2, 05 3 A l-J aw f 26 .3 26 .0 0. 1 0. 0 10 .7 4. 1 7. 9 0. 5 0. 1 2. 5 0. 0 0. 4 0. 2 0. 1 0. 0 73 .7 10 0. 0 12 4 H aj ja h 17 .1 16 .4 1. 6 0. 0 6. 3 1. 3 5. 7 0. 3 0. 2 1. 1 0. 0 0. 6 0. 5 0. 1 0. 0 82 .9 10 0. 0 86 7 A l-H od ie da h 16 .5 13 .7 1. 7 0. 0 7. 4 2. 4 1. 8 0. 3 0. 0 0. 1 0. 0 2. 8 1. 9 0. 5 0. 4 83 .5 10 0. 0 1, 89 1 H ad ra m ou t 37 .3 27 .5 1. 3 0. 0 15 .4 4. 5 1. 6 0. 4 0. 5 3. 7 0. 1 9. 8 5. 5 4. 3 0. 0 62 .7 10 0. 0 88 4 D ha m ar 35 .2 33 .2 4. 2 0. 0 8. 2 8. 1 6. 3 0. 3 0. 9 5. 2 0. 0 2. 0 0. 6 1. 3 0. 0 64 .8 10 0. 0 1, 10 6 S ha bw ah 21 .3 19 .4 2. 0 0. 0 9. 9 3. 2 2. 2 0. 4 0. 4 1. 1 0. 2 1. 9 1. 0 0. 9 0. 1 78 .7 10 0. 0 29 3 S ad ah 32 .7 26 .9 0. 5 0. 0 11 .7 1. 9 9. 4 0. 2 0. 0 3. 3 0. 0 5. 8 1. 2 4. 5 0. 1 67 .3 10 0. 0 50 4 S an a’ a 49 .7 41 .3 4. 1 0. 0 16 .0 10 .5 3. 4 1. 1 1. 0 5. 3 0. 0 8. 4 1. 1 7. 3 0. 0 50 .3 10 0. 0 83 1 A de n 46 .9 40 .4 1. 7 0. 0 20 .9 6. 5 4. 6 1. 1 2. 1 3. 1 0. 4 6. 5 2. 5 4. 0 0. 0 53 .1 10 0. 0 48 7 La hj 33 .2 30 .4 1. 5 0. 2 19 .7 1. 8 2. 3 0. 5 0. 3 4. 1 0. 0 2. 9 1. 3 1. 4 0. 2 66 .8 10 0. 0 40 5 M ar eb 25 .7 21 .3 1. 2 0. 0 7. 9 7. 3 2. 5 0. 4 0. 3 1. 8 0. 0 4. 5 1. 3 2. 6 0. 6 74 .3 10 0. 0 11 1 A l-M hw ei t 23 .1 19 .6 3. 2 0. 0 6. 7 3. 1 4. 0 0. 1 0. 0 2. 5 0. 0 3. 4 1. 1 2. 3 0. 0 76 .9 10 0. 0 42 5 A l-M hr ah 32 .9 20 .0 1. 0 0. 0 7. 7 0. 9 1. 2 0. 4 0. 1 8. 7 0. 0 12 .9 2. 5 10 .3 0. 0 67 .1 10 0. 0 61 A m ra n 48 .3 41 .9 2. 7 0. 0 10 .1 5. 4 4. 7 0. 9 0. 8 17 .1 0. 1 6. 4 0. 7 5. 7 0. 0 51 .7 10 0. 0 59 5 A ld ha la e 34 .2 29 .1 5. 6 0. 0 8. 9 2. 9 5. 2 1. 7 0. 2 4. 5 0. 1 5. 0 2. 1 2. 7 0. 2 65 .8 10 0. 0 38 4 R ei m ah 14 .0 12 .4 0. 7 0. 0 5. 4 1. 8 3. 4 0. 4 0. 2 0. 6 0. 0 1. 6 0. 6 0. 7 0. 3 86 .0 10 0. 0 33 0 Ed uc at io n N o ed uc at io n 28 .0 24 .8 3. 0 0. 1 8. 1 3. 8 4. 8 0. 4 0. 4 4. 0 0. 0 3. 2 0. 9 2. 2 0. 2 72 .0 10 0. 0 8, 33 6 Fu nd am en ta l 37 .7 32 .5 1. 3 0. 1 14 .7 7. 6 3. 8 0. 7 0. 4 3. 9 0. 1 5. 3 2. 1 3. 1 0. 1 62 .3 10 0. 0 5, 09 0 S ec on da ry 42 .6 37 .4 1. 1 0. 0 18 .3 9. 0 3. 3 0. 9 0. 8 3. 9 0. 0 5. 3 2. 5 2. 8 0. 0 57 .4 10 0. 0 1, 51 1 H ig he r 50 .4 40 .8 2. 7 0. 0 17 .0 13 .2 1. 5 0. 7 1. 9 3. 8 0. 1 9. 6 4. 9 4. 7 0. 0 49 .6 10 0. 0 62 9 W ea lth q ui nt ile Lo w es t 14 .5 13 .6 0. 8 0. 0 3. 2 0. 6 3. 5 0. 2 0. 2 5. 2 0. 0 0. 9 0. 2 0. 7 0. 1 85 .5 10 0. 0 2, 84 0 S ec on d 24 .0 21 .0 1. 6 0. 0 6. 7 3. 1 4. 5 0. 2 0. 2 4. 6 0. 0 3. 0 0. 8 2. 1 0. 1 76 .0 10 0. 0 3, 07 6 M id dl e 33 .8 30 .5 2. 8 0. 2 12 .1 4. 9 6. 4 0. 5 0. 3 3. 4 0. 0 3. 3 0. 8 2. 3 0. 1 66 .2 10 0. 0 3, 14 1 Fo ur th 42 .2 35 .8 3. 2 0. 0 14 .5 8. 1 5. 1 1. 0 0. 4 3. 5 0. 1 6. 4 2. 6 3. 5 0. 2 57 .8 10 0. 0 3, 14 7 H ig he st 49 .7 42 .2 2. 8 0. 2 20 .0 12 .0 1. 6 0. 9 1. 4 3. 3 0. 1 7. 5 3. 2 4. 3 0. 0 50 .3 10 0. 0 3, 36 2 To ta l 33 .5 29 .2 2. 3 0. 1 11 .6 5. 9 4. 2 0. 6 0. 5 4. 0 0. 0 4. 3 1. 6 2. 6 0. 1 66 .5 10 0. 0 15 ,5 66 N ot e: If m or e th an o ne m et ho d is u se d, o nl y th e m os t e ffe ct iv e m et ho d is c on si de re d in th is ta bu la tio n. LA M = L ac ta tio na l a m en or rh ea m et ho d. 62 • Family Planning Family Planning • 63 Married women in urban areas are more likely to use contraceptive methods than their counterparts in rural areas (48 percent compared with 27 percent). Among governorates, use of contraceptive methods is highest in Sana’a City (56 percent) and lowest in Reimah Governorate (14 percent). Contraceptive use is positively associated with women’s level of education and wealth. Twenty- eight percent of currently married women with no education use contraceptives, compared with 50 percent of those with higher education. Similarly, only 15 percent of married women in the lowest wealth quintile use contraceptives compared with 50 percent of women in the highest wealth quintile. The same patterns hold for use of modern contraceptives and use of traditional methods. 7.4 TIMING OF STERILIZATION Information on the age at which women gets sterilized is useful for family planning programs. In the 2013 YNHDS, women using female sterilization were asked the month and year at which they had the procedure. Table 7.5 shows the percent distribution of currently married, sterilized women by age at the time of sterilization, according to the number of years since the operation. Table 7.5 Timing of sterilization Percent distribution of currently married women age 15-49 sterilized by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Yemen 2013 Age at time of sterilization Total Number of women Median age1 Years since operation <25 25-29 30-34 35-39 40-44 45-49 <2 2.2 8.3 25.9 31.1 28.3 4.1 100.0 81 34.7 2-3 2.0 7.4 19.3 40.3 27.7 3.2 100.0 60 35.5 4-5 (2.1) (18.4) (25.9) (38.2) (15.5) (0.0) 100.0 44 (34.1) 6-7 (10.5) (15.3) (33.7) (24.5) (16.0) (0.0) 100.0 49 (33.0) 8-9 (4.5) (17.0) (33.4) (36.9) (8.2) (0.0) 100.0 40 (33.9) 10+ 9.7 29.0 44.6 16.6 0.0 0.0 100.0 77 a Total 5.2 15.9 30.8 30.1 16.4 1.5 100.0 353 33.2 Note: Figures in parentheses are based on 25-49 unweighted cases. a = Not calculated due to censoring 1 Median age at sterilization is calculated only for women sterilized before age 40 at less than 40 years of age to avoid problems of censoring The table indicates that more women get sterilized at ages 30-34 and 35-39 than in other age groups, but it also indicates that over one-fifth of sterilized women had the operation when they were relatively young, i.e., under age 30. The median age at the time of sterilization fluctuates by the number of years since the operation, showing no pattern across time. However, comparison with the 1997 YDMCHS shows a slight decrease in the median age at sterilization, from 34 years in 1997 to 33 years in 2013 (CSO and MI, 1998). 7.5 SOURCE OF MODERN CONTRACEPTIVE METHODS Where women obtain the contraceptive methods they use is useful information for family planning program managers and others who plan the distribution of contraceptives. In the 2013 YNHDS, all women who reported that they were currently using any modern contraceptive method at the time of the survey were asked where they obtained the method the last time they acquired it. Because women may know the name of the facility but not exactly in which category the source falls (e.g., government or private, health center or clinic), in such cases, the interviewers were instructed to note the name of the source or facility. Furthermore, supervisors were trained to verify the name and type of source to maintain consistency and improve the accuracy of the information. Table 7.6 shows that just over half (53 percent) of users obtain their contraceptives from public sector sources. Government hospitals are the most common public source (25 percent), followed by government health centers (18 percent). Forty-four percent use the private medical sector to obtain contraceptives. Pharmacies (24 percent) and private hospitals and clinics (20 percent) are the providers from 64 • Family Planning the private medical sector. One percent of women obtain contraceptive methods from non-governmental organizations (NGOs). Table 7.6 Source of modern contraceptive methods Percent distribution of currently married women using modern contraceptive methods age 15-49 by most recent source of method, according to method, Yemen 2013 Source Female sterilization Pill IUD Injectables Implants Male condom Total Public sector 62.0 49.2 53.7 56.8 80.7 30.3 53.0 Government hospital 59.5 16.5 27.7 22.8 44.6 7.9 24.6 Government health center 1.9 20.5 16.8 21.6 21.1 11.1 17.9 Primary health center 0.0 8.1 0.9 8.7 1.0 4.9 5.5 Family planning clinic 0.0 4.0 8.1 3.3 13.9 6.4 4.8 Mobile clinic 0.6 0.1 0.2 0.4 0.0 0.0 0.2 Private medical sector 31.3 49.0 43.3 41.7 15.4 67.6 44.3 Private hospital/ clinic/doctor 31.3 9.1 42.6 14.8 15.4 1.8 19.9 Pharmacy 0.0 39.8 0.6 26.9 0.0 65.8 24.4 NGO 0.2 0.5 2.8 1.3 3.9 0.0 1.2 Other 0.7 1.2 0.0 0.1 0.0 2.1 0.7 Missing 5.7 0.2 0.2 0.1 0.0 0.0 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 353 1,808 921 654 86 82 3,920 Note: Total excludes lactational amenorrhea method (LAM) and other modern methods. Total includes 12 cases of male sterilization, 1 user of the female condom, and 3 users of the diaphragm. The source from which a woman obtains her contraceptive method differs based on the method she uses. For example, 81 percent of implant users obtain this method from a public sector source, typically a government hospital (45 percent) or government health center (21 percent). In contrast, only 30 percent of condom users obtain male condoms from the public sector. Pill users are evenly split between those who obtain the method from a public source and those who use private sources. 7.6 INFORMED CHOICE Women age 15-49 who are currently using a modern contraceptive method and who started the last episode of use within five years of the survey were asked whether they had been informed about possible side effects or problems of their chosen method, what to do if they experienced side effects, and other methods that they could also use. Their responses give a measure of the quality of family planning service provision. Table 7.7 shows the results from the 2013 YNHDS, by method and by source of the current episode of use. Only fifty-nine percent of users of modern contraceptives were ever informed about side effects or health problems associated with the method they used, 45 percent were informed about what to do if they experienced side effects, and 60 percent were told of other methods available. Women using IUDs and implants were the most likely to be informed of side effects and what to do if they experienced side effects. There are small differences by method in the proportions of women who were informed of other methods that they could use. Women who had been sterilized and women using the pill were the least likely to be informed about side effects, about what to do if they experienced side effects, and about other methods. Women who got their contraceptive from the public sector were more likely than those who got their contraceptive from the private sector to be informed of side effects, what to do if they experienced side effects, and other methods that they could use. Family Planning • 65 Table 7.7 Informed choice Among currently married women age 15-49 using modern methods who started the last episode of use within the five years preceding the survey, the percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods they could use, by method and initial source, Yemen 2013 Among women who started last episode of modern contraceptive method within five years preceding the survey: Method/source Percentage who were ever informed about side effects or problems of method used Percentage who were informed about what to do if experienced side effects Percentage who were ever informed by a health or family planning worker of other methods that could be used Number of women Method Female sterilization 53.7 33.4 56.1 155 Pill 52.0 37.8 57.6 1,700 IUD 74.2 62.4 65.2 769 Injectables 59.2 43.3 63.4 599 Implants 71.4 60.7 61.1 86 Initial source of method1 Public sector 63.8 49.2 67.4 1,894 Government hospital 63.5 50.1 65.4 839 Government health center 63.9 47.9 66.7 685 Primary health center 59.9 49.1 67.6 205 Family planning clinic 70.2 50.2 81.0 157 Mobile clinic * * * 8 Private medical sector 52.8 39.2 51.4 1,336 Private hospital/clinic/doctor 63.8 52.6 59.9 686 Pharmacy 41.2 25.0 42.3 650 Private hospital/clinic/doctor NGO (71.7) (59.9) (57.6) 34 Other (38.0) (20.1) (40.4) 36 Total 59.1 44.9 60.4 3,309 Note: Table includes users of only the methods listed. Total includes 9 cases with missing information on Initial source of method. Figures in parentheses are based on 25-49 unweighted cases. 1 Source at start of current episode of use 7.7 RATES OF DISCONTINUING CONTRACEPTIVE METHODS Couples can realize their reproductive goals only when they consistently use reliable methods of contraception. Of particular concern to family planning programs is the rate at which users discontinue contraceptive methods and the reasons for such discontinuation. Armed with this information, family planning providers are able to better advise potential users of the advantages and disadvantages of each contraceptive method, allowing women to make a more informed decision about the method that best suits their needs. Women age 15-49 who started an episode of contraceptive use within the five years preceding the survey and discontinued it within 12 months were asked the reason for the discontinuation. Table 7.8 presents discontinuation rates, by contraceptive type and by reason for discontinuation. Among all methods, 43 percent of episodes of use were discontinued within 12 months. Some methods are much more likely to be discontinued early than others. For example, almost half of those who start using injectables, the pill, and male condoms discontinue within 12 months. In contrast, fewer than one in five women who start using the IUD discontinue within 12 months. The reason for discontinuation also varies by method. For example, whereas 24 percent of episodes of use of injectables were discontinued because of side effects and/or health concerns, no episodes of use of the rhythm method were discontinued for this reason. Use of the rhythm method and withdrawal are particularly subject to discontinuation due to failure of the method (i.e., unwanted pregnancy). 66 • Family Planning Table 7.8 Twelve-month contraceptive discontinuation rates Among ever-married women age 15-49 who started an episode of contraceptive use within the five years preceding the survey, the percentage of episodes discontinued within 12 months, by reason for discontinuation and specific method, Yemen, 2011 Method Method failure Desire to become pregnant Other fertility- related reasons2 Side effects/ health concerns Wanted more effective method Other method- related reasons3 Other reasons Any reason4 Switched to another method5 Number of episodes of use6 Female sterilization (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) 163 Pill 5.1 6.5 10.6 16.9 2.0 2.5 4.1 47.6 8.7 4,887 IUD 1.3 2.0 1.6 10.8 0.7 1.1 1.0 18.5 8.1 1,209 Injectables 1.5 3.8 6.2 24.3 1.5 4.7 6.3 48.5 13.9 1,424 Implants (1.4) (2.3) (1.0) (15.1) (0.0) (6.4) (0.2) (26.5) (9.4) 179 Male condom (7.9) (6.8) (5.1) (6.5) (5.4) (5.3) (11.1) (48.2) (20.3) 156 Rhythm 15.5 5.6 1.7 0.0 4.8 2.0 3.1 32.7 7.9 456 Withdrawal 12.3 5.0 4.5 0.3 7.1 1.0 7.5 37.6 12.1 716 Other1 13.4 3.7 1.3 1.5 17.8 2.7 7.5 48.0 21.7 2,940 All methods 7.2 4.8 5.9 11.4 6.1 2.6 5.0 43.0 12.7 12,167 Note: Figures are based on life table calculations using information on episodes of use that began 3-62 months preceding the survey. Figures in parentheses are based on 125-249 unweighted cases. 1 Includes LAM, male sterilization, diaphragm, other modern methods, and other traditional methods 2 Includes difficult to get pregnant/menopausal and marital dissolution/separation 3 Includes lack of access/too far, costs too much, and inconvenient to use 4 Reasons for discontinuation are mutually exclusive and add to the total given in this column. 5 The episodes of use included in this column are a subset of the discontinued episodes included in the discontinuation rate. A woman is considered to have switched to another method if she used a different method in the month following discontinuation or if she gave “wanted a more effective method” as the reason for discontinuation and started another method within two months of discontinuation. 6 Number of episodes of use includes both episodes of use that were discontinued during the period of observation and episodes of use that were not discontinued during the period of observation. 7.8 REASONS FOR DISCONTINUING CONTRACEPTIVE METHODS Table 7.9 shows the percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason stated for the discontinuation, according to specific method. In total, almost 10,000 discontinuations occurred within this time period. Across all contraceptive methods, the most common reason for discontinuation was health concerns/side effects (26 percent), followed by the desire to become pregnant (21 percent), and method failure (became pregnant while using) (17 percent). Table 7.9 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason stated for discontinuation, according to specific method, Yemen 2013 Reason Pill IUD Injection Implants Male condom LAM Rhythm With- drawal Other All methods Became pregnant while using 10.8 4.9 5.1 2.2 17.3 29.5 40.5 33.9 (20.2) 16.7 Wanted to become pregnant 25.2 27.8 15.3 15.0 18.9 12.0 26.1 23.1 (22.5) 20.7 Husband disapproved 1.8 1.2 2.3 0.7 9.4 0.4 1.9 5.6 (2.2) 1.7 Wanted a more effective method 3.6 2.0 2.6 2.0 12.3 27.2 13.0 14.9 (7.4) 10.4 Side effects/health concerns 33.2 50.6 48.1 64.0 14.4 2.9 1.7 2.3 (26.3) 26.0 Lack of access/too far 0.5 0.1 2.4 0.0 0.6 7.6 0.9 0.0 (0.0) 2.4 Cost too much 0.2 0.1 0.6 1.9 2.6 0.0 0.0 0.0 (0.0) 0.2 Inconvenient to use 3.1 2.6 4.3 10.6 7.2 1.3 2.9 2.5 (2.6) 2.8 Up to God/fatalistic 0.1 0.0 0.3 0.0 0.0 2.1 1.0 1.5 (0.0) 0.7 Difficult to get pregnant/ menopausal 0.1 0.5 0.1 0.0 0.0 0.1 0.6 0.0 (0.0) 0.1 Infrequent sex/husband away 15.0 3.9 9.2 1.9 7.0 2.4 4.4 6.0 (15.7) 9.1 Marital dissolution/separation 0.6 1.4 0.3 0.6 1.6 0.4 0.3 0.1 (0.0) 0.6 Other 1.9 1.3 3.7 0.4 4.2 4.3 2.2 4.0 (0.0) 2.8 Don’t know 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (0.0) 0.0 Missing 3.8 3.6 5.5 0.9 4.5 9.6 4.5 6.3 (3.1) 5.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 4,266 800 1,146 123 123 2,478 364 537 42 9,887 LAM = Lactational amenorrhea method 1 Includes female and male sterilization, and female condom Family Planning • 67 Across specific contraceptive methods, the reasons for discontinuation vary widely. For example, among users of the pill, IUD, injectables, and implants, the main reason for discontinuing was side effects/health concerns, followed by the desire to become pregnant. Almost two-thirds of discontinuations of implants and half of discontinuations of the IUD were due to side effects, health concerns, or both. Discontinuation of condom use was most likely to be due to either the desire to become pregnant or to becoming pregnant while using. Method failure was the most common reason for discontinuing use of LAM, the rhythm method, and withdrawal. 7.9 NEED AND DEMAND FOR FAMILY PLANNING Table 7.10 presents data on unmet need, met need, and total demand for family planning for currently married women. These indicators help to evaluate the extent to which the family planning program in Yemen meets the demand for services. Table 7.10 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Yemen 2013 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Background characteristic For spacing For stopping Total For spacing For stopping Total For spacing For stopping Total Age 15-19 26.6 2.6 29.2 11.9 1.3 13.2 38.5 3.9 42.4 31.2 28.5 1,084 20-24 23.3 5.9 29.2 19.9 5.6 25.4 43.2 11.5 54.7 46.5 42.0 2,968 25-29 19.9 10.0 29.9 23.3 13.1 36.4 43.2 23.2 66.3 54.9 49.4 3,574 30-34 12.5 16.1 28.6 18.1 22.0 40.2 30.6 38.1 68.8 58.4 51.7 2,675 35-39 9.4 22.1 31.6 11.6 28.9 40.5 21.0 51.0 72.0 56.2 47.8 2,409 40-44 3.5 22.4 25.8 4.4 32.9 37.4 7.9 55.3 63.2 59.1 48.4 1,579 45-49 1.8 20.6 22.4 2.7 26.6 29.2 4.4 47.2 51.6 56.6 44.3 1,277 Residence Urban 11.5 8.8 20.3 23.9 23.5 47.5 35.4 32.3 67.7 70.1 59.3 4,949 Rural 16.6 16.1 32.7 11.6 15.3 27.0 28.2 31.4 59.7 45.2 40.3 10,617 Governorate Ibb 19.7 13.7 33.4 14.9 17.8 32.7 34.6 31.5 66.1 49.5 46.4 1,678 Abyan 7.3 10.4 17.7 19.2 13.2 32.4 26.5 23.6 50.0 64.7 59.0 326 Sana’a City 9.5 6.9 16.4 29.8 26.4 56.2 39.3 33.3 72.6 77.4 66.2 1,510 Al-Baidha 15.3 15.3 30.6 15.3 18.6 33.9 30.7 33.9 64.5 52.5 46.8 702 Taiz 14.2 11.9 26.0 13.4 18.0 31.4 27.6 29.9 57.5 54.7 48.2 2,053 Al-Jawf 18.8 15.3 34.0 13.6 12.7 26.3 32.4 28.0 60.4 43.6 43.0 124 Hajjah 21.0 26.5 47.5 4.7 12.4 17.1 25.7 38.9 64.6 26.4 25.5 867 Al-Hodiedah 17.1 20.8 37.9 5.7 10.9 16.5 22.8 31.6 54.4 30.4 25.2 1,891 Hadramout 12.8 5.0 17.7 27.2 10.1 37.3 40.0 15.1 55.1 67.8 50.0 884 Dhamar 16.2 15.8 32.0 17.4 17.8 35.2 33.6 33.6 67.2 52.4 49.4 1,106 Shabwah 21.1 10.4 31.4 11.9 9.4 21.3 33.0 19.7 52.8 40.4 36.7 293 Sadah 11.8 11.0 22.8 16.4 16.3 32.7 28.2 27.3 55.5 58.9 48.5 504 Sana’a 12.7 11.0 23.7 21.3 28.4 49.7 34.0 39.4 73.5 67.7 56.3 831 Aden 8.5 6.8 15.3 17.3 29.5 46.9 25.8 36.3 62.2 75.4 65.0 487 Lahj 9.8 13.9 23.8 12.6 20.6 33.2 22.4 34.6 57.0 58.3 53.3 405 Mareb 22.2 11.2 33.4 15.3 10.5 25.7 37.4 21.7 59.1 43.5 36.0 111 Al-Mhweit 20.3 20.9 41.2 7.1 16.0 23.1 27.4 37.0 64.3 35.9 30.5 425 Al-Mhrah 9.9 5.6 15.5 21.6 11.3 32.9 31.4 17.0 48.4 67.9 41.3 61 Amran 12.0 11.3 23.3 20.4 28.0 48.3 32.4 39.3 71.6 67.4 58.5 595 Aldhalae 13.0 13.7 26.7 12.2 22.0 34.2 25.2 35.7 60.9 56.1 47.8 384 Reimah 20.0 21.5 41.5 5.3 8.7 14.0 25.3 30.2 55.5 25.2 22.4 330 Education No education 13.8 19.2 33.0 9.2 18.7 28.0 23.0 38.0 61.0 45.9 40.7 8,336 Fundamental 17.1 8.4 25.4 20.4 17.3 37.7 37.5 25.7 63.2 59.7 51.4 5,090 Secondary 16.0 5.8 21.8 27.2 15.4 42.6 43.3 21.2 64.4 66.1 58.0 1,511 Higher 11.2 4.1 15.3 31.4 19.0 50.4 42.6 23.1 65.7 76.7 62.1 629 Wealth quintile Lowest 19.3 23.8 43.1 5.1 9.4 14.5 24.4 33.2 57.6 25.2 23.7 2,840 Second 17.6 16.1 33.7 9.6 14.4 24.0 27.1 30.5 57.7 41.6 36.4 3,076 Middle 15.2 13.6 28.8 14.0 19.8 33.8 29.2 33.4 62.6 54.0 48.8 3,141 Fourth 13.0 9.4 22.4 21.2 21.1 42.2 34.2 30.4 64.6 65.4 55.5 3,147 Highest 10.6 7.4 18.0 25.9 23.8 49.7 36.5 31.2 67.7 73.4 62.4 3,362 Total 15.0 13.8 28.7 15.5 18.0 33.5 30.5 31.7 62.2 53.8 46.9 15,566 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, and lactational amenorrhea method (LAM). 68 • Family Planning Unmet need for family planning refers to fecund women who are not using contraception but who wish to postpone the next birth (spacing) or stop childbearing altogether (limiting). Specifically, women are considered to have unmet need for spacing if they are: • At risk of becoming pregnant, not using contraception, and either do not want to become pregnant within the next two years, or are unsure if or when they want to become pregnant. • Pregnant with a mistimed pregnancy. • Postpartum amenorrheic for up to two years following a mistimed birth and not using contraception. Women are considered to have unmet need for stopping childbearing if they are: • At risk of becoming pregnant, not using contraception, and want no (more) children. • Pregnant with an unwanted pregnancy. • Postpartum amenorrheic for up to two years following an unwanted birth and not using contraception. Women who are classified as infecund have no unmet need because they are not at risk of becoming pregnant. Women using contraception are considered to have met need. Women using contraception who say they want no (more) children are considered to have met need for stopping childbearing, and women who are using contraception and say they want to delay having a child, or are unsure if or when they want a/another child, are considered to have met need for spacing. Unmet need, total demand, percentage of demand satisfied, and percentage of demand satisfied by modern methods are defined as follows: • Unmet need: the sum of unmet need for spacing plus unmet need for stopping childbearing • Total demand for family planning: the sum of unmet need plus total contraceptive use • Percentage of demand satisfied: total contraceptive use divided by the sum of unmet need plus total contraceptive use • Percentage of demand satisfied by modern methods: use of modern contraceptive methods divided by the sum of unmet need plus total contraceptive use The definition of unmet need for family planning has been revised to make levels of unmet need comparable over time and across surveys. The aspect of the change in the definition that has the largest impact on levels of unmet need is the removal of information collected from the contraceptive calendar, which is not included in all surveys. Previously, in surveys that included a calendar, women who were pregnant or postpartum amenorrheic resulting from contraceptive failure were not considered to have unmet need, even if their last pregnancy/birth was unwanted or mistimed. By contrast, if the survey did not collect information on contraceptive failure in the calendar, all pregnant and postpartum amenorrheic women whose last pregnancy/birth was unwanted or mistimed were considered to have unmet need. To make the definition of unmet need comparable in both types of surveys, the new definition does not take information on contraceptive failure into account for any woman when assigning unmet need status. Removing contraceptive failure from the calculation can result in a small increase in the estimated level of unmet need by moving some women who were in the contraceptive failure category into the unmet need category. Family Planning • 69 Table 7.10 shows that 29 percent of currently married women have an unmet need for family planning services (15 percent for spacing births and 14 percent for stopping childbearing). Thirty-four percent of married women are currently using a contraceptive method. Almost two in three currently married women (62 percent) have a demand for family planning. At present, 54 percent of the potential demand for family planning is being met. Thus, if all married women who said they want to space or limit their children were to use family planning methods, the contraceptive prevalence rate would increase from 34 percent to 62 percent. As expected, unmet need for spacing is high among younger women, while unmet need for stopping childbearing is higher among older women. Unmet need is higher in rural than urban areas, with urban areas at 20 percent and rural areas at 33 percent. Regional differences in unmet need are also relatively large. Almost half of the currently married women in Hajjah Governorate have an unmet need for family planning services (48 percent), compared with only 15 percent of women in Aden Governorate. Unmet need decreases steadily as women’s education level increases. It declines from 33 percent of women with no education to only 15 percent of those with higher education. Unmet need is also inversely associated with a woman’s wealth status. Among women in the lowest wealth quintile, unmet need is 43 percent, while it is 18 percent among those in the highest wealth quintile. Comparison with the 1997 YDMCHS indicates a large decline in unmet need over the past 16 years. Since the definition of unmet need changed between the surveys, the indicator for the 2013 YNHDS was recalculated using the older definition (see Table C.8 in Appendix C). This shows that unmet need declined from 39 percent of married women in 1997 to 27 percent in 2013 (CSO and MI, 1998). 7.10 FUTURE USE OF CONTRACEPTION An important indicator of the changing demand for family planning is the extent to which nonusers plan to use contraceptive methods in the future, as this is a forecast of potential demand for services. In the 2013 YNHDS, women who were not using contraceptives at the time of the survey were asked about their intention to use family planning in the future. Table 7.11 shows results for currently married women age 15-49. The table shows that 44 percent of currently married nonusers indicated that they intend to use family planning methods in the future, while 40 percent said that they do not intend to use a method in the future; 14 percent were unsure. The proportion of women who intend to use a method is highest among women with one to three children and lowest among those with no children and those with at least four children. Table 7.11 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Yemen 2013 Number of living children1 Total Intention 0 1 2 3 4+ Intends to use 42.7 51.4 50.3 51.1 36.5 43.6 Unsure 17.7 15.4 14.4 10.8 13.6 14.2 Does not intend to use 37.3 32.0 33.4 36.5 47.9 40.3 Missing 2.3 1.2 1.9 1.7 2.0 1.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,425 1,660 1,521 1,301 4,447 10,354 1 Includes current pregnancy 70 • Family Planning 7.11 EXPOSURE TO FAMILY PLANNING MESSAGES IN THE MEDIA Radio, television, and newspapers and/or magazines are potential sources of information about family planning in Yemen. Information on the level of public exposure to messages through these media allows policymakers to ensure the use of the most effective media for various target groups. To assess the effectiveness of such media on the dissemination of family planning information, ever-married women interviewed in the 2013 YNHDS were asked whether they had heard messages about family planning on the radio or seen them on television or in newspapers/magazines during the few months preceding the survey (Table 7.12). Table 7.12 Exposure to family planning messages Percentage of ever-married women age 15-49 who heard or saw a family planning message on radio, on television, or in a newspaper or magazine in the past few months, according to background characteristics, Yemen 2013 Background characteristic Radio Television Newspaper/ magazine None of these three media sources Number of women Age 15-19 27.3 39.6 12.3 47.3 1,112 20-24 30.0 48.6 13.9 40.6 3,099 25-29 29.0 46.3 11.0 43.9 3,731 30-34 30.0 48.5 10.9 41.3 2,824 35-39 28.8 45.1 9.1 44.5 2,612 40-44 29.7 46.6 8.0 44.7 1,744 45-49 24.8 42.1 6.9 49.8 1,442 Residence Urban 30.7 63.1 19.6 30.5 5,322 Rural 28.1 38.1 6.4 50.1 11,242 Governorate Ibb 24.9 55.4 12.7 36.1 1,791 Abyan 19.4 43.9 16.9 51.6 345 Sana’a City 40.4 71.1 25.8 23.3 1,587 Al-Baidha 30.1 56.0 9.9 39.7 768 Taiz 26.4 53.2 12.3 37.2 2,196 Al-Jawf 14.7 29.4 6.5 62.5 141 Hajjah 39.1 27.2 4.5 53.9 895 Al-Hodiedah 38.0 40.2 6.2 43.6 2,023 Hadramout 16.4 28.3 6.8 62.0 958 Dhamar 31.3 38.9 4.7 47.7 1,188 Shabwah 14.0 41.2 13.6 54.4 315 Sadah 8.3 30.0 2.2 69.1 532 Sana’a 48.8 49.1 9.5 36.6 867 Aden 10.6 55.8 15.8 38.8 534 Lahj 34.1 47.0 17.9 42.3 425 Mareb 30.0 48.5 15.9 37.9 123 Al-Mhweit 25.1 44.4 5.1 46.2 445 Al-Mhrah 4.4 29.7 4.7 68.2 62 Amran 23.8 43.0 5.8 46.2 614 Aldhalae 16.5 31.7 10.4 65.8 404 Reimah 22.4 17.3 1.6 66.7 350 Education No education 24.8 34.1 2.1 54.9 8,887 Fundamental 32.0 56.1 14.8 34.5 5,416 Secondary 38.8 68.5 30.8 22.9 1,564 Higher 35.3 72.2 41.9 20.6 697 Wealth quintile Lowest 22.9 8.8 1.3 72.9 3,010 Second 28.9 35.3 4.7 50.6 3,248 Middle 29.4 55.0 7.8 37.6 3,330 Fourth 30.7 60.1 13.8 33.6 3,394 Highest 31.9 66.0 23.6 28.4 3,582 Total 28.9 46.1 10.6 43.8 16,564 Overall, 29 percent of ever-married women reported that they had recently heard a family planning message on the radio, 46 percent had seen a message on television, and 11 percent saw messages in newspapers or magazines. Although these numbers indicate that coverage is far from universal, they indicate an increase over time. The proportion of ever-married women who heard a family planning message on the radio increased from 24 percent in 1997 to 29 percent in 2013, while the proportion who saw a message on television increased from 22 percent in 1997 to 46 percent in 2013 (CSO and MI, 1998). Family Planning • 71 Exposure to family planning messages does not vary substantially by the woman’s age, although women age 15-19 are the least likely to have seen a family planning message on television and woman age 45-49 are the least likely to have heard a message on the radio or seen a message in a newspaper or magazine. Stronger differences in access to media messages are observed by residence, governorate, education, and wealth. For example, women in urban areas are more likely than those in rural areas to have access to family planning messages on television (63 percent and 38 percent respectively) or in newspapers or magazines (20 percent and 6 percent, respectively). The proportion of ever-married women who have heard a family planning message on the radio ranges from 4 percent in Al Mhrah Governorate to a high of 49 percent in Sana’a Governorate. The range is even greater for television, from 17 percent of women in Reimah Governorate to 71 percent of women in Sana’a City. Exposure to family planning messages on all three types of media increases as the respondent’s education level and wealth status increases. The relationship is particularly strong for television and print media. 7.12 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS In the 2013 YNHDS, women who were not using any contraceptive method were asked whether a fieldworker talked with them about family planning in the 12 months preceding the survey. This information is especially useful for determining whether family planning outreach programs reach nonusers. Nonusers were also asked if they had visited a health facility in the preceding 12 months for any reason, and if so, whether any staff member at the facility had spoken to them about family planning. These questions help to assess the level of missed opportunities to inform women about contraception. The results shown in Table 7.13 indicate that only 4 percent of nonusers reported being visited by a fieldworker who discussed family planning with them. Five percent of nonusers visited a health facility and discussed family planning in the 12 months before the survey, while 36 percent of the nonusers had visited a facility but did not discuss family planning. Differences by background characteristics are minimal. Overall, 92 percent of nonusers did not discuss family planning with a fieldworker or a staff member at a health facility. This represents a significant pool of potential users of family planning who could be targeted for family planning counseling. A more vigorous outreach program will be needed to reach these women. Table 7.13 Contact of nonusers with family planning providers Among ever-married women age 15-49 who are not using contraception, the percentage who during the past 12 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who did not discuss family planning either with a fieldworker or at a health facility, by background characteristics, Yemen 2013 Percentage of women who were visited by fieldworker who discussed family planning Percentage of women who visited a health facility in the past 12 months and who: Percentage of women who did not discuss family planning either with fieldworker or at a health facility Number of women Background characteristic Discussed family planning Did not discuss family planning Age 15-19 2.5 2.5 31.6 95.4 969 20-24 3.8 5.5 39.6 91.6 2,344 25-29 3.9 5.7 37.5 91.1 2,430 30-34 5.1 5.2 35.3 90.7 1,749 35-39 4.0 4.2 37.5 92.9 1,637 40-44 3.6 3.3 37.0 93.9 1,154 45-49 3.0 2.5 28.7 94.7 1,069 Residence Urban 4.0 5.3 45.4 91.4 2,974 Rural 3.8 4.3 32.9 92.7 8,378 Governorate Ibb 2.0 3.2 21.1 95.2 1,242 Abyan 2.9 7.4 20.2 90.7 240 Sana’a City 2.8 5.9 33.6 91.4 738 Al-Baidha 2.0 6.1 64.2 92.1 530 Taiz 2.4 6.5 39.9 92.2 1,551 Al-Jawf 9.4 8.3 39.5 86.4 108 Continued… 72 • Family Planning Table 7.13—Continued Percentage of women who were visited by fieldworker who discussed family planning Percentage of women who visited a health facility in the past 12 months and who: Percentage of women who did not discuss family planning either with fieldworker or at a health facility Number of women Background characteristic Discussed family planning Did not discuss family planning Governorate Hajjah 2.1 3.2 27.3 95.1 747 Al-Hodiedah 6.0 2.3 49.6 92.4 1,711 Hadramout 2.1 0.8 29.1 97.0 628 Dhamar 4.4 6.2 23.7 89.8 798 Shabwah 3.4 2.5 43.8 94.3 252 Sadah 3.6 3.2 56.1 93.1 367 Sana’a 10.5 4.8 41.6 86.5 454 Aden 4.8 9.3 61.7 88.6 305 Lahj 8.7 7.8 21.6 86.6 290 Mareb 5.9 3.8 60.0 90.9 95 Al-Mhweit 4.8 7.7 23.6 89.4 347 Al-Mhrah 4.4 4.0 41.6 91.5 42 Amran 5.3 3.5 37.0 92.4 327 Aldhalae 1.7 6.4 22.8 92.0 273 Reimah 0.9 1.2 9.9 97.8 304 Education No education 3.6 3.5 33.1 93.5 6,556 Fundamental 4.0 5.0 40.3 92.0 3,495 Secondary 5.0 8.5 41.9 87.8 920 Higher 4.0 9.2 38.4 87.2 380 Wealth quintile Lowest 3.9 2.8 30.2 93.9 2,598 Second 3.7 3.7 32.7 93.3 2,509 Middle 4.0 5.7 37.1 91.5 2,269 Fourth 4.1 5.9 41.2 90.7 2,064 Highest 3.5 5.2 42.6 91.9 1,912 Total 3.9 4.5 36.2 92.4 11,351 Early Childhood and Maternal Mortality • 73 EARLY CHILDHOOD AND MATERNAL MORTALITY 8 nformation on levels, trends, and differentials in neonatal, infant, and child mortality is important in the demographic assessment of the population and the evaluation of health policies and programs. Estimates of infant and child mortality are used for population projections. Information on mortality of children serves the needs of agencies providing health services by identifying subgroups of the population at high risk of mortality. 8.1 BACKGROUND AND QUALITY OF DATA ON EARLY CHILDHOOD MORTALITY The rates of childhood mortality presented in this chapter are defined as follows: • Neonatal mortality: the probability of dying within the first month of life • Postneonatal mortality: the arithmetic difference between infant and neonatal mortality • Infant mortality: the probability of dying between birth and the first birthday • Child mortality: the probability of dying between the first and the fifth birthday • Under-5 mortality: the probability of dying between birth and the fifth birthday All rates are expressed as deaths per 1,000 live births, except child mortality, which is expressed as deaths per 1,000 children surviving to the first birthday. Information drawn from the questions asked in the birth history section of the Ever-Married Woman’s Questionnaire is used to calculate the mortality rates presented in this chapter. First, the respondents were asked a series of questions about their childbearing experience. In particular, they were asked to report the number of sons and daughters living with them, the number living elsewhere, and the number who have died. In the birth history, for each live birth, information was collected on sex; month and year of birth; survivorship status; and current age or, if the child has died, age at death. The quality of mortality estimates calculated from retrospective birth histories depends on the mother’s ability to recall all of the children she has given birth to, as well as their birth dates and ages at death. Potentially the most serious data quality problem is the selective omission from the birth histories of those births that did not survive. If the problem of omission is serious, it can result in underestimation of childhood mortality. If selective omission of childhood deaths occurs, it is usually most severe for deaths early in infancy. Generally, if deaths are substantially underreported, the result is a low ratio of early neonatal I Key Findings • The under-5 mortality rate in Yemen is 53 deaths per 1,000 live births. This means that about 1 in 19 children dies before age 5. • The infant mortality rate is 43 deaths per 1,000 live births. • There has been a remarkable decline in childhood mortality rates over the past three decades. The under-5 mortality rate decreased from 150 deaths per 1,000 live births in about 1985 to 53 deaths per 1,000 live births in about 2011. • Under-5 mortality is twice as high for births to women with no education as for women with higher education. • Survey data show that spacing births farther apart could have an enormous impact on further reducing under-5 mortality in Yemen. • The maternal mortality ratio measured in the survey is 148 maternal deaths per 100,000 births. 74 • Early Childhood and Maternal Mortality deaths (deaths within the first week of life) to all neonatal deaths and a low ratio of neonatal deaths to infant deaths. An examination of the proportion of early neonatal deaths to all neonatal deaths (Appendix Table C.5) shows that early neonatal deaths represented 79 percent of all neonatal deaths for the five-year period prior to the 2013 YNHDS.1 This relatively high proportion implies little, if any, omission of neonatal deaths. The percentage of early neonatal deaths decreases incrementally for each five-year period further back in time, which is to be expected. An examination of the proportion of neonatal deaths to infant deaths (Appendix Table C.6) shows that neonatal deaths represented 65 percent of infant deaths for the five-year period prior to the 2013 YNHDS. This is higher than the proportion reported in the period 5-19 years before the survey, which ranged between 47 percent and 54 percent. Again, this proportion does not provide evidence of omission of deaths in infancy. Another potential data quality problem involves the displacement of birth dates, which may distort mortality trends. This can occur if an interviewer knowingly records a birth as occurring in a different year, which could happen if an interviewer were trying to cut down on the work load, because live births occurring during the five years preceding the interview are the subject of a lengthy set of additional questions. In the 2013 YNHDS questionnaire, the cut-off year for these questions was 2008. Appendix Table C.4 shows evidence of clear transference of children from 2008 to earlier years. For example, there were 2,673 children born in 2008 compared with 3,702 born in 2007, a 38 percent increase. A third factor that affects childhood mortality estimates is the quality of reporting of age at death. Misreporting the child’s age at death may distort the age pattern of mortality, especially if the net effect of the age misreporting is to transfer deaths from one age bracket to another. For example, a net transfer of deaths from under 1 month to a higher age will affect the estimates of neonatal and postneonatal mortality. To minimize errors in reporting age at death, YNHDS interviewers were instructed to record age at death in days if the death took place in the month following the birth, in months if the child died before age 2, and in years if the child was at least age 2. They also were asked to probe for deaths reported at age 1 to determine a more precise age at death in terms of months. Appendix Table C.6 shows a high level of “heaping” on age at death of 12 months. For example, for the five years preceding the survey, the number of reported deaths at age 12 months is 39, compared with only 4 at age 11 months and 5 at age 10 months. To the extent that at least some of these deaths actually occurred before age 12 months, the infant mortality rate is probably distorted somewhat. However, the table shows that there were no deaths reported to have occurred at age “1 year.” Finally, any method of measuring childhood mortality that relies on mothers’ reports (e.g., birth histories) assumes that female adult mortality is not high, or if it is high, that there is little or no correlation between the mortality risks of the mothers and those of their children. In countries like Yemen that have low rates of female adult mortality, these assumptions are likely valid. 8.2 INFANT AND CHILD MORTALITY LEVELS AND TRENDS Table 8.1 presents childhood mortality rates for the three five-year periods before the 2013 YNHDS. The data show that for the five-year period immediately prior to the survey (which roughly corresponds to the calendar years 2009-2013), under-5 mortality was 53 per 1,000 live births. This means that 1 in 19 children born in Yemen dies before reaching their fifth birthday. Most of the mortality occurs during the first 1 There are no models for mortality patterns during the neonatal period. However, one review of data from several developing countries concluded that, at neonatal mortality levels of 20 per 1,000 or higher, approximately 70 percent of neonatal deaths occur within the first six days of life (Boerma, 1988). Early Childhood and Maternal Mortality • 75 year of life; infant mortality is 43 deaths per 1,000 births, while mortality between the first and fifth birthday is 10 per 1,000. Mortality during the first month of life, or neonatal mortality, is 26 per 1,000 births, while postneonatal mortality (between the first month and the first year of life) is 17 per 1,000. Table 8.1 Early childhood mortality rates Neonatal, post-neonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Yemen 2013 Years preceding the survey Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) 0-4 2009-2013 26 17 43 10 53 5-9 2004-2008 27 23 50 12 62 10-14 1999-2003 32 29 61 23 82 1 Computed as the difference between the infant and neonatal mortality rates An examination of the mortality levels across the three successive five-year periods shown in Table 8.1 suggests that under-5 mortality has progressively declined over the 15 years prior to the 2013 YNHDS: from 82 deaths per 1,000 live births during the period circa 1999-2003, to 62 deaths per 1,000 live births during the period 2004-2008, to 53 deaths per 1,000 live births during the period 2009- 2013. Neonatal, postneonatal, infant, and child mortality all declined during this 15-year span. Trends in mortality in early childhood can also be explored by examining the mortality results from previous surveys in Yemen. Figure 8.1 shows under-5 mortality rates for several five-year periods preceding the 1997 YDMCHS, the 2003 YFHS, the 2006 YMICS, and the 2013 YNHDS surveys. Although not entirely consistent, the data show a remarkable decline in childhood mortality rates over the past three decades. The under-5 mortality rate decreased from 150 deaths per 1,000 live births in about 1985 to 53 deaths per 1,000 live births in about 2011. Figure 8.1 Trends in under-5 mortality 1985-2011 0 20 40 60 80 100 120 140 Deaths per 1,000 Central year of estimates 1997 YDMCHS 2003 YFHS 2006 YMICS 2013 YNHDS 76 • Early Childhood and Maternal Mortality 8.3 SOCIOECONOMIC DIFFERENTIALS IN EARLY CHILDHOOD MORTALITY Table 8.2 shows differentials in infant and child mortality by residence, governorate, mother’s education, and wealth quintile. The mortality estimates are calculated for the 10-year period before the survey (approximately 2004-2013) so that the rates are based on a sufficient number of cases in each category to ensure statistically reliable estimates. Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by background characteristics, Yemen 2013 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Residence Urban 21 15 36 8 44 Rural 28 22 51 12 63 Governorate Ibb 28 23 51 11 62 Abyan 27 15 41 8 49 Sana’a City 22 10 32 5 37 Al-Baidha 30 32 62 9 70 Taiz 29 22 51 10 60 Al-Jawf 15 11 26 6 32 Hajjah 20 12 33 11 43 Al-Hodiedah 29 21 49 18 66 Hadramout 17 10 27 6 32 Dhamar 27 35 62 15 76 Shabwah 21 9 29 9 39 Sadah 23 20 44 10 54 Sana’a 29 31 61 12 71 Aden 22 13 35 5 40 Lahj 18 10 29 6 34 Mareb 32 21 53 8 61 Al-Mhweit 34 20 55 16 70 Al-Mhrah 25 16 41 11 52 Amran 31 28 59 16 74 Aldhalae 33 10 43 5 47 Reimah 33 22 54 13 66 Mother’s education No education 27 23 50 13 62 Fundamental 26 19 45 9 54 Secondary 25 12 37 4 41 Higher 20 9 29 2 31 Wealth quintile Lowest 29 25 53 17 69 Second 32 26 58 14 72 Middle 25 22 48 9 56 Fourth 23 15 38 9 46 Highest 22 11 33 5 38 1 Computed as the difference between the infant and neonatal mortality rates Childhood mortality is higher in rural areas than in urban areas at all age groups. For example, the under-5 mortality rate is 63 deaths per 1,000 live births in rural areas and 44 deaths per 1,000 births in urban areas. Data for governorates should be interpreted with caution due to the relatively high sampling errors associated with mortality rates. Nevertheless, the data show marked differentials by governorate, with under- 5 mortality ranging from 32 deaths per 1,000 births in Al-Jawf and Hadramout governorates to 76 in Dhamar Governorate. A mother’s education and the wealth quintile into which a child is born also relate to survival. The under-5 mortality rate decreases steadily as education of the mother increases, from 62 deaths per 1,000 births to mothers with no education to 31 deaths for mothers with higher education. The under-5 mortality rate is also substantially lower for births in the highest wealth quintile (38 deaths per 1,000 live births) than for births in the lowest two quintiles (69-72 deaths per 1,000 live births). Early Childhood and Maternal Mortality • 77 8.4 DEMOGRAPHIC DIFFERENTIALS IN EARLY CHILDHOOD MORTALITY The relationship between early childhood mortality and various demographic variables is examined in Table 8.3. As expected, mortality for male children is generally slightly higher than for female children, especially for neonatal mortality rates (30 deaths per 1,000 live births for boys and 23 deaths per 1,000 live births for girls). All five childhood mortality rates decline steadily with increasing age of the mother at the time of the birth. For example, the infant mortality rate for children born to women age 45-49 (34 per 1,000 births) is half that for children born to women under age 20 (69 per 1,000) (Figure 8.2). The pattern of mortality by birth order is not consistent, although neonatal, infant, and under-5 mortality rates show the characteristic U-shaped pattern with the highest rates among first births and the lowest among birth orders 4-6. Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under5 mortality rates for the 10-year period preceding the survey, by demographic characteristics, Yemen 2013 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Child’s sex Male 30 18 49 11 59 Female 23 22 45 11 56 Mother’s age at birth <20 41 27 69 12 80 20-29 26 20 46 11 56 30-39 19 18 37 11 48 40-49 18 16 34 (6) (40) Birth order 1 40 19 59 9 67 2-3 28 21 49 11 59 4-6 19 20 39 13 52 7+ 22 22 44 10 53 Previous birth interval2 <2 years 38 35 73 18 89 2 years 16 19 35 9 43 3 years 10 7 17 5 21 4+ years 14 5 19 8 27 Birth size3 Small/very small 26 15 41 na na Average or larger 20 13 33 na na Note: Figures in parentheses are based on 250-499 unweighted cases. na = Not available 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the five-year period before the survey Studies have shown that longer birth intervals increase children’s chances of survival. Data from the 2013 YNHDS generally support this observation. For example, under-5 mortality decreases from 89 deaths per 1,000 live births for children born less than two years after a preceding sibling to 21 deaths per 1,000 live births for children born three years after a preceding sibling before rising slightly to 27 deaths for children born four or more years after a preceding sibling. Neonatal, postneonatal, infant, and child mortality rates also generally decline as the interval between births increases. These findings point out the potential for mortality reduction that could result from successful efforts to promote birth spacing in Yemen. A child’s size at birth is an indicator of the risk of dying during infancy, particularly during the first months of life. In the 2013 YNHDS, in addition to recording the actual birth weight, interviewers asked mothers whether each of their children born in the last five years was very small, small, average size, large, or very large at birth. This type of subjective assessment has been shown to correlate closely with actual birth weight. Survey results indicate that newborns perceived by their mothers to be very small or small were more likely to die in their first year than those perceived as average or larger in size; the differential is especially great during the neonatal period. 78 • Early Childhood and Maternal Mortality Figure 8.2 Infant mortality by demographic characteristics 8.5 PERINATAL MORTALITY Pregnancy losses occurring after seven completed months of gestation (stillbirths) plus deaths of live births within the first seven days of life (early neonatal deaths) constitute perinatal deaths. The distinction between a stillbirth and an early neonatal death is recognized as a fine one, often depending on observing and then remembering sometimes faint signs of life after delivery. Furthermore, the causes of stillbirths and early neonatal deaths are closely linked, and examining just one or the other can understate the true level of mortality around delivery. For this reason, deaths around the time of delivery are combined when assessing the perinatal mortality rate. Information on stillbirths is available for the five years preceding the survey and was collected using the calendar at the end of the Woman’s Questionnaire. Table 8.4 indicates that the perinatal mortality for the country as a whole is 36 deaths per 1,000 pregnancies of seven or more months in duration. There are differentials in perinatal mortality across background characteristics of the mothers. For example, perinatal mortality is highest among both the youngest and oldest mothers as well as for first pregnancies. It is also higher for rural than urban women. 19 17 35 73 44 39 49 59 34 37 46 69 45 49 0 20 40 60 80 4+ years 3 years 2 years <2 years Previous birth interval 7+ 4-6 2-3 1 Birth order 40-49 30-39 20-29 <20 Mother's age at birth Female Male Sex Percentage YNHDS 2013 Early Childhood and Maternal Mortality • 79 Table 8.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Yemen 2013 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother’s age at birth <20 35 68 48 2,144 20-29 143 177 35 9,041 30-39 51 66 28 4,244 40-49 25 10 49 704 Previous pregnancy interval in months4 First pregnancy 73 100 57 3,010 <15 79 118 47 4,190 15-26 34 44 24 3,247 27-38 25 15 18 2,206 39+ 43 44 25 3,480 Residence Urban 39 82 28 4,340 Rural 214 239 38 11,793 Mother’s education No education 142 173 35 8,907 Fundamental 95 106 39 5,218 Secondary 10 29 27 1,456 Higher 6 12 31 552 Wealth quintile Lowest 72 59 36 3,634 Second 62 90 43 3,522 Middle 54 65 36 3,257 Fourth 39 46 29 2,985 Highest 26 61 32 2,735 Total 253 320 36 16,133 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, expressed per 1,000. 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months. 8.6 HIGH-RISK FERTILITY BEHAVIOR Typically, infants and young children have a higher risk of dying if they are born to very young mothers or older mothers, if they are born after a short birth interval, or if their mothers have already had many children. In the following analysis, mothers are classified as at risk if they are younger than age 18 or older than age 35 at the time of childbirth. A short birth interval is defined as less than 24 months, and a high-order birth is defined as occurring after three or more previous births (i.e., birth order 4 or higher). A child may be at an elevated risk of dying due to a combination of factors. The first column of Table 8.5 shows the percentage of births in the five years before the survey classified by various risk categories. Overall, 62 percent of births involved at least one avoidable risk factor, with 39 percent involving a single risk factor and 24 percent involving multiple risk factors. Fortunately, 21 percent of births in Yemen do not fall into any high-risk category, and 17 percent are first births to women age 18-34, which are considered to be in an unavoidable risk category. The second column in Table 8.5 presents risk ratios, which represent the increased risk of mortality among births in various high-risk categories relative to births not having any high-risk characteristics. Among births involving a single risk factor, mother’s age less than 18 (risk ratio = 2.9) is the single factor most associated with increased risk of under-5 mortality in Yemen; however, only 4 percent of births fall in this category. Overall, the risk ratio for single risk factor births was 1.6. Multiple risk factor births were generally associated with higher risk ratios than single risk factor births, with an overall risk ratio of 2.1. The third column of Table 8.5 shows the distribution of currently married women by the risk category into which a birth conceived at the time of the survey would fall. The data in the table show that 17 80 • Early Childhood and Maternal Mortality percent of women are not in any high-risk category and 10 percent are only at risk of having their first birth between ages 18 and 34, which is considered to be an unavoidable risk. Seventy-four percent of currently married women have at least one avoidable risk factor, with 31 percent having a single risk factor and 42 percent having multiple risk factors. Table 8.5 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Yemen 2013 Births in the five years preceding the survey Percentage of currently married women1 Risk category Percentage of births Risk ratio Not in any high risk category 20.9 1.00 17.0a Unavoidable risk category First order births between ages 18 and 34 years 17.0 2.11 9.5 Single high-risk category Mother’s age <18 3.9 2.94 0.9 Mother’s age >34 0.8 2.11 3.0 Birth interval <24 months 11.0 2.28 10.3 Birth order >3 22.8 0.94 17.2 Subtotal 38.5 1.55 31.3 Multiple high-risk category Age <18 and birth interval <24 months2 0.7 5.25 0.3 Age >34 and birth interval <24 months 0.1 (4.12) 0.2 Age >34 and birth order >3 10.7 1.16 25.4 Age >34 and birth interval <24 months and birth order >3 2.5 3.32 5.0 Birth interval <24 months and birth order >3 9.5 2.57 11.3 Subtotal 23.5 2.09 42.2 In any avoidable high-risk category 62.1 1.76 73.5 Total 100.0 na 100.0 Number of births/women 15,880 na 15,566 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the category age <18 and birth order >3 a Includes sterilized women 8.7 MATERNAL MORTALITY The maternal mortality ratio is considered to be a key indicator of the health status of a population. According to the World Health Organization’s international classification of diseases, a maternal death is defined as a death of a woman while pregnant or within 42 days of the end of the pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (WHO, 2014). Maternal deaths are rare events, being far less common than childhood deaths and therefore more difficult to measure. Estimation of maternal mortality rates and ratios requires comprehensive and accurate reporting of deaths to women as well as determination as to whether the death was due to maternal causes. Maternal mortality was measured in the 2013 YNHDS, but not by using the maternal mortality module developed by MEASURE DHS (which is based on the sisterhood method). Instead, the survey used a much more involved methodology designed by the Pan Arab Project for Family Health (PAPFAM) and used in the 2003 YFHS. The maternal mortality component of the YNHDS was implemented in two phases: Early Childhood and Maternal Mortality • 81 Household Listing. During the household listing operation, listers recorded two pieces of information for each of the 113,463 households listed: the number of births and the number of deaths of women age 12-49 in the two previous years. All households with a woman’s death in the past two years were identified 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 (see Appendix D). Among the deaths of women age 12-49 identified during the household listing phase, 332 deaths were confirmed during the data collection phase; that means that a) the household was visited, b) the woman’s age at death was confirmed, and c) the period of death – the last two years – was also confirmed (see Table 8.6). Of these deaths, 83 were subsequently identified as maternal deaths during the data collection phase because they were reported to have occurred during pregnancy, delivery, or within 40 days after giving birth, and they were not caused by an accident. This means that 25 percent of deaths of women age 12-49 can be classified as “maternal” (pregnancy-related) causes. During the listing, 56,018 births were identified in all listed households. Therefore the maternal mortality ratio (ratio of maternal deaths to live births) is estimated to be 148 maternal deaths per 100,000 live births for the two-year period before the survey. The confidence interval for the ratio is 105-190. The maternal mortality ratio is much higher in rural areas than in urban areas (164 compared with 97). Table 8.6 Maternal mortality Results of the maternal mortality survey and maternal mortality ratio, by residence, Yemen 2013 Residence Total Maternal mortality survey Urban Rural Number of deaths of women age 12-49 in the past two years 67 265 332 Number of maternal deaths in the past two years (excluding deaths by accident) 13 70 83 Percentage of deaths to women age 12-49 classified as maternal deaths 19.5 26.3 24.9 Number of live births in the past two years 13,504 42,515 56,018 Maternal mortality ratio (per 100,000 live births) 97 164 148 The maternal mortality ratio of 148 as measured by the 2013 YNHDS is less than half the ratio of 365 deaths per 100,000 births measured in the 2003 YFHS (MOPHP, CSO, PAPFAM, 2004). It is also considerably lower than the maternal mortality ratio of 270 (range of 150-510) estimated by the United Nations for 2013 (WHO, 2014). Although it is likely that maternal deaths in Yemen have declined over time, it is important to recognize the difficulties in measuring maternal mortality and to exercise caution in interpreting numbers, especially since the methodology incorporated in the survey of collecting data on the number of maternal deaths and live births in households is likely to result in maternal mortality ratios that are systematically biased downward due to underreporting of deaths (WHO, 2014). Table 8.7 presents the percent distribution of maternal deaths in the past two years (excluding deaths by accident) by age at death, and woman’s level of education and age at marriage. Globally the distribution of deaths by age follows the fertility curve, with the highest percentage of maternal deaths at age 20-29 years, the age of the highest fertility. While 54 percent of Yemeni women do not have any education, this percentage is much higher among women who have died a maternal death (80 percent). About half of the all women Table 8.7 Maternal deaths by background characteristics Percent distribution of maternal deaths in the past two years (excluding deaths by accident) by age at death, level of education, and age at marriage, Yemen 2013 Background characteristic Percent Age at death < 20 13.3 20-29 48.5 30-39 21.8 40 + 16.5 Total 100.0 Education No education 80.3 Formal education 19.7 Total 100.0 Age at marriage < 18 48.0 18 + 38.8 Missing 13.2 Total 100.0 Number of maternal deaths 83 82 • Early Childhood and Maternal Mortality age 15-49 are married before 20, this proportion is about the same among women who have died a maternal death (48 percent). Figure 8.3 shows the percent distribution of the 83 maternal deaths according to the place where the death occurred: 42 percent of deaths took place at home, or in a relative’s home, while 39 percent of deaths took place in a health facility. The fact that a large proportion of deaths (17 percent) occurred on the way to the health facility suggests that the women and/or her family cannot recognize or recognize too late the signs of complications during pregnancy, delivery, or the few weeks following delivery. Figure 8.3 Percent distribution of maternal deaths by place of death Figure 8.4 shows the percentage of women who had specific symptoms/conditions before they died a maternal death, as reported by the respondent to the Maternal Mortality Questionnaire. It should be noted that a respondent could report several symptoms/conditions. Among all women classified as having died a maternal death, the most commonly reported symptoms/conditions were vaginal bleeding (40 percent), coma (32 percent), high fever (26 percent), and convulsions (21 percent). Figure 8.4 Symptoms/conditions of the women before maternal death On the way to health facility, 17% Other place 2% Home 42% Health facility 39% YNHDS 2013 40 32 26 26 21 5 4 2 Vaginal bleeding Coma High fever Other Convulsion Labor pain stopped Nothing Don't know Percentage YNHDS 2013 Note: More than one symptom/condition may have been reported for each woman. Therefore, the sum of percentages may exceed 100 percent. Maternal Health Care • 83 MATERNAL HEALTH CARE 9 he health care services that a mother receives during pregnancy, childbirth, and the immediate postnatal period are important for the survival and wellbeing of both the mother and the infant. The 2013 YNHDS obtained information on the extent to which women in Yemen receive care during each of these stages. These results are important to those who design policy and implement programs to improve maternal and child health care services. This chapter also includes information on knowledge and self-reported prevalence of obstetric fistula, on self-reported prevalence of tumors, and on problems that women may face in accessing health care. 9.1 ANTENATAL CARE Antenatal care from a skilled provider is important for monitoring pregnancy and reducing the risks for both mother and child during pregnancy, at delivery, and within the postnatal period (within 42 days after delivery). Antenatal care enables (1) screening and/or early detection of complications and prompt treatment (e.g., of sexually transmitted infections or anemia); (2) prevention of diseases through immunization and micronutrient supplementation; (3) birth preparedness and complication readiness; (4) health promotion and disease prevention through health messages; and (5) advice and counseling of pregnant women, including place of delivery and referral of mothers with complications. Collecting information on antenatal care is relevant for identifying subgroups of women who do not use such services and is useful in planning improvements in services provided. In the 2013 YNHDS, women who had given birth in the five years preceding the survey were asked whether they had received antenatal care for their last live birth. If the respondent had received antenatal care for her last birth, she was then asked a series of questions about the care she received, such as the type of provider, number of visits made, stage of pregnancy at the time of the first visit, and services and information provided during these visits. T Key Findings • Six in ten women age 15-49 who gave birth in the five years preceding the survey received antenatal care from a skilled provider for their most recent birth. Less than one-third of women received antenatal care during their first trimester. • Immunizations to prevent tetanus are not common in Yemen; only 28 percent of recent births were fully protected against the disease. • Only 30 percent of births in Yemen take place in a health facility and less than half (45 percent) are assisted by a skilled provider. • Among women who gave birth in the two years preceding the survey, 20 percent received a postnatal checkup within the first two days after birth from a skilled provider. • Only 11 percent of newborns received postnatal care in the first two days of life. • Less than 1 percent of women report having had obstetric fistula. • Less than 2 percent of women reported that they have ever had a tumor. • Four in five women report that a big problem in accessing health care when sick is not wanting to go alone; about three in five indicate that lack of a female provider and distance to a health facility are problems. 84 • Maternal Health Care For women with two or more live births during the five-year period preceding the survey, data refer to the most recent birth. Table 9.1 presents information about the type of provider from whom antenatal care services were received for the most recent birth in the five years before the survey, according to background characteristics. For women who reported more than one source of antenatal services, only the provider with the highest qualifications is presented in the table. Results show that only 6 in 10 women in Yemen receive antenatal care from a skilled provider (doctor, nurse, midwife, or auxiliary nurse/midwife). Nevertheless, this figure is considerably higher than that reported in the 2006 YMICS (47 percent). Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Yemen 2013 Antenatal care provider Missing No ANC Total Percentage receiving antenatal care from a skilled provider1 Number of women Background characteristic Doctor Nurse/ midwife Auxiliary nurse/ midwife Traditional birth attendant, grand- mother, other Mother’s age at birth <20 58.6 3.4 0.0 0.2 2.1 36.1 100.4 62.0 1,192 20-34 57.0 4.2 0.2 0.3 2.4 36.7 100.6 61.4 7,398 35-49 45.3 6.1 0.1 0.2 2.1 46.9 100.7 51.4 1,779 Birth order 1 68.0 3.4 0.2 0.2 1.6 27.0 100.3 71.5 1,846 2-3 59.0 4.4 0.0 0.2 3.0 34.3 100.9 63.4 3,454 4-5 54.6 4.2 0.1 0.0 2.4 39.3 100.6 58.9 2,323 6+ 42.4 5.3 0.3 0.4 1.7 50.3 100.4 48.0 2,747 Residence Urban 75.1 4.7 0.1 0.1 1.7 18.8 100.4 79.9 3,077 Rural 46.8 4.3 0.2 0.2 2.6 46.6 100.7 51.3 7,292 Governorate Ibb 74.1 1.6 0.0 0.5 1.7 23.4 101.2 75.7 1,147 Abyan 58.0 12.6 0.0 0.2 1.7 28.4 100.8 70.5 207 Sanaa City 83.5 0.5 0.0 0.0 2.3 14.1 100.4 84.0 933 Al-Baidha 58.1 1.5 0.1 0.3 1.0 39.6 100.5 59.7 446 Taiz 60.1 0.8 0.0 0.4 4.9 34.2 100.4 60.9 1,274 Al-Jawf 49.6 7.6 0.1 0.8 4.9 38.2 101.3 57.3 95 Hajjah 32.9 5.7 0.0 0.6 1.5 59.8 100.5 38.6 620 Al-Hodiedah 41.6 14.5 0.3 0.0 2.0 41.9 100.4 56.5 1,257 Hadramout 72.4 7.9 0.5 0.5 1.4 18.5 101.1 80.8 543 Dhamar 33.0 1.4 0.3 0.0 2.6 62.9 100.2 34.7 802 Shabwah 67.2 0.1 0.0 0.0 1.0 32.4 100.7 67.3 194 Sadah 25.8 4.9 0.4 0.4 4.1 67.1 102.6 31.1 320 Sanaa 51.8 1.0 0.0 0.0 1.6 45.9 100.4 52.8 598 Aden 87.4 0.9 0.0 0.0 2.8 9.3 100.4 88.2 291 Lahj 59.9 6.7 0.4 0.0 0.9 32.4 100.3 67.0 276 Mareb 65.2 1.2 0.0 0.2 1.1 32.2 100.0 66.4 78 Al-Mhweit 29.2 6.6 0.4 0.3 0.9 62.8 100.2 36.2 304 Al-Mhrah 73.7 6.1 0.0 0.2 3.2 18.6 101.8 79.8 42 Amran 48.5 4.9 0.0 0.0 1.8 44.9 100.2 53.4 445 Aldhalae 63.3 4.8 0.2 0.2 2.6 29.1 100.3 68.4 251 Reimah 12.5 5.0 0.8 0.2 1.4 81.5 101.3 18.2 246 Education No education 43.4 4.3 0.2 0.3 2.3 50.2 100.7 47.9 5,475 Fundamental 64.1 4.5 0.1 0.1 2.2 29.6 100.6 68.7 3,463 Secondary 74.6 5.0 0.2 0.3 2.7 17.5 100.4 79.8 1,025 Higher 89.2 3.6 0.1 0.0 1.9 5.6 100.4 93.0 407 Wealth quintile Lowest 34.2 4.6 0.1 0.3 2.7 59.0 101.0 39.0 2,097 Second 39.9 6.1 0.1 0.1 2.1 52.0 100.3 46.1 2,136 Middle 53.6 3.3 0.3 0.4 2.9 40.3 100.8 57.2 2,107 Fourth 66.8 5.4 0.3 0.1 1.8 26.1 100.5 72.4 2,016 Highest 83.2 2.7 0.0 0.1 1.9 12.6 100.5 85.9 2,014 Total 55.2 4.4 0.2 0.2 2.3 38.4 100.6 59.8 10,369 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife Maternal Health Care • 85 Almost all women who received antenatal care reported that they received care from a doctor. Fifty- five percent received antenatal care from a doctor, 4 percent from a nurse or midwife, and a tiny fraction from an auxiliary nurse/midwife. Thirty-eight percent of women received no antenatal care. There are large differences in the percentage of women who receive antenatal care from a skilled provider by background characteristics. Antenatal care coverage declines with both age of the mother and birth order of the child. For example, women get antenatal care from a skilled provider for 72 percent of first births, compared with only 48 percent of sixth and higher order births. In urban areas, 80 percent of pregnant women receive antenatal care from skilled providers, while in rural areas, the corresponding percentage was only 51 percent. By governorate, antenatal care coverage by a skilled provider is highest in Aden Governorate (88 percent) and lowest in Reimah Governorate (18 percent). There are also large educational and wealth status variations in the percentages of women who receive antenatal care from a skilled provider. For example, women with higher education are almost twice as likely to receive antenatal care services from a skilled provider (93 percent) as women with no education (48 percent). Similarly, women in the highest wealth quintile (86 percent) are more than twice as likely to receive antenatal care from a skilled provider as those in the lowest wealth quintile (39 percent). 9.2 NUMBER AND TIMING OF ANTENATAL VISITS Antenatal care is more effective in preventing adverse pregnancy outcomes when sought early in the pregnancy and continued through to delivery. Health professionals recommend that the first antenatal visit occur within 12 to 16 weeks of pregnancy. The second visit should occur at 28 weeks, the third visit at 32 weeks, and the fourth visit at 36 weeks. Under normal circumstances, WHO recommends that a woman without complications should have at least four visits. Women with complications, special needs, or conditions beyond the scope of basic care may require additional visits. In the 2013 YNHDS, respondents were asked how many antenatal care visits they made during the pregnancy preceding their last live birth in the five years before the survey and how many months pregnant they were at the time of the first visit. Table 9.2 and Figure 9.1 show that among women who had a live birth in the five years preceding the survey, 25 percent had four or more antenatal care visits, 23 percent had two to three visits, and 12 percent had one visit only. Urban women are much more likely to receive four or more visits (47 percent) than rural women (16 percent). The proportion of women with four or more antenatal care visits has increased over time, from 11 percent in 1997, to 14 percent in 2003, and to 25 percent in 2013 (CSO and MI, 1998; MOPHP, CSO, PAPFAM, 2004). Table 9.2 also shows that less than one-third of women (31 percent) had an antenatal care visit at less than four months of pregnancy, as recommended. Fifteen percent of women had their first visit in the fourth to the fifth month of pregnancy, 11 percent had their first visit in the sixth to the seventh month of pregnancy, and 5 percent had their first visit from the eighth month onwards. The median duration of pregnancy at the first visit was 4.0 months, hardly changed from the 4.3 months reported in the 1997 YDMCHS (CSO and MI, 1998). Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, and by the timing of the first visit, and among women with ANC, median months pregnant at first visit, according to residence, Yemen 2013 Residence Total Number and timing of ANC visits Urban Rural Number of ANC visits None 18.8 46.6 38.4 1 9.3 13.8 12.4 2-3 23.8 22.9 23.1 4+ 47.2 15.8 25.1 Don’t know/missing 0.9 1.0 1.0 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 18.8 46.6 38.4 <4 49.5 22.7 30.6 4-5 17.3 13.5 14.6 6-7 9.0 11.2 10.5 8+ 4.8 5.5 5.3 Don’t know/missing 0.5 0.6 0.6 Total 100.0 100.0 100.0 Number of women 3,077 7,292 10,369 Median months pregnant at first visit (for those with ANC) 3.3 4.5 4.0 Number of women with ANC 2,499 3,894 6,393 86 • Maternal Health Care Figure 9.1 Number of ANC visits 9.3 COMPONENTS OF ANTENATAL CARE The content of antenatal care is an essential component of the quality of services. Apart from receiving basic care, every pregnant woman should be monitored for complications. Ensuring that pregnant women receive information on and undergo screening for complications should be a routine part of all antenatal care visits. To assess antenatal care services, respondents were asked whether they had been advised of complications or received certain screening tests during at least one of the antenatal care visits. Table 9.3 presents information on the content of antenatal services, including the percentages of women who took iron supplements, took drugs for intestinal parasites, were informed of the signs of pregnancy complications, and received selected routine services during antenatal care visits for their most recent birth in the past five years. Overall, 29 percent of women took iron tablets during the pregnancy of their last birth. Variations by background characteristics indicate that urban women are more likely than rural women to take iron supplements, as are women in Aden and Shabwah governorates. The proportion of women who took iron supplements increases steadily with both education and wealth quintile. As a component of antenatal care, the administration of drugs to treat intestinal worms is much less common than the administration of iron supplements. Overall, only 3 percent of women took drugs to treat intestinal worms during their last pregnancy. Differences by background characteristics are minor. Half of the women who received antenatal care for their most recent live birth in the five years preceding the survey were informed of the signs of pregnancy complications. The proportion of women who were informed about pregnancy complications during antenatal care is remarkably similar across background characteristics. Notable exceptions occur by governorate, where coverage ranges from a low of 27 percent for women in Hadramout Governorate to a high of 69 percent for women in Aldhalae Governorate. Among the various other antenatal care services, overall, 86 percent of women who received antenatal care had their blood pressure measured, 76 percent had a urine sample taken, and 80 percent had a blood sample taken. By background characteristics, the likelihood of women receiving each of these antenatal care services varies little, showing only a slight increase among women with higher education and those in the highest wealth quintile. None 38% Don't know/missing 1% 1 visit 12% 2-3 visits 23% 4+ visits 25% YNHDS 2013 Maternal Health Care • 87 Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the five years preceding the survey, the percentage who took iron tablets or syrup and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the five years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Yemen 2013 Among women with a live birth in the past five years, the percentage who during the pregnancy of their last birth: Among women who received antenatal care for their most recent birth in the past five years, the percentage with selected services Background characteristic Took iron tablets or syrup Took intestinal parasite drugs Number of women with a live birth in the past five years Informed of signs of pregnancy complications Blood pressure measured Urine sample taken Blood sample taken Number of women with ANC for their most recent birth Mother’s age at birth <20 29.6 2.3 1,192 46.2 85.6 80.7 84.9 762 20-34 30.0 3.5 7,398 50.1 85.5 75.4 78.9 4,686 35-49 24.9 3.9 1,779 50.4 90.5 78.1 82.6 944 Birth order 1 37.2 3.2 1,846 48.9 87.4 82.8 86.6 1,347 2-3 31.0 3.0 3,454 47.7 85.2 75.0 77.5 2,270 4-5 27.2 3.9 2,323 52.2 85.7 72.5 78.2 1,410 6+ 22.8 3.8 2,747 51.2 87.3 76.4 80.3 1,366 Residence Urban 43.6 2.2 3,077 49.8 89.9 77.8 81.1 2,499 Rural 22.9 4.0 7,292 49.6 83.9 75.5 79.6 3,894 Governorate Ibb 25.3 4.1 1,147 49.0 76.7 71.3 75.0 879 Abyan 37.3 3.2 207 56.8 91.9 80.8 89.1 148 Sanaa City 51.8 1.4 933 48.9 88.9 77.0 76.9 802 Al-Baidha 21.6 3.4 446 65.8 81.9 65.5 72.7 270 Taiz 33.4 5.4 1,274 56.2 85.1 77.0 79.2 838 Al-Jawf 24.5 4.2 95 60.7 86.2 64.4 65.8 59 Hajjah 14.5 3.0 620 44.8 86.1 89.7 88.4 249 Al-Hodiedah 24.3 2.3 1,257 49.6 89.0 76.7 81.8 730 Hadramout 42.3 1.3 543 26.6 98.0 94.6 98.0 442 Dhamar 18.6 4.0 802 61.4 89.0 73.5 78.9 298 Shabwah 55.7 1.0 194 58.2 94.1 84.7 90.4 131 Sadah 21.5 1.6 320 42.2 86.7 76.1 78.4 105 Sanaa 15.4 3.0 598 38.6 77.0 68.7 73.4 323 Aden 60.6 1.2 291 33.9 98.2 81.5 91.8 264 Lahj 43.1 4.1 276 55.6 92.0 78.5 85.4 187 Mareb 41.1 3.2 78 56.6 85.1 71.3 83.2 53 Al-Mhweit 15.2 5.9 304 63.0 73.6 64.6 70.4 113 Al-Mhrah 43.1 2.8 42 41.1 96.1 87.9 95.0 34 Amran 14.6 7.3 445 43.6 79.2 61.3 61.6 245 Aldhalae 37.8 2.1 251 69.0 86.6 78.8 84.5 178 Reimah 9.4 5.9 246 61.4 86.1 77.8 78.3 46 Education No education 20.8 3.9 5,475 47.8 85.1 75.3 79.5 2,727 Fundamental 33.5 3.1 3,463 50.4 85.4 76.0 79.7 2,437 Secondary 43.8 2.5 1,025 51.8 89.9 76.3 79.8 845 Higher 64.9 2.1 407 53.7 91.0 87.1 88.3 384 Wealth quintile Lowest 16.3 3.9 2,097 49.1 84.2 79.3 81.4 859 Second 18.9 4.3 2,136 49.1 82.9 72.4 78.0 1,026 Middle 24.3 4.4 2,107 50.4 82.2 73.3 76.9 1,258 Fourth 35.9 2.3 2,016 49.5 86.9 74.8 79.2 1,490 Highest 51.3 2.1 2,014 50.0 91.4 80.8 83.9 1,760 Total 29.1 3.4 10,369 49.7 86.2 76.4 80.2 6,393 9.4 TETANUS TOXOID Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus, a leading cause of early infant death in many developing countries that is often due to poor hygiene during delivery. For full protection of her newborn baby, a pregnant woman should receive at least two injections of the vaccine during the pregnancy. If a woman has been vaccinated during a previous pregnancy, however, she may only require one or no doses for the current pregnancy. Five doses are considered to provide lifetime protection. Table 9.4 presents the percentage of women age 15-49 with a live birth in the five years preceding the survey who received two or more tetanus toxoid injections during their most recent pregnancy and the percentage whose last birth was protected against neonatal tetanus. 88 • Maternal Health Care Table 9.4 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the five years preceding the survey, the percentage receiving two or more tetanus toxoid injections during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Yemen 2013 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Mother’s age at birth <20 10.2 23.9 1,192 20-34 9.0 29.5 7,398 35-49 7.1 24.0 1,779 Birth order 1 12.8 28.6 1,846 2-3 8.8 31.3 3,454 4-5 7.4 27.3 2,323 6+ 7.5 23.6 2,747 Residence Urban 12.4 37.5 3,077 Rural 7.3 23.8 7,292 Governorate Ibb 10.3 27.9 1,147 Abyan 8.7 19.3 207 Sanaa City 13.7 33.8 933 Al-Baidha 3.2 15.6 446 Taiz 10.6 31.9 1,274 Al-Jawf 5.1 10.5 95 Hajjah 7.5 31.6 620 Al-Hodiedah 8.1 25.6 1,257 Hadramout 8.5 36.5 543 Dhamar 11.2 31.9 802 Shabwah 3.5 8.7 194 Sadah 4.3 5.4 320 Sanaa 5.5 16.7 598 Aden 14.1 52.9 291 Lahj 5.6 31.3 276 Mareb 7.6 29.8 78 Al-Mhweit 9.1 31.2 304 Al-Mhrah 17.8 35.0 42 Amran 7.1 32.8 445 Aldhalae 8.0 28.4 251 Reimah 5.0 14.3 246 Education No education 7.1 21.3 5,475 Fundamental 9.1 30.3 3,463 Secondary 13.4 44.1 1,025 Higher 18.2 55.9 407 Wealth quintile Lowest 6.1 19.5 2,097 Second 7.9 21.9 2,136 Middle 7.2 25.2 2,107 Fourth 9.3 33.2 2,016 Highest 13.8 40.4 2,014 Total 8.8 27.9 10,369 1 Includes mothers with two injections during the pregnancy of her last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within 10 years of the last live birth), or five or more injections at any time prior to the last birth. Results show that coverage of tetanus vaccination for pregnant women is very low in Yemen. Only 9 percent of women received two or more tetanus toxoid injections during the pregnancy of their last live birth. This is identical to the 9 percent reported in the 1997 YDMCHS (based on all births in the five years before the survey). Overall, because some women had received injections before the index pregnancy, 28 percent of births were protected against tetanus, a slight decline from 31 percent in 2006 (MOHP and UNICEF, 2008). Births to women in urban areas are more likely to be protected against tetanus than births to women in rural areas (38 percent and 24 percent, respectively). Births in Aden Governorate are substantially more likely to be protected against tetanus (53 percent) than births in other areas, particularly those in Sadah (5 percent) and Shabwah (9 percent) governorates. The proportion of births protected against tetanus increases with both mother’s education level and wealth quintile. Maternal Health Care • 89 9.5 PLACE OF DELIVERY Increasing the proportion of women who deliver in health facilities is an important factor in reducing health risks to the mother and the newborn. Proper medical attention and hygienic conditions during delivery can reduce the risks of complications and infections that can cause morbidity and mortality to either the mother or the infant. Table 9.5 presents the percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics. Table 9.5 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivered in a health facility, according to background characteristics, Yemen 2013 Health facility Home Other Missing Total Percentage delivered in a health facility Number of births Background characteristic Public sector Private sector Mother’s age at birth <20 21.9 11.2 65.2 0.5 1.2 100.0 33.1 2,109 20-34 19.0 11.0 68.4 0.6 1.2 100.0 29.9 11,521 35-49 16.6 9.4 72.4 0.7 0.8 100.0 26.0 2,250 Birth order 1 29.1 15.7 53.2 0.7 1.4 100.0 44.8 3,283 2-3 18.8 11.0 68.6 0.3 1.3 100.0 29.8 5,374 4-5 16.6 9.8 72.0 0.6 1.0 100.0 26.4 3,373 6+ 12.9 7.1 78.5 0.8 0.7 100.0 20.0 3,850 Antenatal care visits1 None 10.3 4.7 83.5 0.5 1.0 100.0 15.0 3,977 1-3 21.4 11.4 66.2 1.0 0.0 100.0 32.8 3,690 4+ 35.4 23.3 40.7 0.5 0.1 100.0 58.7 2,602 Don’t know/missing 22.6 8.5 66.1 1.9 0.8 100.0 31.1 100 Residence Urban 30.8 18.3 49.5 0.2 1.2 100.0 49.1 4,301 Rural 14.7 8.0 75.6 0.7 1.1 100.0 22.6 11,579 Governorate Ibb 20.1 10.6 67.6 0.7 1.1 100.0 30.7 1,738 Abyan 51.0 6.5 40.9 0.8 0.8 100.0 57.5 309 Sanaa City 31.4 25.1 42.6 0.2 0.7 100.0 56.5 1,280 Al-Baidha 19.9 23.8 55.2 0.4 0.8 100.0 43.6 643 Taiz 12.3 9.7 76.9 0.2 0.9 100.0 22.0 1,994 Al-Jawf 18.3 19.8 60.1 0.0 1.8 100.0 38.1 144 Hajjah 7.5 5.4 85.6 0.8 0.8 100.0 12.8 1,019 Al-Hodiedah 9.1 9.4 79.4 0.2 1.8 100.0 18.5 2,037 Hadramout 50.8 2.5 44.1 0.4 2.1 100.0 53.3 738 Dhamar 8.1 8.0 82.8 0.9 0.2 100.0 16.0 1,322 Shabwah 25.4 14.2 59.0 0.0 1.5 100.0 39.5 275 Sadah 27.2 1.6 67.5 1.1 2.6 100.0 28.8 479 Sanaa 17.1 11.6 68.7 1.8 0.7 100.0 28.8 919 Aden 53.2 14.3 31.2 0.2 1.2 100.0 67.4 389 Lahj 37.2 3.8 56.9 0.2 1.9 100.0 41.0 416 Mareb 21.8 16.7 59.8 1.0 0.7 100.0 38.5 120 Al-Mhweit 8.0 9.5 81.0 0.8 0.8 100.0 17.5 517 Al-Mhrah 57.0 2.9 33.3 3.9 2.8 100.0 59.9 63 Amran 13.9 9.8 73.9 1.1 1.2 100.0 23.7 670 Aldhalae 10.5 19.6 68.1 0.4 1.5 100.0 30.1 384 Reimah 2.8 0.9 95.5 0.1 0.8 100.0 3.7 423 Mother’s education No education 13.9 7.3 77.1 0.7 1.0 100.0 21.2 8,765 Fundamental 24.2 12.4 61.6 0.6 1.3 100.0 36.6 5,123 Secondary 25.8 19.2 53.7 0.1 1.2 100.0 44.9 1,446 Higher 34.5 30.1 34.6 0.0 0.9 100.0 64.5 546 Wealth quintile Lowest 7.2 5.3 85.9 0.5 1.1 100.0 12.5 3,562 Second 12.2 6.2 79.5 0.9 1.1 100.0 18.4 3,460 Middle 18.5 9.0 70.6 0.7 1.1 100.0 27.5 3,203 Fourth 28.4 13.0 56.9 0.4 1.3 100.0 41.4 2,946 Highest 33.7 23.5 41.6 0.3 1.0 100.0 57.1 2,709 Total 19.0 10.8 68.5 0.6 1.1 100.0 29.8 15,880 1 Includes only the most recent birth in the five years preceding the survey Table 9.5 shows that only 30 percent of births occurred in health facilities. This figure is higher than that recorded in the 2006 YMICS (24 percent). Almost two in ten births take place in public health facilities and just over one in ten takes place in private health facilities 90 • Maternal Health Care First births are much more likely to take place in health facilities than higher order births (45 percent and 20-30 percent, respectively). There is a strong relationship between uptake of antenatal care and place of delivery. Only 15 percent of births to women who received no antenatal care services took place in a health facility compared with 59 percent of live births to women who received four or more antenatal care visits. Place of delivery differs greatly by residence; 49 percent of births in urban areas were delivered in a health facility compared with 23 percent of births in rural areas. By governorate, the percentage of births delivered in a health facility ranges from a low of 4 percent in Reimah Governorate to a high of 67 percent in Aden Governorate. There is a strong correlation between a mother’s education and place of delivery, and between household wealth and place of delivery. Births to mothers with higher education are much more likely to take place in a health facility than births to mothers with no education (65 percent compared with 21 percent). Likewise, births to women in the highest wealth quintile are more than four times as likely to take place in a health facility as births to women in the lowest wealth quintile (57 percent and 13 percent, respectively). Respondents whose most recent birth in the five years before the survey was not delivered in a health facility were asked why they did not deliver at a facility. Results are shown in Table 9.6. A majority of women (62 percent) said they did not deliver at a health facility because it was better to give birth at home. One-quarter of women cited cost as a factor in their decision to deliver at home, while another one-quarter said that the delivery service was too far away (24 percent). Nine percent of women said that poor treatment by health providers was a reason for their deciding to deliver at home, and another 9 percent said they had emergency labor and presumably could not get to the health facility in time. Differences by age of the mother at the time of birth are generally small. 9.6 ASSISTANCE DURING DELIVERY Obstetric care from a skilled provider (doctor, nurse, midwife, or auxiliary nurse/midwife) during delivery is recognized as a critical element in the reduction of maternal and neonatal mortality. Births delivered at home are usually more likely to be delivered without assistance from a skilled provider, whereas births delivered at a health facility are more likely to be delivered by a trained health professional. Table 9.7 shows the percent distribution of live births in the five years preceding the survey by person providing assistance at delivery and the percentage of births delivered by Caesarean section (C-section), according to background characteristics. Forty-five percent of births in the five years preceding the survey were delivered by a skilled provider, with 26 percent of the deliveries assisted by a doctor, 18 percent by a nurse or midwife, and 2 percent by an auxiliary nurse/midwife. Twelve percent of births were assisted by a traditional birth attendant or a grandmother, and 41 percent by relatives or friends. Overall, the percentage of live births delivered by a skilled provider observed in the 2013 YNHDS (45 percent) represents an increase from the figure reported in the 2006 YMICS (36 percent). Table 9.6 Reason for delivery outside a health facility Among women age 15-49 whose most recent live birth in the five years preceding the survey was not delivered in a health facility, the percentage reporting reasons for not delivering in a facility, according to age at birth, Yemen 2013 Mother’s age at birth Total Reason <20 20-34 35-49 Better at home 61.7 62.7 58.4 61.8 Service not available 7.7 6.5 6.4 6.6 Service too far 22.7 23.3 25.2 23.6 Cost too much 16.7 24.4 32.7 25.1 Husband did not allow 1.1 1.6 1.9 1.6 Emergency labor 13.4 8.9 6.9 9.0 Health providers treat badly 8.8 9.6 7.3 9.1 No female provider at facility 2.4 1.9 1.8 1.9 Availability of the service 1.4 0.8 0.8 0.8 Husband not present 0.6 0.6 0.6 0.6 Other 0.9 0.7 0.2 0.6 Number of births 751 4,977 1,278 7,005 Note: Women may report multiple reasons so the sum may exceed 100 percent. Maternal Health Care • 91 Table 9.7 Assistance during delivery Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to background characteristics, Yemen 2013 Person providing assistance during delivery Percentage delivered by a skilled provider1 Percentage delivered by C-section Number of births Background characteristic Doctor Nurse/ midwife Auxiliary nurse/ midwife Tradition- al birth attendant/ grand- mother Relative/ other No one Don’t know/ missing Total Mother’s age at birth <20 30.0 18.9 2.0 10.9 36.0 0.9 1.3 100.0 50.9 3.8 2,109 20-34 25.6 17.7 1.7 11.8 40.4 1.5 1.4 100.0 44.9 4.9 11,521 35-49 20.6 15.4 1.5 13.1 45.2 3.1 1.2 100.0 37.5 5.4 2,250 Birth order 1 39.1 21.4 2.4 8.6 26.2 0.6 1.7 100.0 63.0 8.7 3,283 2-3 25.5 18.9 1.5 12.6 39.1 0.9 1.5 100.0 45.9 5.0 5,374 4-5 22.1 16.4 1.7 12.3 44.5 2.0 1.1 100.0 40.2 3.2 3,373 6+ 16.7 13.2 1.3 13.5 51.2 3.1 1.1 100.0 31.1 2.7 3,850 Antenatal care visits1 None 11.5 13.6 1.5 15.1 54.6 2.3 1.3 100.0 26.7 2.0 3,977 1-3 28.7 20.4 2.1 11.3 35.7 1.7 0.2 100.0 51.1 4.7 3,690 4+ 52.4 23.5 2.0 5.5 15.5 1.0 0.2 100.0 77.8 13.2 2,602 Place of delivery Health facility 75.5 22.5 1.0 0.3 0.5 0.1 0.1 100.0 99.0 16.2 4,731 Elsewhere 4.3 15.6 2.0 17.1 58.3 2.3 0.4 100.0 21.9 0.0 10,971 Missing 0.0 0.8 0.0 0.3 4.3 0.6 94.0 100.0 0.8 0.0 178 Residence Urban 45.6 24.9 2.5 6.8 18.3 0.5 1.3 100.0 73.0 10.2 4,301 Rural 18.0 14.7 1.4 13.8 48.7 2.0 1.4 100.0 34.1 2.8 11,579 Governorate Ibb 30.5 9.3 2.6 13.7 39.8 2.8 1.3 100.0 42.4 6.1 1,738 Abyan 23.5 48.8 1.7 8.0 16.0 1.1 1.0 100.0 74.0 6.1 309 Sanaa City 61.2 10.7 2.9 3.3 20.5 0.7 0.7 100.0 74.8 13.4 1,280 Al-Baidha 33.8 26.9 0.5 8.6 25.6 3.8 0.9 100.0 61.2 7.9 643 Taiz 23.3 17.7 0.5 14.2 42.9 0.7 0.7 100.0 41.5 3.2 1,994 Al-Jawf 25.2 27.1 1.5 14.4 29.2 0.5 2.1 100.0 53.8 4.3 144 Hajjah 8.3 11.4 0.5 13.8 64.5 0.0 1.6 100.0 20.1 1.4 1,019 Al-Hodiedah 12.1 33.8 3.0 20.5 28.0 0.8 1.9 100.0 48.9 2.8 2,037 Hadramout 27.7 34.7 2.9 6.0 20.7 5.7 2.3 100.0 65.3 7.4 738 Dhamar 17.1 4.2 0.8 13.2 63.9 0.3 0.5 100.0 22.1 1.6 1,322 Shabwah 33.8 17.8 1.4 6.8 37.5 0.6 2.0 100.0 53.0 5.0 275 Sadah 14.3 15.4 0.6 2.1 63.5 1.5 2.6 100.0 30.3 1.2 479 Sanaa 28.4 6.3 1.1 10.9 48.8 3.6 0.8 100.0 35.8 6.2 919 Aden 63.0 17.7 3.1 9.4 5.7 0.0 1.2 100.0 83.7 12.0 389 Lahj 30.0 19.9 1.9 18.9 26.1 0.2 3.0 100.0 51.8 5.4 416 Mareb 34.1 10.3 0.9 4.1 47.2 2.7 0.7 100.0 45.2 3.8 120 Al-Mhweit 16.1 17.7 0.4 11.5 50.2 2.8 1.3 100.0 34.2 3.5 517 Al-Mhrah 37.2 26.9 0.6 2.8 19.1 8.8 4.6 100.0 64.7 7.7 63 Amran 15.6 17.8 1.9 7.6 52.3 3.1 1.6 100.0 35.3 2.3 670 Aldhalae 29.5 13.6 1.8 9.4 42.4 1.1 2.3 100.0 44.9 2.7 384 Reimah 5.2 5.4 1.9 12.3 73.3 0.3 1.5 100.0 12.6 0.7 423 Mother’s education No education 17.7 11.9 1.3 14.2 51.5 2.0 1.3 100.0 31.0 2.6 8,765 Fundamental 31.2 23.3 1.8 10.0 30.9 1.5 1.4 100.0 56.3 6.2 5,123 Secondary 38.9 27.5 3.5 7.5 20.8 0.4 1.5 100.0 69.8 7.7 1,446 Higher 60.4 26.8 1.5 3.8 6.4 0.0 1.0 100.0 88.8 19.8 546 Wealth quintile Lowest 9.5 8.4 1.2 15.3 61.5 2.3 1.6 100.0 19.1 1.0 3,562 Second 15.3 13.9 1.0 15.2 51.3 2.1 1.2 100.0 30.2 2.7 3,460 Middle 22.6 18.2 1.6 12.9 41.7 1.7 1.3 100.0 42.4 3.1 3,203 Fourth 34.1 25.0 2.6 9.3 26.3 1.1 1.6 100.0 61.7 7.0 2,946 Highest 53.4 25.1 2.3 4.7 13.0 0.5 1.0 100.0 80.8 12.1 2,709 Total3 25.5 17.5 1.7 11.9 40.5 1.6 1.4 100.0 44.7 4.8 15,880 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife. 2 Includes only the most recent birth in the five years preceding the survey 3 Total includes 100 cases with missing information on ANC visits. Large variations occur in the prevalence of skilled assistance at delivery by mother’s age, birth order, number of antenatal care visits, place of delivery, residence, governorate, education, and wealth quintile. The percentage of births delivered by a skilled provider decreases as mother’s age at birth increases. First-order births are twice as likely to receive assistance from a skilled provider (63 percent) compared with sixth and higher-order births (31 percent). Births to mothers who had four or more antenatal care visits (78 92 • Maternal Health Care percent) were much more likely than those with fewer visits (51 percent) or no antenatal care (27 percent) to be delivered by a skilled provider. Almost all births delivered in a health facility were delivered by a skilled provider (99 percent) compared with 22 percent of births that occurred elsewhere. Among births that occurred outside a health facility, 58 percent were assisted by a relative or friend, 17 percent by a traditional birth attendant, and 16 percent by a nurse or midwife. In urban areas, 73 percent of births were assisted by a skilled provider compared with 34 percent in rural areas. By governorate, more than eight in ten deliveries in Aden Governorate (84 percent) were assisted by a skilled provider compared with only 13 percent of births in Reimah Governorate. Mother’s education is strongly related to the type of assistance at delivery. There is a steady increase in the proportion of births with skilled attendance at delivery as mother’s education level increases, from only 31 percent of births to women with no education to 89 percent of births to women with higher education. As with education, wealth quintile is strongly associated with type of assistance at delivery. Births to women in the highest wealth quintile were more likely to get assistance at delivery from a skilled provider (81 percent) compared with births to women in the lowest wealth quintile (19 percent). Figure 9.2 shows that there has been an increase over time in three key indicators related to maternal care. The percentage of births delivered by a health professional has doubled from 22 percent in 1997 to 45 percent in 2013. Figure 9.2 Trends in maternal care indicators, Yemen 1997-2013 Respondents were also asked whether each of their live births in the five years preceding the survey were delivered by Caesarean (C-section). As shown in Table 9.7, five percent of births were delivered by C- section; this figure is higher than the one reported in the 1997 YDMCHS (1 percent). C-sections are most common among first births (9 percent), births to women who had four or more antenatal care visits (13 percent), births in health facilities (16 percent), births in urban areas (10 percent), births in Sana’a City (13 percent), births to women with higher than secondary education (20 percent), and births to women in the highest wealth quintile (12 percent). 9.7 POSTNATAL CARE FOR THE MOTHER A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery. Thus, prompt postnatal care (PNC) for both the mother and the child is important to treat any complications arising from the delivery, as well as to provide the mother with important information on how to care for herself and her child. Safe motherhood programs recommend that all women receive a check of their health within two days after delivery. Women who deliver at home should go to a health facility for postnatal care 34 22 16 41 29 20 47 36 24 60 45 30 Antenatal care from a skilled provider Delivery by a skilled provider Delivery in a health facility 1997 YDMCHS 2003 YFHS 2006 YMICS 2013 YNHDS Percentage Maternal Health Care • 93 services within 24 hours, and subsequent visits (including those by women who deliver in a health facility) should be made at three days, seven days, and six weeks after delivery. To assess the extent of postnatal care utilization, respondents were asked, for the last birth in the two years preceding the survey, whether they had received a checkup after delivery, the timing of the first check-up, and the type of health provider performing the postnatal check-up. This information is presented according to background characteristics in Tables 9.8 and 9.9. Table 9.8 Timing of first postnatal checkup Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution of the mother’s first postnatal checkup for the last live birth by time after delivery, and the percentage of women with a live birth in the two years preceding the survey who received a postnatal checkup in the first two days after giving birth, according to background characteristics, Yemen 2013 Time after delivery of mother’s first postnatal checkup No postnatal checkup1 Total Percentage of women with a postnatal checkup in the first two days after birth Number of women Background characteristic Less than 4 hours 4-23 hours 1-2 days 3-6 days 7-41 days Don’t know/ missing Mother’s age at birth <20 18.5 0.6 1.7 0.1 1.1 0.6 77.4 100.0 20.8 785 20-34 17.6 0.8 1.6 0.5 0.7 0.8 78.0 100.0 20.0 4,404 35-49 14.4 1.6 2.2 1.2 0.7 1.0 78.9 100.0 18.4 920 Birth order 1 24.3 1.2 1.9 0.3 1.1 1.2 69.9 100.0 27.4 1,262 2-3 18.9 0.6 2.1 0.7 0.9 0.4 76.3 100.0 21.8 2,063 4-5 14.7 1.0 1.2 0.1 0.6 1.0 81.3 100.0 16.9 1,322 6+ 11.1 0.9 1.3 0.8 0.4 0.8 84.6 100.0 13.5 1,464 Place of delivery Health facility 42.1 1.7 4.4 1.0 1.3 2.2 47.3 100.0 48.3 1,952 Elsewhere 5.7 0.5 0.4 0.3 0.5 0.1 92.5 100.0 6.6 4,133 Residence Urban 31.0 1.5 3.3 0.6 1.1 1.1 61.3 100.0 35.8 1,590 Rural 12.4 0.7 1.1 0.5 0.6 0.7 83.9 100.0 14.3 4,520 Governorate Ibb 15.4 1.0 1.7 0.8 0.5 0.0 80.5 100.0 18.2 686 Abyan 32.1 1.2 1.5 0.3 1.0 0.0 63.9 100.0 34.8 126 Sanaa City 31.5 2.4 3.8 0.6 1.0 0.7 60.0 100.0 37.7 473 Al-Baidha 25.9 1.1 0.7 0.5 0.7 0.2 70.9 100.0 27.7 247 Taiz 11.5 0.0 2.4 0.3 0.6 0.7 84.5 100.0 13.9 762 Al-Jawf 19.4 0.4 1.5 1.1 0.3 3.0 74.2 100.0 23.2 54 Hajjah 8.7 0.6 0.6 0.2 0.3 0.6 88.9 100.0 9.9 390 Al-Hodiedah 19.0 0.9 1.9 0.6 0.8 0.6 76.2 100.0 22.0 757 Hadramout 26.8 1.6 2.4 0.0 0.5 6.9 61.8 100.0 30.8 255 Dhamar 10.3 0.0 0.2 0.5 0.5 0.8 87.7 100.0 10.6 557 Shabwah 23.9 1.0 1.3 0.0 0.5 0.0 73.3 100.0 26.2 102 Sadah 12.8 0.8 0.6 1.0 0.4 0.0 84.5 100.0 14.1 183 Sanaa 11.1 1.0 1.4 0.8 0.9 0.9 83.8 100.0 13.5 374 Aden 45.8 1.1 3.6 1.3 2.7 2.4 43.2 100.0 50.5 153 Lahj 22.8 2.5 2.9 0.0 0.3 0.5 71.0 100.0 28.2 168 Mareb 16.5 2.3 2.3 1.4 1.3 0.4 75.8 100.0 21.1 45 Al-Mhweit 6.3 0.7 2.2 1.2 1.9 0.0 87.7 100.0 9.2 199 Al-Mhrah 38.5 0.4 2.2 0.9 0.0 0.0 58.0 100.0 41.1 23 Amran 14.8 1.0 0.0 0.0 0.8 0.0 83.5 100.0 15.8 261 Aldhalae 15.9 0.0 0.4 1.5 1.7 0.5 79.9 100.0 16.3 147 Reimah 4.4 0.5 0.7 0.4 0.9 0.1 92.9 100.0 5.7 150 Education No education 11.9 0.8 0.8 0.5 0.6 0.6 84.9 100.0 13.6 3,194 Fundamental 19.8 0.7 2.5 0.7 0.9 0.9 74.4 100.0 23.1 2,101 Secondary 30.5 1.2 3.0 0.4 0.6 1.6 62.7 100.0 34.7 605 Higher 34.9 3.1 3.6 1.1 2.5 0.0 54.7 100.0 41.6 210 Wealth quintile Lowest 7.9 0.3 0.6 0.4 0.2 0.4 90.3 100.0 8.8 1,350 Second 11.2 1.1 0.9 0.5 0.7 0.6 85.0 100.0 13.3 1,375 Middle 15.3 0.8 1.4 0.4 1.0 0.6 80.5 100.0 17.5 1,274 Fourth 23.2 1.2 2.6 0.8 0.6 1.5 70.2 100.0 26.9 1,114 Highest 34.2 1.2 3.7 0.7 1.7 1.0 57.4 100.0 39.1 996 Total2 17.3 0.9 1.7 0.5 0.8 0.8 78.0 100.0 19.9 6,110 1 Includes women who received a checkup after 41 days 2 Total includes 100 cases with missing information on place of delivery. 94 • Maternal Health Care Overall, only 20 percent of mothers received a postnatal checkup within two days for the most recent birth in the two years preceding the survey. Seventeen percent of mothers received a postnatal checkup within 4 hours after delivery, 1 percent within 4 to 23 hours, 2 percent within 1 to 2 days, and 1 percent within 3 to 41 days after delivery. Over three-quarters of mothers (78 percent) had no postnatal checkup within 41 days. Nevertheless, this shows improvement from the 87 percent of mothers with no postnatal care reported in the 2003 YFHS. Although differences in postnatal care coverage by mother’s age at birth were minor, women are less likely to have a postnatal checkup within two days after delivery for higher-order births than for first births. Women who deliver in a health facility, who reside in urban areas, who had higher levels of education, and who were in the higher wealth quintiles are much more likely to receive a postnatal checkup within two days of delivery compared with other women. For instance, 48 percent of women who delivered at a health facility received a postnatal check-up within two days after birth compared with 7 percent who delivered elsewhere. Similarly, 36 percent of women living in urban areas had a postnatal checkup within two days compared with 14 percent of women living in rural areas. The proportion of women who received a checkup within two days of delivery ranges from a low of 6 percent in Reimah Governorate to a high of 51 percent in Aden Governorate. Mothers with higher education are more likely to have had a postnatal checkup within two days of delivery than those with no education (42 percent and 14 percent, respectively). Also, mothers in the highest wealth quintile are more likely to have had a checkup within two days of delivery than those within the lowest wealth quintile (39 percent and 9 percent, respectively). Table 9.9 shows the type of provider of the mother’s first postnatal checkup that took place within two days after the last live birth: 20 percent of women received a postnatal checkup from a skilled provider (doctor, nurse, midwife, or auxiliary nurse/midwife). Differentials by background characteristics are similar to those observed for women who received a postnatal checkup within two days after delivery (Table 9.8). Table 9.9 Type of provider of first postnatal checkup for the mother Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution by type of provider of the mother’s first postnatal health check in the two days after the last live birth, according to background characteristics, Yemen 2013 Type of health provider of mother’s first postnatal checkup No postnatal checkup in the first two days after birth Total Number of women Background characteristic Doctor/nurse/ midwife Auxiliary nurse/midwife Traditional birth attendant Mother’s age at birth <20 20.6 0.2 0.0 79.2 100.0 785 20-34 19.8 0.1 0.1 80.0 100.0 4,404 35-49 17.9 0.3 0.1 81.6 100.0 920 Birth order 1 27.2 0.1 0.1 72.6 100.0 1,262 2-3 21.7 0.0 0.1 78.2 100.0 2,063 4-5 16.5 0.2 0.3 83.1 100.0 1,322 6+ 13.1 0.4 0.0 86.5 100.0 1,464 Place of delivery Health facility 48.2 0.2 0.0 51.7 100.0 1,952 Elsewhere 6.3 0.2 0.2 93.4 100.0 4,133 Residence Urban 35.6 0.0 0.2 64.2 100.0 1,590 Rural 14.0 0.2 0.1 85.7 100.0 4,520 Governorate Ibb 17.7 0.2 0.2 81.8 100.0 686 Abyan 34.1 0.7 0.0 65.2 100.0 126 Sanaa City 37.7 0.0 0.0 62.3 100.0 473 Al-Baidha 27.0 0.0 0.7 72.3 100.0 247 Taiz 13.6 0.3 0.0 86.1 100.0 762 Al-Jawf 23.2 0.0 0.0 76.8 100.0 54 Hajjah 9.9 0.0 0.0 90.1 100.0 390 Al-Hodiedah 21.7 0.3 0.0 78.0 100.0 757 Hadramout 30.0 0.4 0.3 69.2 100.0 255 Dhamar 10.6 0.0 0.0 89.4 100.0 557 Shabwah 25.4 0.8 0.0 73.8 100.0 102 Sadah 14.1 0.0 0.0 85.9 100.0 183 Continued… Maternal Health Care • 95 Table 9.9—Continued Type of health provider of mother’s first postnatal checkup No postnatal checkup in the first two days after birth Total Number of women Background characteristic Doctor/nurse/ midwife Auxiliary nurse/midwife Traditional birth attendant Governorate Sanaa 13.4 0.1 0.0 86.5 100.0 374 Aden 49.9 0.0 0.6 49.5 100.0 153 Lahj 27.9 0.3 0.0 71.8 100.0 168 Mareb 21.1 0.0 0.0 78.9 100.0 45 Al-Mhweit 9.2 0.0 0.0 90.8 100.0 199 Al-Mhrah 39.3 0.0 1.9 58.9 100.0 23 Amran 15.8 0.0 0.0 84.2 100.0 261 Aldhalae 15.8 0.0 0.5 83.7 100.0 147 Reimah 5.7 0.0 0.0 94.3 100.0 150 Education No education 13.3 0.2 0.1 86.4 100.0 3,194 Fundamental 22.8 0.2 0.1 76.9 100.0 2,101 Secondary 34.6 0.0 0.1 65.3 100.0 605 Higher 41.2 0.0 0.4 58.4 100.0 210 Wealth quintile Lowest 8.4 0.3 0.1 91.2 100.0 1,350 Second 13.3 0.0 0.0 86.7 100.0 1,375 Middle 17.4 0.0 0.1 82.5 100.0 1,274 Fourth 26.2 0.5 0.3 73.1 100.0 1,114 Highest 39.0 0.0 0.1 60.9 100.0 996 Total2 19.6 0.2 0.1 80.1 100.0 6,110 1 Includes women who received a checkup after 41 days 2 Total includes 100 cases with missing information on place of delivery. 9.8 POSTNATAL CARE FOR THE NEWBORN As mentioned, a significant proportion of neonatal deaths occur during the first few hours of life (48 hours) after delivery. The provision of postnatal care services for newborns should therefore start as soon as possible after the child is born. The recommended timing of the postnatal checkup for the newborn is similar to that of the mother--within two days after birth. Table 9.10 shows that only 11 percent of last births in the two years preceding the survey received a postnatal checkup in the first two days after birth. Place of delivery, residence, mother’s education level, and wealth quintile are closely linked to the timing of the first postnatal checkup for the newborn. Newborns whose mothers deliver in a health facility, live in urban areas, have more education, and are in the higher wealth quintiles have a greater chance of receiving a postnatal checkup within two days after birth when compared with those newborns whose mothers delivered elsewhere, reside in rural areas, are less educated, and are members of households in the lower wealth quintiles. For instance, 24 percent of newborns whose mothers live in urban areas received a checkup within two days compared with 7 percent of those whose mothers live in rural areas. Newborns whose mothers reside in Al-Mhrah and Aden governorates and in Sana’a City were most likely to have a postnatal checkup within two days after birth, whereas those whose mothers live in Reimah and Al-Mhweit governorates were the least likely (less than 2 percent). Newborns whose mothers have at least some higher education are more likely to have a postnatal checkup within two days after birth when compared with their counterparts whose mothers have no education (33 percent and 7 percent, respectively). Newborns of mothers in the highest wealth quintile have a better chance of a checkup within two days after birth than those newborns whose mothers are part of the lowest wealth quintile (26 percent and 5 percent, respectively). 96 • Maternal Health Care Table 9.10 Timing of first postnatal checkup for the newborn Percent distribution of last births in the two years preceding the survey by time after birth of first postnatal checkup, and the percentage of births with a postnatal checkup in the first two days after birth, according to background characteristics, Yemen 2013 Time after birth of newborn’s first postnatal checkup No postnatal checkup1 Total Percentage of births with a postnatal checkup in the first two days after birth Number of births Background characteristic Less than 1 hour 1-3 hours 4-23 hours 1-2 days 3-6 days Don’t know/ missing Mother’s age at birth <20 4.3 5.8 0.1 0.8 0.9 0.0 88.1 100.0 11.0 785 20-34 3.9 6.6 0.3 0.6 0.5 0.1 87.9 100.0 11.5 4,404 35-49 3.6 5.5 0.6 0.2 0.6 0.4 89.2 100.0 9.8 920 Birth order 1 5.5 8.2 0.4 1.0 0.8 0.1 83.9 100.0 15.2 1,262 2-3 4.6 6.9 0.3 0.4 0.5 0.3 87.0 100.0 12.2 2,063 4-5 3.2 6.2 0.3 0.7 0.4 0.0 89.2 100.0 10.4 1,322 6+ 2.2 4.2 0.3 0.3 0.6 0.1 92.3 100.0 7.0 1,464 Place of delivery Health facility 8.6 16.0 0.7 1.0 0.9 0.3 72.4 100.0 26.4 1,952 Elsewhere 1.7 1.8 0.2 0.4 0.4 0.1 95.4 100.0 4.1 4,133 Residence Urban 9.4 12.4 0.6 1.2 0.9 0.2 75.3 100.0 23.6 1,590 Rural 2.0 4.2 0.3 0.4 0.4 0.2 92.6 100.0 6.8 4,520 Governorate Ibb 0.3 7.4 0.5 0.6 1.1 0.0 90.1 100.0 8.8 686 Abyan 5.5 7.8 0.3 1.7 0.0 1.1 83.7 100.0 15.2 126 Sanaa City 10.1 19.2 1.8 1.8 1.3 0.0 65.8 100.0 32.9 473 Al-Baidha 7.0 1.6 0.0 0.0 0.9 0.6 90.0 100.0 8.9 247 Taiz 1.5 3.2 0.0 0.6 0.4 0.3 94.0 100.0 5.2 762 Al-Jawf 0.0 5.1 0.7 1.6 0.5 1.7 90.4 100.0 7.4 54 Hajjah 0.0 5.6 0.2 0.3 0.3 0.0 93.5 100.0 6.1 390 Al-Hodiedah 9.8 3.5 0.4 0.6 0.0 0.0 85.7 100.0 14.3 757 Hadramout 0.4 6.4 0.0 0.3 0.6 0.0 92.2 100.0 7.1 255 Dhamar 3.6 4.0 0.0 0.2 0.6 0.0 91.6 100.0 7.8 557 Shabwah 0.3 13.8 0.0 1.2 0.0 0.0 84.7 100.0 15.3 102 Sadah 6.9 3.3 0.0 0.7 0.0 0.5 88.6 100.0 10.9 183 Sanaa 0.5 3.7 0.0 0.8 0.4 0.5 94.1 100.0 5.0 374 Aden 14.5 15.0 0.0 0.5 0.9 0.9 68.3 100.0 30.0 153 Lahj 1.4 10.3 1.8 0.0 0.6 0.0 85.9 100.0 13.5 168 Mareb 0.2 8.8 0.5 0.4 0.2 0.4 89.6 100.0 9.9 45 Al-Mhweit 0.2 1.4 0.0 0.0 0.9 0.0 97.6 100.0 1.6 199 Al-Mhrah 8.3 22.5 2.1 1.9 0.0 0.0 65.2 100.0 34.8 23 Amran 2.0 8.5 0.0 0.0 0.3 0.0 89.2 100.0 10.5 261 Aldhalae 7.7 7.0 0.0 0.5 0.9 0.0 83.9 100.0 15.3 147 Reimah 0.0 1.2 0.0 0.0 0.0 0.0 98.7 100.0 1.3 150 Mother’s education No education 2.2 4.1 0.3 0.3 0.2 0.1 92.8 100.0 6.8 3,194 Fundamental 4.4 7.5 0.2 0.6 0.9 0.2 86.1 100.0 12.8 2,101 Secondary 6.9 12.4 0.6 0.9 1.3 0.1 77.7 100.0 20.9 605 Higher 16.3 12.3 1.4 3.1 0.0 0.0 66.9 100.0 33.1 210 Wealth quintile Lowest 1.9 2.2 0.2 0.2 0.2 0.2 95.1 100.0 4.5 1,350 Second 2.6 3.7 0.3 0.3 0.5 0.0 92.4 100.0 7.0 1,375 Middle 1.9 5.8 0.2 0.5 0.3 0.2 91.2 100.0 8.3 1,274 Fourth 4.1 8.8 0.6 1.2 0.8 0.3 84.3 100.0 14.7 1,114 Highest 10.7 13.6 0.5 0.9 1.2 0.1 73.0 100.0 25.7 996 Total2 3.9 6.4 0.3 0.6 0.5 0.2 88.1 100.0 11.2 6,110 1 Includes newborns who received a checkup after the first week 2 Total includes 100 cases with missing information on place of delivery. Maternal Health Care • 97 Table 9.11 shows the type of provider of the newborn’s first postnatal checkup that took place within two days after birth. As is true for the mother’s postnatal care, children’s postnatal care is provided almost entirely by doctors. Table 9.11 Type of provider of first postnatal checkup for the newborn Percent distribution of last births in the two years preceding the survey by type of provider of the newborn’s first postnatal health check during the two days after the last live birth, according to background characteristics, Yemen 2013 Type of health provider of newborn’s first postnatal checkup No postnatal checkup in the first two days after birth Total Number of births Background characteristic Doctor/nurse/ midwife Auxiliary nurse/midwife Traditional birth attendant Mother’s age at birth <20 10.6 0.1 0.3 89.0 100.0 785 20-34 11.4 0.0 0.1 88.5 100.0 4,404 35-49 9.2 0.4 0.2 90.2 100.0 920 Birth order 1 14.9 0.1 0.2 84.8 100.0 1,262 2-3 12.1 0.0 0.1 87.8 100.0 2,063 4-5 10.0 0.1 0.3 89.6 100.0 1,322 6+ 6.7 0.2 0.1 93.0 100.0 1,464 Place of delivery Health facility 26.3 0.1 0.0 73.6 100.0 1,952 Elsewhere 3.7 0.1 0.2 95.9 100.0 4,133 Residence Urban 23.2 0.1 0.3 76.4 100.0 1,590 Rural 6.6 0.1 0.1 93.2 100.0 4,520 Governorate Ibb 8.1 0.0 0.7 91.2 100.0 686 Abyan 13.9 0.2 1.2 84.8 100.0 126 Sanaa City 32.9 0.0 0.0 67.1 100.0 473 Al-Baidha 8.9 0.0 0.0 91.1 100.0 247 Taiz 5.2 0.0 0.0 94.8 100.0 762 Al-Jawf 4.7 2.7 0.0 92.6 100.0 54 Hajjah 6.1 0.0 0.0 93.9 100.0 390 Al-Hodiedah 13.9 0.3 0.0 85.7 100.0 757 Hadramout 6.7 0.4 0.0 92.9 100.0 255 Dhamar 7.8 0.0 0.0 92.2 100.0 557 Shabwah 15.3 0.0 0.0 84.7 100.0 102 Sadah 10.9 0.0 0.0 89.1 100.0 183 Sanaa 5.0 0.0 0.0 95.0 100.0 374 Aden 27.8 0.0 2.2 70.0 100.0 153 Lahj 13.5 0.0 0.0 86.5 100.0 168 Mareb 9.9 0.0 0.0 90.1 100.0 45 Al-Mhweit 1.6 0.0 0.0 98.4 100.0 199 Al-Mhrah 34.8 0.0 0.0 65.2 100.0 23 Amran 10.5 0.0 0.0 89.5 100.0 261 Aldhalae 14.6 0.0 0.7 84.7 100.0 147 Reimah 1.3 0.0 0.0 98.7 100.0 150 Mother’s education No education 6.6 0.1 0.1 93.2 100.0 3,194 Fundamental 12.5 0.1 0.2 87.2 100.0 2,101 Secondary 20.5 0.0 0.3 79.1 100.0 605 Higher 32.7 0.0 0.4 66.9 100.0 210 Wealth quintile Lowest 4.2 0.2 0.2 95.5 100.0 1,350 Second 7.0 0.0 0.0 93.0 100.0 1,375 Middle 8.0 0.1 0.2 91.7 100.0 1,274 Fourth 14.4 0.1 0.2 85.3 100.0 1,114 Highest 25.5 0.0 0.2 74.3 100.0 996 Total1 10.9 0.1 0.2 88.8 100.0 6,110 1 Total includes 100 cases with missing information on place of delivery. 9.9 OBSTETRIC FISTULA Vaginal fistula is a medical condition consisting of an abnormal opening between the vagina and bladder or between the vagina and rectum. A woman with a fistula experiences an uncontrollable leakage of urine and/or feces from her vagina (Johnson and Peterman, 2008). Although largely eradicated in the developed world due to improved obstetric care, fistula continues to have devastating effects on the lives of many women in developing countries. In most parts of the world, vaginal fistula usually results from prolonged obstructed labor (Johnson and Peterman, 2008). 98 • Maternal Health Care The 2013 YNHDS included a module in which ever-married women were asked whether they had heard of a medical condition in which women experience constant leakage of stool or urine from their vagina that usually occurs after a difficult childbirth, but may occur after sexual assault or after pelvic surgery. Those who had ever heard of this problem were asked whether they had ever experienced such a leakage. Although about one-third of ever-married women (30 percent) had heard of the problem, less than 1 percent reported having experienced symptoms consistent with a fistula (Table 9.12). However, obstetric fistula is highly stigmatized and respondents may choose not to report such a “socially undesirable” condition. In addition, women with fistula may not have been reported as members of a household during the household interviews. Consequently, the occurrence of fistula may be underreported in the YNHDS, and the actual prevalence may be much higher than 1 percent of married women, constituting a severe threat to maternal health. Thus, the YNHDS findings should be interpreted with caution. Differentials in fistula are minor; however, awareness of fistula does increase with women’s education level and wealth quintile. Table 9.12 Obstetric fistula Percentage of ever-married women age 15-49 who have heard of obstetric fistula and percentage who have experienced obstetric fistula, according to background characteristics, Yemen 2013 Background characteristic Percentage of women who have heard of obstetric fistula Percentage of women who have experienced obstetric fistula Number of ever- married women Age 15-19 23.8 0.2 1,112 20-24 25.4 0.4 3,099 25-29 29.9 0.9 3,731 30-34 32.7 0.5 2,824 35-39 32.8 0.8 2,612 40-44 33.4 1.2 1,744 45-49 31.6 0.4 1,442 Residence Urban 39.2 0.9 5,322 Rural 25.8 0.5 11,242 Governorate Ibb 31.8 0.4 1,791 Abyan 57.6 1.6 345 Sanaa City 43.5 1.5 1,587 Al-Baidha 32.1 0.3 768 Taiz 37.2 1.5 2,196 Al-Jawf 32.7 1.4 141 Hajjah 9.1 0.0 895 Al-Hodiedah 20.4 0.3 2,023 Hadramout 20.7 0.1 958 Dhamar 20.9 0.2 1,188 Shabwah 15.5 0.3 315 Sadah 27.1 0.1 532 Sanaa 23.1 0.7 867 Aden 51.7 0.6 534 Lahj 49.5 0.6 425 Mareb 21.9 0.7 123 Al-Mhweit 30.5 0.8 445 Al-Mhrah 14.7 0.0 62 Amran 42.7 0.4 614 Aldhalae 22.3 1.3 404 Reimah 21.9 0.1 350 Education No education 24.6 0.6 8,887 Fundamental 33.2 0.9 5,416 Secondary 40.1 0.3 1,564 Higher 54.1 0.9 697 Wealth quintile Lowest 19.6 0.6 3,010 Second 25.8 0.4 3,248 Middle 27.9 0.6 3,330 Fourth 34.4 0.9 3,394 Highest 40.8 0.9 3,582 Total 30.1 0.7 16,564 Maternal Health Care • 99 Women who reported experiencing symptoms consistent with fistula were asked whether the problem started after a natural delivery, after a Caesarean delivery, after an operation, or in some other way. As shown in Table 9.13, the vast majority (90 percent) of women said the leakage started after a natural delivery. Table 9.13 Origin of fistula Percent distribution of ever-married women who have experienced obstetric fistula, according to the origin of the fistula, Yemen 2013 Origin of the fistula Total After natural birth 89.8 After caesarean birth 5.9 After an operation 2.8 Other 1.5 Total 100.0 Number of women who have experienced fistula 124 Women were also asked if they sought treatment for the fistula. As shown in Table 9.14, just under half of ever-married women who have experienced fistula did not seek treatment (46 percent), while just over half went to a doctor (52 percent) and two percent went to a nurse or midwife for treatment. Table 9.14 Treatment of fistula Percent distribution of ever-married women age 15-49 who have experienced obstetric fistula by source of treatment, Yemen 2013 Source of treatment Total Did not seek treatment 46.1 Doctor 51.8 Nurse, midwife 2.1 Total 100.0 Number of women who have experienced fistula 124 9.10 TUMORS In the 2013 YNHDS, women were asked if they had ever had a tumor, and if so, in what part of the body the tumor was located, who discovered the tumor and when, what treatments she might have had, and whether the tumor was benign or malignant. The series of questions was included in both the Ever-Married Woman’s Questionnaire and the Never-Married Woman’s Questionnaire. Table 9.15 shows that fewer than 2 percent of all women age 15-49 in Yemen report that they have ever had any kind of tumor. Differences by background characteristics of women are small. 100 • Maternal Health Care Table 9.15 Self-reported prevalence of tumors Percentage of all women age 15-49 who reported ever having a tumor, according to background characteristics, Yemen 2013 Background characteristic Percentage who have ever had any kind of tumor Number of women Marital status Never married 1.2 8,870 Married 1.5 15,566 Divorced/widowed 3.1 998 Residence Urban 2.1 8,619 Rural 1.1 16,815 Governorate Ibb 1.3 2,739 Abyan 3.1 551 Sanaa City 1.3 2,487 Al-Baidha 1.8 1,101 Taiz 1.4 3,512 Al-Jawf 2.0 181 Hajjah 0.9 1,374 Al-Hodiedah 1.0 3,261 Hadramout 1.5 1,427 Dhamar 0.8 1,670 Shabwah 1.9 528 Sadah 0.3 823 Sanaa 1.7 1,265 Aden 3.4 921 Lahj 1.7 678 Mareb 2.0 183 Al-Mhweit 1.7 623 Al-Mhrah 1.5 95 Amran 2.4 852 Aldhalae 1.8 641 Reimah 1.5 520 Education No education 1.4 10,705 Fundamental 1.4 9,339 Secondary 1.1 3,767 Higher 2.5 1,623 Wealth quintile Lowest 0.9 4,435 Second 1.0 4,808 Middle 1.4 5,046 Fourth 1.6 5,320 Highest 2.2 5,825 Total 1.5 25,434 Table 9.16 shows the location of tumors among those women who reported ever having a tumor. More than one-quarter of the women with tumors say their tumor is/was in their cervix, while almost one- quarter say they have had a breast tumor. Other commonly mentioned sites for tumors are the leg (10 percent), arm (7 percent), and neck (7 percent). Table 9.17 shows information about who discovered the tumor, types of treatment, and whether the tumor was diagnosed as malignant or not. Among all women with tumors, the results indicate that 78 percent were discovered by a doctor and 2 percent were discovered by a nurse or midwife. The table further indicates that almost all women with tumors said that they sought treatment (89 percent) and that 62 percent said they had either a biopsy and/or an ultrasound. Among the women who had a biopsy or ultrasound, 88 percent said their tumor was malignant (cancerous). M at er na l H ea lth C ar e • 1 01 Ta bl e 9. 16 L oc at io n of tu m or s P er ce nt d is tri bu tio n of a ll w om en a ge 1 5- 49 w ho re po rte d ev er h av in g a tu m or a cc or di ng to th e lo ca tio n of th e tu m or , b y ba ck gr ou nd c ha ra ct er is tic s, Y em en 2 01 3 Lo ca tio n of th e tu m or N um be r o f w om en w ho ha ve e ve r h ad a tu m or B ac kg ro un d ch ar ac te ris tic B re as t C er vi x G la nd s N ec k E ar A rm Le g (K ne e) E ye B ac k A nu s S to m ac h Ja w B ra in Th ro at O th er tu m or s M is si ng To ta l A ge 15 -2 9 27 .3 15 .6 0. 1 7. 5 3. 3 7. 0 12 .0 1. 6 0. 5 7. 0 5. 0 2. 1 3. 6 3. 9 2. 0 1. 5 10 0. 0 15 5 30 -4 9 19 .8 35 .9 2. 1 5. 9 1. 6 6. 3 9. 3 2. 0 3. 6 4. 3 2. 3 0. 2 1. 1 0. 5 3. 1 1. 9 10 0. 0 21 5 M ar ita l s ta tu s N ev er m ar rie d 32 .8 10 .0 0. 2 7. 2 5. 0 4. 9 15 .5 2. 3 0. 8 0. 0 6. 5 2. 1 4. 7 5. 7 1. 6 0. 7 10 0. 0 10 7 M ar rie d 19 .3 36 .1 1. 9 6. 9 1. 2 5. 2 5. 6 1. 8 3. 3 8. 0 2. 4 0. 7 1. 2 0. 4 3. 5 2. 5 10 0. 0 23 2 D iv or ce d/ w id ow ed (1 6. 5) (2 2. 3) (0 .0 ) (1 .9 ) (1 .3 ) (2 2. 5) (2 9. 4) (0 .0 ) (0 .7 ) (4 .1 ) (0 .5 ) (0 .0 ) (0 .0 ) (0 .8 ) (0 .0 ) (0 .0 ) 10 0. 0 31 R es id en ce U rb an 25 .1 28 .9 2. 0 5. 4 2. 7 6. 5 9. 8 0. 0 2. 4 5. 9 3. 5 0. 3 0. 9 3. 3 0. 9 2. 2 10 0. 0 18 4 R ur al 20 .8 26 .0 0. 5 7. 7 1. 8 6. 6 11 .0 3. 6 2. 3 4. 9 3. 4 1. 7 3. 3 0. 6 4. 3 1. 3 10 0. 0 18 6 To ta l 23 .0 27 .4 1. 2 6. 6 2. 3 6. 6 10 .4 1. 8 2. 3 5. 4 3. 4 1. 0 2. 1 2. 0 2. 6 1. 7 10 0. 0 37 0 N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. Maternal Health Care • 101 102 • Maternal Health Care Table 9.17 Tumors Among women who reported ever having a tumor, percentage whose tumor was discovered by a doctor or by a nurse/midwife, percentage who sought treatment, percentage who had a biopsy and/or an ultrasound, and percent distribution of women who had a biopsy and/or an ultrasound according to the type of tumor, by background characteristics, Yemen 2013 Among women who have ever had a tumor Number of women who have ever had a tumor Among women who had a biopsy or an ultrasound Total Number of women who had a biopsy or an ultrasound Background characteristic Percentage discovered by a doctor Percentage discovered by a nurse/ midwife Percentage who sought treatment Percentage who had a biopsy or an ultrasound Malignant tumor Benign tumor Others, missing Age 15-29 71.9 3.0 86.6 59.0 155 88.6 1.9 9.5 100.0 91 30-49 82.3 1.8 90.1 63.7 215 87.5 5.0 7.5 100.0 137 Marital status Never married 69.5 2.5 87.6 63.8 107 88.7 2.6 8.7 100.0 68 Married 82.1 2.5 90.8 63.4 232 88.0 4.3 7.7 100.0 147 Divorced/widowed (75.5) (0.0) (76.1) (42.7) 31 * * * * 13 Residence Urban 82.6 0.8 92.0 67.9 184 87.4 2.8 9.7 100.0 125 Rural 73.3 3.7 85.3 55.7 186 88.5 4.9 6.6 100.0 104 Total 77.9 2.3 88.6 61.7 370 87.9 3.8 8.3 100.0 228 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed 9.11 PROBLEMS IN ACCESSING HEALTH CARE Many factors can prevent women from accessing medical advice or treatment for themselves when they are sick. Information on such factors is particularly important in understanding and addressing the barriers women may face when seeking care during pregnancy, delivery, and the postnatal period. In the 2013 YNHDS, all women (regardless of marital status) were asked whether each of the following factors would be an impediment (or not) in seeking medical care: getting permission to go for treatment, getting money for treatment, distance to a health facility, not wanting to go alone, and not having a female health care provider. Table 9.18 shows that 92 percent of women reported at least one of these concerns as a hindrance when it came to accessing health care. The most common factor impeding women from accessing health care for themselves is not wanting to go alone; 80 percent of women mentioned this concern. Not having a female health care provider available was cited by 63 percent of women as being a big problem in accessing health care. Distance to a health facility was cited by almost three in five women as a big problem in accessing health care (59 percent), which was closely followed by getting money for treatment (56 percent). The least common problem in accessing health care for women was getting permission to go (cited by 37 percent of women). Looking at the proportion of women who cite at least one problem in accessing health care, differences by background characteristics are not large. Women in rural areas, less educated women, and women in the lower wealth quintiles are more likely than other women to report having at least one problem. In fact, for each of the problems asked about in the survey, the proportion of rural women who report the problem is substantially higher than the proportion of urban women. The proportion of women who reported each of these factors as big problems in seeking medical care decreased with increasing educational attainment and wealth quintile. Maternal Health Care • 103 Table 9.18 Problems in accessing health care Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Yemen 2013 Problems in accessing health care Background characteristic Getting permission to go for treatment Getting money for treatment Distance to health facility Not wanting to go alone No female provider At least one problem accessing health care Number of women Age 15-19 38.5 53.2 59.4 85.7 62.5 94.2 6,342 20-34 36.7 55.9 58.6 79.5 63.6 92.2 13,055 35-49 34.5 59.5 58.8 75.9 61.9 90.4 6,037 Number of living children 0 38.5 52.3 59.9 83.8 64.0 91.8 2,075 1-2 35.6 53.7 56.5 78.3 64.0 91.9 4,890 3-4 35.9 57.6 58.5 77.4 64.8 91.5 4,145 5+ 36.9 57.0 59.6 81.2 61.9 92.7 14,324 Marital status Never married 35.8 53.8 57.6 81.5 59.8 92.2 8,870 Married 37.3 57.0 59.7 79.9 64.9 92.4 15,566 Divorced/widowed 32.7 61.3 57.2 74.0 60.6 89.9 998 Employed last 12 months Not employed 37.2 56.4 59.1 80.8 63.4 92.6 23,628 Employed for cash 22.8 45.7 43.6 58.4 48.9 81.2 972 Employed not for cash 35.6 58.6 68.0 88.4 66.0 94.9 829 Residence Urban 20.6 42.4 30.4 62.0 50.6 84.1 8,619 Rural 44.8 63.0 73.4 89.6 69.3 96.5 16,815 Governorate Ibb 50.0 70.0 68.2 83.2 73.7 97.1 2,739 Abyan 49.3 68.0 73.0 85.0 72.6 97.2 551 Sanaa City 15.2 49.0 32.6 48.6 47.4 78.8 2,487 Al-Baidha 35.3 50.4 55.1 90.5 75.8 97.6 1,101 Taiz 29.8 47.3 59.8 87.0 60.0 95.9 3,512 Al-Jawf 35.8 53.1 87.4 82.0 91.8 98.5 181 Hajjah 40.6 68.7 66.4 82.9 58.9 96.6 1,374 Al-Hodiedah 53.0 69.0 66.5 84.0 66.2 93.5 3,261 Hadramout 7.4 18.5 40.1 79.1 49.9 88.9 1,427 Dhamar 42.8 66.2 65.9 79.8 59.7 88.8 1,670 Shabwah 48.7 58.1 59.4 91.9 44.9 97.0 528 Sadah 36.9 45.2 60.0 79.4 69.4 89.9 823 Sanaa 37.1 51.3 61.1 92.4 63.3 97.2 1,265 Aden 8.1 34.7 16.9 41.8 39.5 68.9 921 Lahj 27.6 50.9 67.1 87.9 50.9 95.8 678 Mareb 28.6 56.7 59.3 93.6 54.5 96.8 183 Al-Mhweit 52.3 71.7 71.4 92.0 80.2 97.9 623 Al-Mhrah 16.6 26.9 38.0 61.2 36.7 77.3 95 Amran 51.4 61.2 66.1 89.0 77.0 96.3 852 Aldhalae 32.5 60.4 73.7 93.4 90.0 96.4 641 Reimah 67.8 75.6 85.8 88.2 84.5 94.8 520 Education No education 46.0 68.0 71.2 86.2 69.7 95.8 10,705 Fundamental 34.5 52.1 55.1 80.7 62.2 92.3 9,339 Secondary 25.3 42.3 45.3 74.3 53.8 89.6 3,767 Higher 13.7 32.5 29.8 51.5 44.1 75.3 1,623 Wealth quintile Lowest 54.9 81.7 88.0 92.8 74.7 98.7 4,435 Second 50.1 69.9 78.0 90.6 71.5 97.4 4,808 Middle 40.3 57.3 67.6 87.5 67.9 95.6 5,046 Fourth 27.7 44.6 42.0 75.4 56.5 91.3 5,320 Highest 16.6 34.5 28.7 60.1 48.5 81.1 5,825 Total1 36.6 56.1 58.8 80.2 62.9 92.3 25,434 1 Total includes five cases with missing information on employment. 9.12 HEALTH INSURANCE COVERAGE The 2013 YNHDS collected data on respondents’ health insurance coverage, regardless of marital status (Table 9.19). The vast majority of all women age 15-49 (98 percent) report that they do not have health insurance. Less than 1 percent of women have social security insurance, 1 percent have other employer- based insurance, and less than 1 percent are covered by other mechanisms. Differences in insurance coverage 104 • Maternal Health Care by background characteristics are minimal, with urban women, women with more education, and women in higher wealth quintiles being only slightly more likely than other women to have health insurance. Table 9.19 Health insurance coverage Percentage of all women age 15-49 with specific types of health insurance coverage, according to background characteristics, Yemen 2013 Background characteristic Social security Other employer based insurance Mutual health organization/ community- based insurance Privately purchased commercial insurance Other None, missing Number of women Residence Urban 0.2 3.2 0.4 0.4 0.0 95.8 8,619 Rural 0.8 0.3 0.1 0.3 0.1 98.4 16,815 Education No education 0.8 0.4 0.1 0.2 0.0 98.5 10,705 Fundamental 0.4 1.0 0.2 0.2 0.1 98.1 9,339 Secondary 0.4 2.7 0.4 0.5 0.2 95.8 3,767 Higher 0.4 5.5 0.7 1.1 0.1 92.2 1,623 Wealth quintile Lowest 1.0 0.2 0.0 0.0 0.0 98.9 4,435 Second 1.0 0.1 0.1 0.0 0.0 98.8 4,808 Middle 0.9 0.2 0.0 0.1 0.1 98.7 5,046 Fourth 0.2 1.0 0.3 0.3 0.3 98.0 5,320 Highest 0.0 4.3 0.6 1.0 0.0 94.1 5,825 Total 0.6 1.3 0.2 0.3 0.1 97.5 25,434 Child Health • 105 CHILD HEALTH 10 his chapter presents findings about child health and survival, including characteristics of the neonate (birth weight and size), the vaccination status of young children, and treatment practices— particularly contact with health services—among children suffering from three childhood illnesses: acute respiratory infection (ARI), fever, and diarrhea. Because appropriate sanitary practices can help prevent and reduce the severity of diarrheal disease, information is also provided on how children’s fecal matter is disposed. These results from the 2013 YNHDS are expected to assist policymakers and program managers as they formulate appropriate strategies and interventions to improve the health of children in Yemen. 10.1 CHILD’S WEIGHT AND SIZE AT BIRTH Birth weight is an important indicator when assessing a child’s health in terms of early exposure to childhood morbidity and mortality. Children who weigh less than 2.5 kilograms, or are reported to be “very small” or “smaller than average,” are considered to have a higher-than-average risk of early childhood death. In the 2013 YNHDS, for births in the five years preceding the survey, birth weight was recorded in the Ever- Married Woman’s Questionnaire based on either a written record or the mother’s report. The mother’s estimate of the infant’s size at birth was also obtained because birth weight may be unknown for many infants. Although the mother’s estimate of size is subjective, it can be a useful proxy for the child’s weight. Table 10.1 shows that a birth weight was reported for only 8 percent of the live births that occurred in the five years preceding the survey. This very low overall proportion and the additional fact that it is skewed towards children of urban residence, some governorates, and better educated and wealthier mothers, means that children for whom a birth weight was reported are not representative of all children. Thus, the figure of 23 percent of infants who had low birth weights (less than 2.5 kg) and, especially, differentials in low birth weight, should be interpreted with caution. T Key Findings • Forty-three percent of children age 12-23 months are fully vaccinated; 36 percent of this age group received all basic vaccinations before reaching age 12 months. • Twelve percent of children under age 5 experienced symptoms of an acute respiratory infection (ARI) in the two weeks preceding the survey. Among those with symptoms, advice or treatment from a health facility or provider was sought for one-third; slightly more than half (53 percent) received antibiotics. • Less than one-third of children under age 5 had a fever within the two weeks preceding the survey. Among those with a fever, one-third were taken to a health facility or provider for advice or treatment, and almost half were given antibiotics. • Thirty-one percent of children under age 5 had diarrhea in the two weeks preceding the survey. One-third of the children with diarrhea were taken to a health facility or provider. Three in five (60 percent) of the children with diarrhea were treated with oral rehydration therapy (ORT) or increased fluids. 106 • Child Health Table 10.1 Child’s size and weight at birth Percent distribution of live births in the five years preceding the survey by mother’s estimate of baby’s size at birth, percentage of live births in the five years preceding the survey that have a reported birth weight, and among live births in the five years preceding the survey with a reported birth weight, percentage less than 2.5 kg, according to background characteristics, Yemen 2013 Percent distribution of all live births by size of child at birth Percentage of all births that have a reported birth weight1 Number of births Births with a reported birth weight1 Background characteristic Smaller than average Average or larger Don’t know/ missing Total Percentage less than 2.5 kg Number of births Mother’s age at birth <20 36.0 62.3 1.7 100.0 7.0 2,109 21.3 147 20-34 30.5 68.0 1.5 100.0 8.5 11,521 23.7 979 35-49 31.3 67.4 1.3 100.0 7.1 2,250 23.7 161 Birth order 1 35.6 62.7 1.7 100.0 11.4 3,283 25.4 375 2-3 30.4 67.9 1.7 100.0 9.4 5,374 20.7 503 4-5 29.6 68.8 1.6 100.0 8.0 3,373 27.0 270 6+ 30.6 68.4 1.1 100.0 3.6 3,850 20.5 139 Residence Urban 30.6 68.0 1.4 100.0 21.5 4,301 22.3 923 Rural 31.6 66.8 1.5 100.0 3.1 11,579 26.2 363 Governorate Ibb 26.5 72.0 1.5 100.0 2.4 1,738 * 42 Abyan 28.3 70.4 1.3 100.0 10.3 309 40.0 32 Sana’a City 33.5 65.4 1.1 100.0 26.9 1,280 23.9 345 Al-Baidha 36.4 62.6 1.0 100.0 5.1 643 (23.9) 32 Taiz 34.0 64.4 1.6 100.0 6.4 1,994 14.4 128 Al-Jawf 23.1 74.5 2.4 100.0 3.1 144 * 4 Hajjah 41.2 56.9 1.9 100.0 1.2 1,019 * 13 Al-Hodiedah 31.3 66.8 1.8 100.0 6.7 2,037 37.1 136 Hadramout 19.6 77.6 2.8 100.0 17.5 738 23.7 129 Dhamar 33.2 66.5 0.3 100.0 2.3 1,322 * 31 Shabwah 17.9 80.2 1.9 100.0 8.9 275 13.4 24 Sadah 23.2 74.6 2.2 100.0 2.9 479 * 14 Sana’a 34.2 64.9 0.9 100.0 4.6 919 (24.4) 42 Aden 23.9 74.6 1.6 100.0 47.3 389 15.3 184 Lahj 35.5 62.8 1.7 100.0 10.6 416 31.0 44 Mareb 26.6 72.7 0.7 100.0 9.3 120 38.6 11 Al-Mhweit 40.9 57.9 1.2 100.0 2.5 517 * 13 Al-Mhrah 28.4 67.8 3.8 100.0 40.1 63 16.4 25 Amran 31.1 66.9 2.0 100.0 2.6 670 * 17 Aldhalae 28.1 69.9 2.1 100.0 3.8 384 (20.4) 15 Reimah 29.3 70.0 0.7 100.0 1.2 423 * 5 Mother’s education No education 32.4 66.2 1.5 100.0 2.5 8,765 20.1 223 Fundamental 30.8 67.5 1.7 100.0 10.1 5,123 25.5 515 Secondary 28.9 69.7 1.4 100.0 21.8 1,446 24.3 315 Higher 26.8 72.4 0.7 100.0 42.6 546 20.8 233 Wealth quintile Lowest 38.4 59.9 1.7 100.0 0.5 3,562 (29.4) 18 Second 30.6 68.0 1.4 100.0 1.6 3,460 42.5 57 Middle 28.9 69.6 1.5 100.0 3.3 3,203 26.2 105 Fourth 27.5 70.9 1.6 100.0 10.4 2,946 27.1 307 Highest 30.1 68.5 1.4 100.0 29.5 2,709 20.1 800 Total 31.4 67.1 1.5 100.0 8.1 15,880 23.4 1,286 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Based on either a written record or the mother’s recall Table 10.1 also includes information on a mother’s estimate of her infant’s size at birth. Almost one-third of births (31 percent) are reported as smaller than average, and 67 percent as average or larger than average. The proportion of births reported as smaller than average declines slightly as mother’s education and wealth quintile increase. Births in Hajjah and Al-Mhweit governorates are the most likely to be reported as smaller than average (41 percent in each). Child Health • 107 10.2 VACCINATION OF CHILDREN According to the World Health Organization (WHO), a child is considered fully vaccinated if he or she has received a BCG vaccination against tuberculosis; three doses of DPT vaccine to prevent diphtheria, pertussis, and tetanus; at least three doses of polio vaccine; and one dose of measles vaccine. In Yemen, in 2005, the three doses of DPT vaccine were replaced by three doses of pentavalent vaccine: DPT, hepatitis B (hep B), and Haemophilus influenza type B (Hib). In addition, in early 2011, the Ministry of Public Health and Population introduced the pneumococcal conjugate vaccine that protects against pneumococcal infections as part of its routine immunization program. It is also recommended that children receive the complete schedule of vaccinations before their first birthday: the BCG vaccine should be given at birth; pentavalent, polio, and pneumococcal vaccines should be given at approximately age 2, 3, and 4 months; and measles vaccine should be given at or soon after the child reaches 9 months. The 2013 YNHDS collected information on the coverage for these vaccinations among all children born in the five years preceding the survey. 10.2.1 Sources of Information Following internationally recommended procedures, information on vaccination coverage was obtained in two ways in the survey – from child health cards and from mothers’ verbal reports. All mothers were asked to show the interviewer the child health cards in which immunization dates were recorded for all children born since January 2008. If a card was available, the interviewer recorded onto the questionnaire the dates of each vaccination received by the child. If a card indicated that the child was not fully vaccinated, the mother was then asked whether the child had received other vaccinations that were not recorded on the card, and they too were noted on the questionnaire. If a child never received a health card or if the mother was unable to show the card to the interviewer, the vaccination information for the child was based on the mother’s report. Questions were asked for each vaccine type. Mothers were asked to recall whether the child had received BCG, polio, pentavalent, and measles vaccinations. If the mother indicated that the child had received the polio or pentavalent vaccines, she was asked about the number of doses that the child received. The results presented here are based on both health card information and, for those children without a card, information provided by the mother.1 The methodology utilized in the 2013 YNHDS to collect vaccination coverage information has been widely used in international surveys, such as the Demographic and Health Surveys and the UNICEF Multiple Indicator Cluster Surveys. It differs in some ways from methods used in other surveys such as the Expanded Program on Immunization (EPI) cluster surveys, which often utilize simpler methods for selecting households and children and which may utilize health workers as interviewers (WHO, 2005). Consequently, results of the YNHDS or MICS may significantly differ from the findings of EPI surveys and from other sources that report vaccination coverage such as routine health information system. 10.2.2 Vaccination Coverage Table 10.2 shows vaccination coverage by source of information for children age 12-23 months, the age by which they should have received all vaccinations. Mothers were able to present health cards for 47 percent of these children (Table 10.3). Overall, 43 percent of children age 12-23 months are fully vaccinated, meaning that they received the basic vaccinations (BCG, three doses of pentavalent and polio vaccine, and one dose of measles vaccine) at any time before the survey (Figure 10.1). Sixty-eight percent of children received BCG at any time before the survey, 77 percent received the first dose of pentavalent vaccine, and 76 percent received the first dose of polio. Sixty percent of children completed the required three doses of 1 Information on pneumococcal vaccine is only based on health cards. 108 • Child Health the pentavalent and 59 percent the three doses of polio vaccine. Coverage of vaccination against measles is 63 percent. Table 10.2 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s report), and percentage vaccinated 12 months of age, Yemen 2013 BCG Penta1 Polio Measles All basic vaccina- tions3 No vaccina- tions Pneumococcal Number of children Source of information 1 2 3 02 1 2 3 1 2 3 Vaccinated at any time before survey Vaccination card 40.4 46.0 43.7 40.4 31.4 46.4 43.9 40.8 39.3 33.7 0.0 43.9 41.7 38.4 1,427 Mother’s report 27.1 30.6 26.4 19.3 9.3 29.7 26.2 17.9 24.0 8.8 16.0 0.0 0.0 0.0 1,601 Total (either source) 67.6 76.6 70.1 59.6 40.7 76.1 70.1 58.7 63.3 42.6 16.0 43.9 41.7 38.4 3,028 Vaccinated by 12 months of age4 66.9 75.3 68.3 57.6 40.6 74.5 68.1 56.7 51.4 35.5 17.8 42.9 40.6 37.0 3,028 1 Penta: diphtheria, pertussis, tetanus, Hemophilus influenza type B (Hib), and hepatitis B. 2 Polio 0 is the polio vaccination given at birth. 3 BCG, measles, and three doses each of penta and polio vaccine (excluding polio vaccine given at birth). 4 For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccination. Figure 10.1 Vaccination coverage among children 12-23 months Overall, 16 percent of children in Yemen have not received any basic vaccinations. This represents a slight deterioration from 2006 YMICS in which 12 percent of children were reported to have not received any vaccinations. However, 44 percent of children have now received the first dose of pneumococcal conjugate vaccine and 38 percent have received the three doses. Table 10.2 also shows vaccination coverage by age 12 months. The rates for each vaccination by the time the child reaches age 12 months is a measure of children receiving vaccines on time. Overall, 36 percent of children are fully immunized by 12 months, compared with 18 percent in the 2006 YMICS. Table 10.3 presents information on vaccine coverage among children age 12-23 months from vaccination cards and mothers’ reports, by background characteristics. The proportion of children fully vaccinated decreases with increasing birth order, from 49 percent of first births to 34 percent of sixth and higher births. Children in urban areas are more likely than rural children to be fully vaccinated (59 percent 68 77 60 76 59 63 43 16 44 38 Percentage YNHDS 2013 Child Health • 109 compared with 37 percent) and to have received the three doses of pneumococcal vaccine (52 percent compared with 33 percent). Mothers’ educational status is highly correlated with the child being fully vaccinated. For example, 34 percent of children of mothers with no education are fully vaccinated compared with 69 percent of children of mothers with higher education. Children in the highest wealth quintile are more likely to be fully vaccinated than those in the lowest (62 percent and 24 percent, respectively). By governorate, the proportion of children fully vaccinated is highest in Aden Governorate (64 percent) and lowest in Sadah Governorate (13 percent). Table 10.3 Vaccinations by background characteristics Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and percentage with a vaccination card, by background characteristics, Yemen 2013 Background characteristic BCG Penta1 Polio Measles All basic vaccina- tions3 No vaccina- tions Pneumococcal Percentage with a vaccination card seen Number of children 1 2 3 02 1 2 3 1 2 3 Sex Male 66.6 77.1 69.5 59.7 41.6 76.3 69.8 57.8 63.5 41.3 15.4 44.8 42.2 38.6 48.5 1,540 Female 68.6 76.0 70.7 59.6 39.8 75.9 70.4 59.6 63.2 43.9 16.7 43.0 41.3 38.3 45.7 1,488 Birth order 1 75.4 82.5 77.8 66.2 48.3 82.2 76.5 65.7 69.7 49.2 10.7 53.6 51.4 46.4 58.2 620 2-3 69.6 78.1 72.4 64.4 44.6 77.4 72.9 62.0 64.8 46.0 15.4 45.3 43.5 40.9 48.7 1,045 4-5 64.0 72.7 66.1 56.3 39.0 73.0 66.5 55.5 60.4 41.1 18.9 42.4 40.4 37.5 44.9 634 6+ 61.1 72.7 63.7 50.2 30.2 71.8 63.6 50.8 58.4 33.5 19.1 34.9 32.2 28.9 37.4 730 Residence Urban 85.8 85.7 82.7 76.5 66.6 86.3 81.5 69.6 74.4 58.8 9.7 56.1 55.2 52.4 58.2 801 Rural 61.0 73.3 65.6 53.6 31.4 72.4 66.0 54.8 59.4 36.7 18.3 39.5 36.9 33.4 43.1 2,227 Governorate Ibb 64.1 70.7 62.2 50.9 36.4 75.6 68.8 60.0 59.1 41.4 17.0 39.4 36.9 34.6 44.1 344 Abyan 62.8 57.4 53.3 50.6 30.3 66.4 63.2 55.9 49.6 44.0 29.3 36.6 33.7 31.7 40.2 63 Sana’a City 92.0 92.9 89.7 88.1 76.7 93.7 90.3 73.7 76.1 59.5 4.2 54.5 54.5 54.2 56.0 244 Al-Baidha 50.8 57.2 50.6 34.5 27.8 54.3 50.5 38.1 41.5 26.1 37.2 28.9 25.7 19.7 31.2 120 Taiz 71.6 85.3 81.9 75.7 50.8 82.9 80.5 71.4 74.0 51.2 9.4 43.9 43.3 42.8 45.9 402 Al-Jawf 40.8 36.5 21.7 20.8 13.1 46.3 35.9 20.2 29.3 15.8 40.4 12.9 9.7 8.9 14.0 24 Hajjah 59.3 69.7 65.3 49.1 19.9 71.9 63.8 47.6 56.2 34.1 20.0 43.6 42.8 35.6 45.6 186 Al-Hodiedah 66.6 80.6 73.2 56.3 45.6 80.2 68.4 58.9 65.2 39.5 13.7 48.3 45.2 38.1 54.0 368 Hadramout 76.5 82.5 79.5 77.5 31.5 78.4 75.4 68.3 62.8 51.7 17.5 47.8 45.8 42.7 51.7 125 Dhamar 75.0 82.6 73.4 57.3 33.1 76.7 68.8 55.4 65.7 42.2 10.2 37.3 35.4 34.6 40.5 274 Shabwah 56.0 59.5 52.7 48.5 35.8 56.6 52.7 45.4 48.8 39.2 39.2 42.3 39.0 36.9 46.0 51 Sadah 28.5 30.5 26.4 20.0 22.0 35.6 29.5 21.5 44.3 13.0 46.1 16.2 14.3 12.7 17.4 89 Sana’a 64.6 71.8 61.3 51.4 35.9 71.1 64.2 51.4 59.1 37.9 18.3 46.7 43.4 38.5 49.1 183 Aden 90.2 90.0 85.1 72.9 82.6 92.5 90.1 75.4 79.8 63.8 7.5 64.7 61.0 58.9 69.9 72 Lahj 73.8 84.0 79.3 73.1 54.1 81.2 76.6 71.7 68.9 54.7 13.5 63.1 58.8 55.0 71.5 75 Mareb 55.3 66.2 54.9 41.9 23.1 67.0 58.3 45.8 53.6 29.6 27.6 34.2 30.9 27.6 36.6 24 Al-Mhweit 62.8 83.1 76.4 62.4 29.5 75.7 73.4 62.5 69.4 40.7 13.0 54.2 53.0 47.7 57.7 101 Al-Mhrah 84.8 82.6 81.4 75.1 62.6 86.4 75.9 59.2 71.1 46.0 10.6 47.5 44.1 41.2 52.7 13 Amran 59.0 76.3 70.4 62.6 21.0 76.2 72.0 63.5 63.2 42.0 14.0 46.2 42.8 39.0 48.3 125 Aldhalae 56.1 69.5 56.9 42.0 27.4 63.1 56.6 44.1 52.2 33.8 23.9 29.9 27.1 23.6 29.9 67 Reimah 69.7 87.2 76.8 61.0 43.6 87.1 77.5 52.8 67.7 34.3 5.1 51.9 47.2 39.8 53.7 77 Mother’s education No education 59.3 71.7 64.0 50.8 29.5 71.1 64.7 51.9 57.7 34.2 19.0 36.7 34.7 30.9 39.7 1,621 Fundamental 73.2 79.4 73.3 65.0 48.6 79.0 72.7 63.5 67.7 49.2 14.4 50.6 47.7 44.3 54.4 1,019 Secondary 84.0 86.5 84.1 78.3 63.3 86.5 82.4 72.0 71.8 57.2 9.7 57.1 55.6 54.0 59.3 277 Higher 95.8 96.3 94.6 93.0 75.1 95.6 94.2 80.8 84.5 68.6 3.3 55.0 54.8 54.8 58.1 111 Wealth quintile Lowest 49.7 67.5 57.1 42.4 21.7 69.2 61.2 44.3 51.8 23.8 20.4 32.0 28.8 23.5 35.6 675 Second 57.4 73.2 66.6 54.3 31.2 69.8 64.4 55.0 58.9 36.3 18.4 38.8 37.4 34.6 42.8 657 Middle 70.6 76.7 68.8 57.9 38.5 74.8 66.6 59.1 63.7 44.9 17.5 44.7 41.4 38.1 48.4 628 Fourth 76.7 78.6 74.0 66.7 51.2 80.3 75.1 65.3 69.6 52.0 14.6 50.8 48.9 45.7 53.5 557 Highest 90.5 90.5 89.1 83.7 69.4 90.4 87.9 74.8 77.1 62.4 7.1 57.5 57.1 55.4 59.4 511 Total 67.6 76.6 70.1 59.6 40.7 76.1 70.1 58.7 63.3 42.6 16.0 43.9 41.7 38.4 47.1 3,028 1 Penta: diphtheria, pertussis, tetanus, Hemophilus influenzae type B (Hib), and hepatitis B. 2 Polio 0 is the polio vaccination given at birth. 3 BCG, measles, and three doses each of penta and polio vaccine (excluding polio vaccine given at birth). 10.2.3 Trends in Vaccination Coverage There was significant improvement in childhood vaccination coverage between 1997 and 2006 (Figure 10.2). The coverage increased from 28 percent in 1997 to 38 percent in 2006. Since 2006, the coverage for each individual vaccination has slightly decreased, and the proportion of children who received 110 • Child Health no vaccinations increased from 12 percent to 16 percent. However, the proportion of children age 12-23 months who were fully vaccinated by the time of the survey has continued to increase, from 38 percent in 2006 to 43 percent in 2013. In contrast, the proportion of children partially vaccinated has decreased from 51 percent to 41 percent (Figure 10.2). Figure 10.2 Trends in vaccination coverage - children 12-23 months, Yemen 1997-2013 10.3 PREVALENCE AND TREATMENT OF ACUTE RESPIRATORY INFECTION Acute respiratory infection (ARI) is among the leading causes of childhood morbidity and mortality throughout the world. Among acute respiratory diseases, pneumonia is the most serious for young children. Early diagnosis and treatment with antibiotics can prevent a large number of deaths caused by ARIs. In the 2013 YNHDS, ARI prevalence was estimated by asking mothers whether, in the two weeks before the survey, their children under age 5 had been ill with a cough accompanied by short, rapid breathing, and/or by difficulty in breathing that was chest-related. It should be noted that these data are subjective in the sense that they are based on the mother’s perception of illness without validation by medical personnel. Table 10.4 shows the prevalence of ARI symptoms among children under 5 during the two-week period preceding the interview and the actions that mothers took in response to their children’s illness. Overall, 12 percent of children are reported to have had ARI symptoms in the two weeks preceding the survey, almost identical to the 13 percent reported in the 2006 YMICS. Mothers who reported that their children had had ARI symptoms were asked about the actions they had taken to treat the illness. Among children with ARI symptoms, advice or treatment was sought from a health facility or a health provider for 34 percent of children. Over half (53 percent) of children with ARI symptoms received antibiotics, an increase from the level of 38 percent found in the 2006 YMICS. 54 40 46 43 28 12 60 69 61 63 65 38 12 51 68 60 59 63 43 16 41 BCG DPT 3 Polio 3 Measles All basic vaccinations No vaccination Partially vaccinated Percentage 1997 YDMCHS 2006 YMICS 2013 YNHDS Child Health • 111 Table 10.4 Prevalence and treatment of symptoms of ARI Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider, and the percentage who received antibiotics as treatment, according to background characteristics, Yemen 2013 Among children under age f5: Among children under age 5 with symptoms of ARI: Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Age in months <6 8.6 1,654 39.4 55.1 142 6-11 16.7 1,548 38.3 55.8 259 12-23 15.5 3,028 37.6 56.7 468 24-35 12.4 3,066 31.1 49.8 379 36-47 12.0 2,894 26.7 52.1 347 48-59 8.8 2,978 33.9 50.9 263 Sex Male 12.5 7,764 40.8 55.5 970 Female 12.0 7,406 26.5 51.0 889 Residence Urban 10.2 4,137 37.8 63.0 424 Rural 13.0 11,033 32.8 50.5 1,436 Governorate Ibb 17.7 1,644 34.4 61.8 291 Abyan 8.4 300 47.1 57.2 25 Sana’a City 5.8 1,242 (50.6) (81.1) 72 Al-Baidha 16.8 604 38.8 58.9 102 Taiz 18.1 1,910 25.9 46.9 347 Al-Jawf 16.7 140 34.9 68.7 23 Hajjah 7.1 983 22.0 47.4 69 Al-Hodiedah 10.1 1,932 34.7 48.3 194 Hadramout 3.2 716 * * 23 Dhamar 6.3 1,251 29.2 47.7 79 Shabwah 6.8 267 (35.2) (54.5) 18 Sadah 10.9 454 44.9 74.0 49 Sana’a 16.8 874 26.3 32.8 146 Aden 6.8 377 (48.5) (26.7) 26 Lahj 10.2 402 49.1 67.1 41 Mareb 11.7 114 35.0 53.0 13 Al-Mhweit 14.4 492 38.2 50.7 71 Al-Mhrah 7.9 61 (55.2) (70.9) 5 Amran 23.3 632 35.0 52.3 147 Aldhalae 18.8 373 34.0 62.7 70 Reimah 11.7 401 34.0 48.3 47 Mother’s education No education 12.5 8,350 33.2 49.0 1,043 Fundamental 11.9 4,886 33.8 58.1 581 Secondary 12.5 1,401 31.3 57.1 175 Higher 11.4 533 (56.2) (71.6) 61 Wealth quintile Lowest 14.4 3,407 30.7 41.7 489 Second 13.6 3,248 32.0 52.1 443 Middle 12.1 3,068 34.5 56.9 371 Fourth 10.9 2,832 34.7 57.6 310 Highest 9.4 2,615 42.4 68.2 247 Total 12.3 15,170 34.0 53.4 1,859 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Symptoms of ARI (cough accompanied by short, rapid breathing that was chest-related and/or by difficulty in breathing that was chest-related) is considered a proxy for pneumonia. 2 Excludes pharmacy, shop, and traditional practitioner. Differences in treatment of ARI are observed by background characteristics. One of the most striking findings is that whereas the percentages of male and female children with symptoms of ARI were nearly identical (13 percent and 12 percent, respectively), male children are much more likely than female children to have had advice or treatment sought from a health facility or provider (41 percent and 27 percent, respectively). Wealth is related to treatment of ARI symptoms; the proportions of children with ARI for whom medical advice was sought and who received antibiotics both increase as wealth quintile increases. 112 • Child Health 10.4 PREVALENCE AND TREATMENT OF FEVER Fever is a symptom of malaria, but it may also accompany other illnesses including pneumonia, common colds, and influenza. In the 2013 YNHDS, fever prevalence was estimated by asking mothers whether their children under 5 had been ill with fever in the two weeks preceding the survey. For children with fever, mothers were also asked about the actions they took to treat fever, including whether or not the child had been given any drug to treat the fever, and, if so, what drug the child was given. Table 10.5 shows that 32 percent of children under 5 had a fever during the two weeks preceding the survey. The prevalence of fever varies with children’s ages. Children age 6-23 months are more likely to be sick with fever (42-43 percent) than children in other age groups. The proportion of children under 5 reported as having had a fever in the two weeks before the survey varies from 22 percent in Hadramout and Al-Mhrah governorates to 45 percent in Al-Mhweit Governorate. Differences by other background characteristics are not large. Table 10.5 Prevalence and treatment of fever Among children under age five, the percentage who had a fever in the two weeks preceding the survey; and among children with fever, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial drugs, and the percentage who received antibiotics as treatment, by background characteristics, Yemen 2013 Among children under age 5: Among children under age 5 with fever Background characteristic Percentage with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who had blood taken from a finger or heel for testing Percentage who took antimalarial drugs Percentage who took antibiotic drugs Number of children Age in months <6 25.8 1,654 33.3 14.4 1.0 39.6 426 6-11 43.0 1,548 38.1 17.4 0.9 52.5 666 12-23 41.7 3,028 36.9 18.2 1.2 49.7 1,26 24-35 32.0 3,066 29.8 12.7 1.6 45.9 980 36-47 27.2 2,894 28.6 13.1 0.9 48.0 787 48-59 23.4 2,978 32.2 16.7 1.5 48.4 697 Sex Male 32.8 7,764 36.8 16.4 1.3 49.3 2,545 Female 30.7 7,406 29.4 14.7 1.2 46.4 2,275 Residence Urban 30.7 4,137 37.9 19.6 0.6 57.4 1,271 Rural 32.2 11,033 31.6 14.2 1.4 44.6 3,549 Governorate Ibb 36.1 1,644 34.7 17.0 0.3 55.9 594 Abyan 27.7 300 46.5 21.1 0.0 54.0 83 Sana’a City 27.4 1,242 36.9 10.7 0.5 65.6 341 Al-Baidha 42.3 604 35.0 24.7 0.0 51.9 256 Taiz 39.8 1,910 25.8 15.2 0.3 42.8 761 Al-Jawf 34.5 140 48.4 14.3 0.0 59.2 48 Hajjah 27.3 983 20.3 4.5 0.4 38.3 268 Al-Hodiedah 26.8 1,932 40.2 27.6 6.5 46.0 518 Hadramout 22.0 716 47.3 32.8 0.0 74.1 158 Dhamar 27.4 1,251 16.2 9.5 0.0 34.4 343 Shabwah 27.7 267 35.7 17.3 0.0 38.9 74 Sadah 28.6 454 41.3 5.7 0.5 53.0 130 Sana’a 34.5 874 32.6 4.1 0.3 35.2 301 Aden 24.2 377 49.1 20.9 0.7 41.6 91 Lahj 28.9 402 42.0 23.0 0.0 52.6 116 Mareb 34.4 114 29.6 16.7 0.0 31.2 39 Al-Mhweit 44.9 492 31.5 7.4 1.1 44.6 221 Al-Mhrah 21.7 61 59.5 28.1 2.2 45.3 13 Amran 39.2 632 36.7 12.1 0.3 49.4 248 Aldhalae 26.4 373 40.2 24.0 10.8 58.1 99 Reimah 29.7 401 33.6 10.3 2.4 41.4 119 Mother’s education No education 32.0 8,350 31.5 13.6 1.8 44.2 2,672 Fundamental 32.1 4,886 34.4 16.7 0.4 51.5 1,569 Secondary 31.5 1,401 36.5 19.8 1.0 56.0 442 Higher 25.7 533 45.8 26.9 0.4 54.1 137 Wealth quintile Lowest 34.8 3,407 28.0 13.2 1.8 37.9 1,184 Second 31.9 3,248 31.0 13.0 1.6 44.1 1,036 Middle 31.1 3,068 33.1 14.3 1.2 49.3 954 Fourth 30.5 2,832 38.7 18.0 0.9 52.4 865 Highest 29.9 2,615 38.6 21.4 0.3 61.7 782 Total 31.8 15,170 33.3 15.6 1.2 48.0 4,820 1 Excludes pharmacy, shop, market, and traditional practitioners Child Health • 113 Advice or treatment was sought from a health facility or provider for one-third of the children with fever, and 16 percent had blood taken for testing, presumably for malaria. Very few children with fever received an antimalarial drug (1 percent); however, almost half (48 percent) received an antibiotic drug during the episode of the fever. Advice or treatment for fever was more commonly sought for boys than for girls (37 and 29 percent, respectively) and for children in urban areas (38 percent) than for children in rural areas (32 percent). The proportion of children with fever for whom advice or treatment was sought increases with education and wealth of the mother. Treatment with antibiotics is higher among urban children with fever, as well as among those whose mothers have more education and those in the higher wealth quintiles. 10.5 PREVALENCE AND TREATMENT OF DIARRHEAL DISEASE Dehydration caused by severe diarrhea is a major cause of morbidity and mortality among young children. Exposure to diarrhea-causing agents frequently relates to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta. The 2013 YNHDS obtained information on the prevalence of diarrhea among young children by asking mothers whether their children under 5 had diarrhea during the two weeks preceding the survey. If a child was identified as having had diarrhea, information was collected on treatment and feeding practices during the episode. The mother was also asked whether there was blood in the child’s stools. Diarrhea with blood in the stools indicates an infection that needs to be treated differently than diarrhea in which there is no blood in the stools. 10.5.1 Prevalence of Diarrhea Table 10.6 shows that 31 percent of children under 5 had a diarrheal episode in the two weeks preceding the survey and 5 percent had blood in the stool. The prevalence of diarrhea increases from 28 percent among children less than age 6 months to 45-46 percent among children age 6-11 and 12-23 months. This observation is expected because children age 6 months and older are typically introduced to liquids in addition to breast milk and complementary foods. Rural children are slightly more likely to have diarrhea than urban children (32 versus 28 percent, respectively.) The prevalence of diarrhea varies at the governorate level: it was highest in Al-Mhweit Governorate (43 percent each) and lowest in Hadramout Governorate (14 percent). Diarrhea prevalence varies little by education of the mother except for those with higher education. Similarly, prevalence is rather uniform by wealth quintile until it decreases among those in the highest quintile. Figure 10.3 summarizes the prevalence of all three childhood illnesses (ARI, fever, and diarrhea) by age group. It indicates that ages 6-23 Table 10.6 Prevalence of diarrhea Percentage of children under age 5 who had diarrhea in the two weeks preceding the survey, by background characteristics, Yemen 2013 Diarrhea in the two weeks preceding the survey Number of children Background characteristic All diarrhea Diarrhea with blood Age in months <6 27.6 1.6 1,654 6-11 44.7 5.9 1,548 12-23 46.1 7.6 3,028 24-35 31.6 5.4 3,066 36-47 24.6 5.2 2,894 48-59 17.1 3.8 2,978 Sex Male 32.3 5.5 7,764 Female 30.0 4.7 7,406 Residence Urban 28.1 3.1 4,137 Rural 32.4 5.9 11,033 Governorate Ibb 37.7 6.8 1,644 Abyan 26.1 3.5 300 Sana’a City 24.0 2.0 1,242 Al-Baidha 40.1 5.7 604 Taiz 34.7 6.5 1,910 Al-Jawf 35.7 5.7 140 Hajjah 29.4 4.9 983 Al-Hodiedah 28.8 5.5 1,932 Hadramout 13.7 1.2 716 Dhamar 31.0 6.1 1,251 Shabwah 26.6 3.0 267 Sadah 35.1 4.0 454 Sana’a 34.0 5.0 874 Aden 19.3 1.5 377 Lahj 26.2 4.5 402 Mareb 33.8 5.9 114 Al-Mhweit 43.1 8.1 492 Al-Mhrah 19.3 2.3 61 Amran 35.9 5.1 632 Aldhalae 35.6 5.2 373 Reimah 30.6 7.6 401 Mother’s education No education 31.3 6.2 8,350 Fundamental 31.9 4.2 4,886 Secondary 31.1 2.9 1,401 Higher 23.7 2.2 533 Wealth quintile Lowest 32.5 7.7 3,407 Second 33.8 6.6 3,248 Middle 33.0 4.7 3,068 Fourth 30.2 3.7 2,832 Highest 25.2 1.9 2,615 Total 31.2 5.1 15,170 114 • Child Health months are the riskiest ages for children under 5, with a higher prevalence of all three illnesses, but particularly of fever and diarrhea. Figure 10.3 Prevalence of ARI, fever, and diarrhea by age 10.5.2 Treatment of Diarrhea A simple, effective response to dehydration caused by diarrhea is oral rehydration therapy (ORT). Oral rehydration salt (ORS) packets are one source of rehydration therapy available in Yemen. Table 10.7 shows that advice or treatment was sought from a health facility or provider for 33 percent of children with diarrhea. Advice and/or treatment for the diarrhea were sought more often for children whose mothers have higher education than for those whose mothers are less educated (50 percent and 30-34 percent, respectively). Some form of ORT, either fluid from ORS packets or recommended home fluid (RHF), was used to treat the diarrhea for just over one-quarter of children (28 percent). Four percent of children suffering from diarrhea in the two weeks preceding the survey were given RHF, and 25 percent were given fluid from ORS packets. Forty-five percent of the children were given increased amounts of other fluids. Three out of five children (60 percent) were given either ORT or increased fluids. Other treatments given to children with diarrhea were principally antibiotics (34 percent), home remedies (21 percent), and anti-motility drugs (11 percent). Nineteen percent of children with diarrhea did not receive any treatment. 0 5 10 15 20 25 30 35 40 45 50 <6 6-11 12-23 24-35 36-47 48-59 Percentage Age in months ARI Fever Diarrhea YNHDS 2013 C hi ld H ea lth • 1 15 Ta bl e 10 .7 D ia rr he a tre at m en t A m on g ch ild re n un de r ag e 5 w ho h ad d ia rr he a in th e tw o w ee ks p re ce di ng th e su rv ey , t he p er ce nt ag e fo r w ho m a dv ic e or tr ea tm en t w as s ou gh t f ro m a h ea lth fa ci lit y or p ro vi de r, th e pe rc en ta ge g iv en o ra l r eh yd ra tio n th er ap y (O R T) , t he p er ce nt ag e gi ve n in cr ea se d flu id s, th e pe rc en ta ge g iv en O R T or in cr ea se d flu id s, a nd th e pe rc en ta ge g iv en o th er tr ea tm en ts , b y ba ck gr ou nd c ha ra ct er is tic s, Y em en 2 01 3 P er ce nt ag e of ch ild re n w ith di ar rh ea fo r w ho m ad vi ce o r t re at m en t w as s ou gh t f ro m a he al th fa ci lit y or pr ov id er 1 O ra l r eh yd ra tio n th er ap y (O R T) In cr ea se d flu id s O R T or in cr ea se d flu id s O th er tr ea tm en ts M is si ng N o tre at m en t N um be r o f ch ild re n w ith di ar rh ea B ac kg ro un d ch ar ac te ris tic Fl ui d fro m O R S p ac ke ts or p re - pa ck ag ed liq ui d R ec om - m en de d ho m e flu id s (R H F) E ith er O R S or R H F A nt ib io tic dr ug s A nt i- m ot ili ty dr ug s Zi nc su pp le - m en ts In tra - ve no us so lu tio n H om e re m ed y/ ot he r A ge in m on th s <6 28 .5 17 .8 1. 2 18 .4 25 .2 38 .9 24 .4 8. 9 0. 5 1. 4 17 .7 0. 4 36 .3 45 6 6- 11 39 .2 33 .9 5. 1 35 .8 39 .7 58 .9 32 .4 12 .9 0. 4 2. 2 22 .4 0. 9 18 .4 69 1 12 -2 3 38 .6 31 .1 3. 7 33 .2 48 .0 64 .5 40 .1 11 .9 0. 2 3. 8 22 .0 0. 2 12 .8 1, 39 5 24 -3 5 28 .9 21 .1 4. 6 24 .4 51 .6 63 .3 32 .1 12 .2 0. 2 3. 0 19 .4 0. 5 17 .0 97 0 36 -4 7 29 .2 21 .1 3. 2 23 .3 48 .2 60 .4 33 .9 10 .3 0. 7 2. 2 21 .9 0. 6 20 .7 71 2 48 -5 9 24 .9 17 .9 4. 0 21 .1 43 .5 56 .6 28 .4 9. 1 0. 9 2. 9 21 .9 0. 3 21 .6 50 9 Se x M al e 34 .3 26 .7 3. 9 29 .0 44 .9 60 .0 34 .1 11 .5 0. 3 3. 6 21 .3 0. 5 17 .4 2, 51 0 Fe m al e 31 .2 23 .7 3. 7 26 .0 44 .9 58 .9 33 .0 11 .0 0. 5 2. 0 20 .8 0. 3 20 .6 2, 22 3 Ty pe o f d ia rr he a N on -b lo od y 32 .6 24 .6 3. 8 27 .1 43 .7 58 .1 32 .8 11 .5 0. 4 2. 7 21 .1 0. 4 19 .9 3, 88 3 B lo od y 34 .7 28 .7 3. 9 30 .5 49 .8 65 .7 38 .0 10 .2 0. 1 3. 3 21 .4 0. 4 14 .0 77 6 M is si ng 25 .0 24 .4 1. 5 24 .4 58 .6 68 .4 32 .7 9. 0 2. 4 3. 5 15 .8 4. 5 13 .9 74 R es id en ce U rb an 39 .0 24 .0 7. 6 28 .6 43 .2 57 .9 32 .5 12 .9 0. 1 4. 6 28 .7 0. 2 15 .7 1, 16 1 R ur al 30 .9 25 .7 2. 6 27 .3 45 .5 60 .0 34 .0 10 .7 0. 5 2. 3 18 .6 0. 5 19 .9 3, 57 2 G ov er no ra te Ib b 32 .0 22 .6 8. 0 27 .1 58 .9 67 .1 39 .0 16 .9 0. 8 3. 3 13 .4 0. 3 12 .6 61 9 A by an 53 .1 26 .3 15 .6 32 .0 9. 0 39 .6 37 .8 15 .9 0. 0 5. 8 32 .8 0. 0 23 .2 78 S an a’ a C ity 31 .0 19 .4 3. 9 21 .9 40 .4 52 .5 28 .8 6. 0 0. 0 1. 9 31 .1 0. 0 22 .7 29 8 A l-B ai dh a 40 .0 21 .9 9. 8 26 .9 56 .1 68 .1 34 .5 23 .2 0. 2 8. 1 15 .7 0. 4 14 .5 24 2 Ta iz 22 .4 18 .2 1. 4 19 .6 52 .0 61 .0 30 .4 7. 2 0. 0 1. 2 22 .7 0. 3 21 .3 66 3 A l-J aw f 58 .5 51 .6 1. 7 51 .6 25 .3 59 .5 67 .5 34 .9 1. 0 7. 6 20 .5 0. 0 7. 5 50 H aj ja h 20 .5 20 .5 0. 0 20 .5 28 .4 42 .9 35 .6 7. 8 0. 0 1. 8 16 .0 0. 4 34 .8 28 9 A l-H od ie da h 44 .5 28 .3 1. 7 28 .7 38 .5 54 .9 33 .8 13 .4 0. 0 5. 3 33 .4 0. 4 15 .5 55 7 H ad ra m ou t 36 .5 10 .6 4. 1 14 .7 2. 7 17 .3 40 .4 11 .2 0. 0 8. 9 17 .7 0. 0 32 .9 98 D ha m ar 24 .0 29 .7 5. 1 34 .1 55 .1 75 .2 31 .6 9. 4 0. 0 1. 1 19 .8 1. 5 11 .4 38 8 S ha bw ah 32 .2 22 .2 1. 3 22 .2 14 .6 33 .2 45 .4 29 .0 0. 5 4. 4 11 .9 0. 0 26 .9 71 S ad ah 43 .0 44 .8 0. 4 44 .8 49 .9 73 .6 36 .4 5. 7 7. 1 3. 0 17 .6 0. 4 10 .7 15 9 S an a’ a 33 .3 29 .0 1. 9 29 .8 50 .2 64 .2 17 .1 2. 0 0. 0 1. 2 31 .4 1. 1 20 .5 29 7 A de n 43 .5 28 .5 3. 0 30 .6 8. 0 35 .5 30 .8 14 .7 0. 0 4. 4 15 .2 0. 0 29 .1 73 La hj 38 .6 34 .0 9. 2 40 .8 30 .4 54 .5 27 .9 7. 6 0. 0 0. 9 15 .1 0. 7 24 .3 10 5 M ar eb 35 .8 33 .8 0. 5 33 .8 30 .4 51 .4 43 .6 11 .2 0. 6 1. 7 12 .0 0. 0 23 .8 39 A l-M hw ei t 34 .8 22 .3 0. 3 22 .3 37 .4 51 .9 27 .4 10 .4 0. 0 0. 5 18 .4 0. 0 25 .2 21 2 A l-M hr ah 49 .2 25 .3 0. 0 25 .3 25 .1 30 .7 22 .5 19 .3 0. 0 3. 6 33 .3 0. 0 23 .8 12 A m ra n 30 .9 30 .8 2. 0 31 .4 67 .5 78 .4 40 .2 7. 5 0. 4 1. 3 16 .2 0. 3 11 .4 22 7 A ld ha la e 33 .5 23 .8 10 .0 32 .1 31 .5 52 .9 47 .2 20 .7 0. 0 3. 0 15 .0 0. 0 17 .9 13 3 R ei m ah 33 .4 33 .9 1. 6 35 .1 50 .3 64 .4 30 .4 4. 1 0. 0 0. 4 7. 9 1. 0 21 .9 12 3 C on tin ue d… Child Health • 115 11 6 • C hi ld H ea lth Ta bl e 10 .7 — C on tin ue d P er ce nt ag e of ch ild re n w ith di ar rh ea fo r w ho m ad vi ce o r t re at m en t w as s ou gh t f ro m a he al th fa ci lit y or pr ov id er 1 O ra l r eh yd ra tio n th er ap y (O R T) In cr ea se d flu id s O R T or in cr ea se d flu id s O th er tr ea tm en ts M is si ng N o tre at m en t N um be r o f ch ild re n w ith di ar rh ea B ac kg ro un d ch ar ac te ris tic Fl ui d fro m O R S p ac ke ts or p re - pa ck ag ed liq ui d R ec om - m en de d ho m e flu id s (R H F) E ith er O R S or R H F A nt ib io tic dr ug s A nt i- m ot ili ty dr ug s Zi nc su pp le - m en ts In tra - ve no us so lu tio n H om e re m ed y/ ot he r M ot he r’s e du ca tio n N o ed uc at io n 31 .7 26 .3 1. 7 27 .3 45 .5 60 .5 33 .4 10 .2 0. 5 2. 6 19 .6 0. 4 20 .6 2, 61 2 Fu nd am en ta l 34 .2 23 .2 6. 7 27 .8 43 .4 57 .4 34 .0 12 .1 0. 2 2. 8 22 .5 0. 4 16 .9 1, 55 9 S ec on da ry 29 .7 26 .8 5. 1 29 .0 46 .7 60 .7 33 .6 14 .0 0. 0 4. 7 22 .9 0. 8 17 .7 43 6 H ig he r 50 .1 23 .0 6. 1 27 .2 44 .2 59 .8 34 .0 14 .4 1. 1 1. 6 26 .7 0. 0 11 .8 12 6 W ea lth q ui nt ile Lo w es t 28 .9 27 .0 1. 5 28 .0 43 .2 58 .6 31 .7 10 .0 0. 6 2. 1 16 .1 1. 0 23 .5 1, 10 6 S ec on d 31 .9 26 .0 1. 5 26 .9 46 .5 60 .6 34 .7 9. 3 0. 5 2. 3 18 .5 0. 1 20 .0 1, 09 7 M id dl e 32 .9 25 .8 3. 8 28 .2 47 .6 62 .2 34 .8 12 .0 0. 6 2. 3 21 .5 0. 7 16 .4 1, 01 4 Fo ur th 33 .6 24 .9 7. 1 29 .4 43 .6 59 .2 33 .4 10 .8 0. 0 2. 8 23 .8 0. 2 16 .3 85 6 H ig he st 39 .9 20 .7 7. 1 24 .8 42 .5 55 .5 33 .4 16 .2 0. 1 5. 7 29 .4 0. 0 16 .3 66 0 To ta l 32 .8 25 .3 3. 8 27 .6 44 .9 59 .5 33 .6 11 .3 0. 4 2. 8 21 .1 0. 4 18 .9 4, 73 3 N ot e: O R T in cl ud es fl ui d pr ep ar ed fr om o ra l r eh yd ra tio n sa lt (O R S ) p ac ke ts , p re -p ac ka ge d O R S flu id , a nd re co m m en de d ho m e flu id s (R H F) . 1 E xc lu de s ph ar m ac y, s ho p, a nd tr ad iti on al p ra ct iti on er s 116 • Child Health Child Health • 117 10.5.3 Feeding Practices during Diarrhea When a child has diarrhea, mothers are encouraged to continue feeding their child the same amount of food as they would if the child did not have diarrhea, and they are also encouraged to increase the child’s fluid intake. These practices help to reduce dehydration and minimize the adverse consequences of diarrhea on the child’s nutritional status. In the 2013 YNHDS, mothers were asked whether they gave their child with diarrhea less, the same amount of, or more fluids and food than usual. Table 10.8 shows the percent distribution of children under 5 who had diarrhea in the two weeks preceding the survey by feeding practices, according to background characteristics. Twenty-four percent of the children with diarrhea were given the same amount of liquids as usual, and 45 percent were given more. It is of concern that 23 percent of the children were given somewhat less and 7 percent were given much less to drink during the diarrhea episode. Twenty-four percent of children were given the same amount of food as usual, 2 percent were given more food, 43 percent were given somewhat less food, and 18 percent were given much less food. Thirteen percent of children were not given any food during the diarrhea episode. Overall, only 30 percent of children had increased fluid intake and continued feeding. Forty percent of children were given ORT and/or increased fluids, and continued feeding, a decline from the 48 percent reported in the 2006 YMICS. The proportion of children who were given ORT and/or increased fluids and continued feeding during the diarrhea varies little by most background characteristics. Exceptions include the lower proportions among children under 6 months (15 percent) and in Hadramout (16 percent), and Al- Mhrah (17 percent) governorates. 11 8 • C hi ld H ea lth Ta bl e 10 .8 F ee di ng p ra ct ic es d ur in g di ar rh ea P er ce nt d is tri bu tio n of c hi ld re n un de r a ge fi ve w ho h ad d ia rr he a in th e tw o w ee ks p re ce di ng th e su rv ey b y am ou nt o f l iq ui ds a nd fo od o ffe re d co m pa re d w ith n or m al p ra ct ic e, th e pe rc en ta ge o f c hi ld re n gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g du rin g th e di ar rh ea e pi so de , a nd th e pe rc en ta ge o f c hi ld re n w ho c on tin ue d fe ed in g an d w er e gi ve n O R T an d/ or in cr ea se d flu id s du rin g th e ep is od e of d ia rrh ea , b y ba ck gr ou nd c ha ra ct er is tic s, Y em en 2 01 3 A m ou nt o f l iq ui ds g iv en A m ou nt o f f oo d gi ve n P er ce nt ag e gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g1 P er ce nt ag e w ho co nt in ue d fe ed in g an d w er e gi ve n O R T an d/ or in cr ea se d flu id s1 N um be r o f ch ild re n w ith di ar rh ea B ac kg ro un d ch ar ac te ris tic M or e S am e as us ua l S om e- w ha t l es s M uc h le ss N on e D on ’t kn ow / m is si ng To ta l M or e S am e as us ua l S om e- w ha t l es s M uc h le ss N ev er ga ve fo od D on ’t kn ow / m is si ng To ta l A ge in m on th s <6 25 .2 34 .0 27 .3 7. 4 6. 0 0. 1 10 0. 0 3. 1 22 .1 20 .3 5. 4 48 .6 0. 5 10 0. 0 9. 0 14 .6 45 6 6- 11 39 .7 26 .6 24 .5 6. 7 1. 7 0. 8 10 0. 0 2. 0 19 .7 39 .1 16 .0 22 .7 0. 4 10 0. 0 23 .4 35 .4 69 1 12 -2 3 48 .0 20 .2 22 .8 7. 3 1. 6 0. 0 10 0. 0 2. 5 19 .8 41 .9 23 .7 12 .2 0. 0 10 0. 0 30 .2 40 .0 1, 39 5 24 -3 5 51 .6 21 .5 19 .1 5. 9 1. 7 0. 3 10 0. 0 2. 1 26 .1 47 .8 19 .6 4. 4 0. 1 10 0. 0 38 .9 47 .3 97 0 36 -4 7 48 .2 22 .7 22 .5 4. 7 1. 2 0. 6 10 0. 0 1. 7 24 .8 51 .5 18 .2 3. 6 0. 2 10 0. 0 35 .0 45 .1 71 2 48 -5 9 43 .5 25 .1 22 .1 7. 0 1. 1 1. 2 10 0. 0 1. 9 34 .0 48 .1 13 .0 2. 5 0. 4 10 0. 0 35 .4 44 .9 50 9 Se x M al e 44 .9 23 .4 22 .9 6. 6 1. 8 0. 4 10 0. 0 1. 8 24 .1 42 .7 17 .8 13 .3 0. 3 10 0. 0 30 .7 40 .1 2, 51 0 Fe m al e 44 .9 23 .9 22 .3 6. 4 2. 1 0. 4 10 0. 0 2. 6 23 .0 42 .7 18 .2 13 .3 0. 1 10 0. 0 29 .7 39 .2 2, 22 3 Ty pe o f d ia rr he a N on -b lo od y 43 .7 25 .1 22 .5 6. 3 2. 1 0. 3 10 0. 0 2. 3 24 .6 42 .6 17 .1 13 .2 0. 1 10 0. 0 29 .9 39 .5 3, 88 3 B lo od y 49 .8 16 .3 23 .9 8. 1 1. 2 0. 6 10 0. 0 1. 8 17 .1 45 .5 22 .2 13 .4 0. 0 10 0. 0 31 .5 40 .8 77 6 M is si ng 58 .6 22 .9 13 .1 0. 0 0. 0 5. 4 10 0. 0 0. 0 36 .1 20 .8 18 .8 19 .0 5. 4 10 0. 0 30 .7 37 .4 74 R es id en ce U rb an 43 .2 29 .8 20 .4 5. 2 1. 0 0. 4 10 0. 0 2. 5 28 .3 39 .1 15 .6 14 .3 0. 1 10 0. 0 29 .9 39 .8 1, 16 1 R ur al 45 .5 21 .6 23 .3 6. 9 2. 2 0. 4 10 0. 0 2. 1 22 .0 43 .9 18 .8 13 .0 0. 2 10 0. 0 30 .3 39 .6 3, 57 2 G ov er no ra te Ib b 58 .9 8. 6 25 .8 4. 7 0. 6 1. 4 10 0. 0 0. 9 13 .7 51 .8 20 .9 12 .3 0. 5 10 0. 0 37 .8 41 .8 61 9 A by an 9. 0 33 .6 45 .4 10 .5 1. 0 0. 4 10 0. 0 1. 4 21 .7 46 .9 21 .1 8. 5 0. 4 10 0. 0 3. 7 21 .6 78 S an a’ a C ity 40 .4 40 .4 14 .3 2. 0 2. 4 0. 6 10 0. 0 4. 8 50 .5 26 .2 5. 1 13 .4 0. 0 10 0. 0 29 .8 41 .2 29 8 A l-B ai dh a 56 .1 20 .7 17 .3 5. 6 0. 3 0. 0 10 0. 0 2. 0 24 .5 40 .2 20 .7 12 .6 0. 0 10 0. 0 37 .9 45 .4 24 2 Ta iz 52 .0 28 .6 8. 5 2. 1 8. 3 0. 4 10 0. 0 1. 7 29 .3 34 .3 18 .3 16 .4 0. 0 10 0. 0 35 .1 40 .2 66 3 A l-J aw f 25 .3 13 .8 37 .9 20 .1 2. 6 0. 3 10 0. 0 2. 6 13 .0 49 .3 24 .6 10 .4 0. 0 10 0. 0 20 .8 38 .2 50 H aj ja h 28 .4 17 .5 35 .9 17 .9 0. 3 0. 0 10 0. 0 3. 2 23 .9 37 .2 24 .9 10 .7 0. 0 10 0. 0 13 .7 22 .8 28 9 A l-H od ie da h 38 .5 25 .1 25 .5 10 .1 0. 4 0. 3 10 0. 0 2. 9 18 .9 40 .5 20 .4 17 .3 0. 0 10 0. 0 28 .3 37 .5 55 7 H ad ra m ou t 2. 7 59 .1 37 .1 0. 0 1. 2 0. 0 10 0. 0 0. 0 52 .4 44 .5 0. 0 3. 1 0. 0 10 0. 0 1. 0 15 .7 98 D ha m ar 55 .1 11 .0 23 .1 10 .2 0. 6 0. 0 10 0. 0 1. 9 8. 1 48 .8 27 .6 13 .1 0. 6 10 0. 0 33 .1 44 .4 38 8 S ha bw ah 14 .6 38 .9 35 .6 10 .3 0. 0 0. 6 10 0. 0 1. 9 28 .6 42 .6 8. 3 18 .6 0. 0 10 0. 0 12 .4 22 .9 71 S ad ah 49 .9 16 .3 22 .0 10 .6 0. 5 0. 7 10 0. 0 3. 9 18 .5 42 .1 24 .6 10 .2 0. 7 10 0. 0 28 .8 45 .4 15 9 S an a’ a 50 .2 29 .9 15 .9 1. 9 2. 2 0. 0 10 0. 0 3. 2 27 .4 41 .7 12 .6 14 .8 0. 3 10 0. 0 34 .2 46 .1 29 7 A de n 8. 0 44 .8 37 .5 9. 8 0. 0 0. 0 10 0. 0 1. 0 34 .4 39 .9 20 .8 4. 0 0. 0 10 0. 0 7. 3 26 .6 73 La hj 30 .4 23 .4 38 .7 6. 7 0. 8 0. 0 10 0. 0 2. 2 16 .1 65 .7 7. 5 8. 5 0. 0 10 0. 0 26 .6 42 .7 10 5 M ar eb 30 .4 28 .8 35 .2 3. 1 1. 9 0. 7 10 0. 0 2. 3 21 .8 55 .2 10 .3 10 .4 0. 0 10 0. 0 22 .3 40 .7 39 A l-M hw ei t 37 .4 31 .6 28 .0 2. 3 0. 5 0. 3 10 0. 0 0. 5 19 .6 44 .3 17 .5 17 .7 0. 4 10 0. 0 21 .1 32 .1 21 2 A l-M hr ah 25 .1 32 .3 31 .3 11 .4 0. 0 0. 0 10 0. 0 0. 0 38 .3 39 .3 20 .6 1. 9 0. 0 10 0. 0 12 .6 16 .6 12 A m ra n 67 .5 17 .9 9. 9 3. 2 1. 6 0. 0 10 0. 0 2. 5 25 .6 46 .4 19 .2 6. 3 0. 0 10 0. 0 52 .2 59 .2 22 7 A ld ha la e 31 .5 23 .5 37 .8 4. 6 1. 5 1. 1 10 0. 0 0. 3 22 .3 56 .9 8. 1 12 .4 0. 0 10 0. 0 25 .0 41 .2 13 3 R ei m ah 50 .3 21 .9 13 .9 12 .4 0. 7 0. 7 10 0. 0 3. 8 25 .6 41 .4 8. 9 19 .5 0. 7 10 0. 0 36 .8 45 .9 12 3 C on tin ue d… 118 • Child Health C hi ld H ea lth • 1 19 Ta bl e 10 .8 — C on tin ue d A m ou nt o f l iq ui ds g iv en A m ou nt o f f oo d gi ve n P er ce nt ag e gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g1 P er ce nt ag e w ho co nt in ue d fe ed in g an d w er e gi ve n O R T an d/ or in cr ea se d flu id s1 N um be r o f ch ild re n w ith di ar rh ea B ac kg ro un d ch ar ac te ris tic M or e S am e as us ua l S om e- w ha t l es s M uc h le ss N on e D on ’t kn ow / m is si ng To ta l M or e S am e as us ua l S om e- w ha t l es s M uc h le ss N ev er ga ve fo od D on ’t kn ow / m is si ng To ta l M ot he r’s e du ca tio n N o ed uc at io n 45 .5 21 .6 22 .6 7. 9 2. 1 0. 3 10 0. 0 2. 1 22 .2 42 .4 20 .0 13 .1 0. 2 10 0. 0 29 .3 38 .9 2, 61 2 Fu nd am en ta l 43 .4 24 .6 24 .4 5. 6 1. 3 0. 7 10 0. 0 2. 2 24 .7 42 .9 16 .9 13 .0 0. 3 10 0. 0 30 .1 39 .2 1, 55 9 S ec on da ry 46 .7 29 .2 17 .9 2. 6 3. 5 0. 0 10 0. 0 1. 4 28 .2 45 .4 10 .9 14 .2 0. 0 10 0. 0 35 .9 46 .3 43 6 H ig he r 44 .2 35 .2 16 .7 3. 2 0. 7 0. 0 10 0. 0 6. 3 22 .0 38 .4 14 .4 18 .8 0. 0 10 0. 0 30 .4 38 .6 12 6 W ea lth q ui nt ile Lo w es t 43 .2 20 .1 25 .8 8. 9 1. 7 0. 2 10 0. 0 2. 7 19 .5 42 .9 21 .3 13 .6 0. 1 10 0. 0 27 .0 36 .3 1, 10 6 S ec on d 46 .5 22 .9 21 .7 5. 8 2. 8 0. 3 10 0. 0 1. 9 23 .0 42 .9 16 .1 15 .9 0. 3 10 0. 0 31 .6 40 .0 1, 09 7 M id dl e 47 .6 17 .2 23 .1 8. 5 2. 6 1. 0 10 0. 0 1. 5 20 .0 47 .2 18 .9 11 .8 0. 6 10 0. 0 32 .1 41 .7 1, 01 4 Fo ur th 43 .6 30 .3 20 .7 4. 2 1. 0 0. 2 10 0. 0 2. 2 27 .7 43 .6 16 .1 10 .5 0. 0 10 0. 0 32 .2 44 .2 85 6 H ig he st 42 .5 32 .2 20 .4 3. 6 0. 9 0. 3 10 0. 0 2. 9 31 .7 34 .1 16 .7 14 .5 0. 0 10 0. 0 27 .8 35 .9 66 0 To ta l 44 .9 23 .6 22 .6 6. 5 1. 9 0. 4 10 0. 0 2. 2 23 .6 42 .7 18 .0 13 .3 0. 2 10 0. 0 30 .2 39 .7 4, 73 3 N ot e: It is re co m m en de d th at c hi ld re n sh ou ld b e gi ve n m or e liq ui ds to d rin k du rin g di ar rh ea a nd fo od s ho ul d no t b e re du ce d. 1 C on tin ue d fe ed in g pr ac tic es in cl ud es c hi ld re n w ho w er e gi ve n m or e, s am e as u su al , o r s om ew ha t l es s fo od d ur in g th e di ar rh ea e pi so de . Child Health • 119 120 • Child Health 10.5.4 Knowledge of ORS Packets for Diarrhea To ascertain respondents’ knowledge of ORS in Yemen, ever-married women were asked whether they had heard of a special product called oral rehydration salt packets or solution that can be used to treat diarrhea. Table 10.9 presents information on the percentage of mothers with a birth in the five years preceding the survey that had heard of ORS packets. Almost three in four mothers (74 percent) had heard of ORS. Knowledge of ORS packets is lower among mothers age 15-19, among mothers in rural areas, and among those with less education and in the lower wealth quintiles. Table 10.9 Knowledge of ORS packets or pre-packaged liquids Percentage of women age 15-49 with a live birth in the five years preceding the survey who know about ORS packets or ORS pre- packaged liquids for treatment of diarrhea by background characteristics, Yemen 2013 Background characteristic Percentage of women who know about ORS packets or ORS pre-packaged liquids Number of women Age 15-19 58.9 514 20-24 70.7 2,308 25-34 75.6 4,932 35-49 75.0 2,615 Residence Urban 83.3 3,077 Rural 69.4 7,292 Governorate Ibb 67.8 1,147 Abyan 50.7 207 Sana’a City 85.3 933 Al-Baidha 68.9 446 Taiz 79.0 1,274 Al-Jawf 95.7 95 Hajjah 68.2 620 Al-Hodiedah 74.4 1,257 Hadramout 62.6 543 Dhamar 72.8 802 Shabwah 67.8 194 Sadah 74.6 320 Sana’a 75.1 598 Aden 84.7 291 Lahj 60.1 276 Mareb 81.1 78 Al-Mhweit 65.4 304 Al-Mhrah 46.6 42 Amran 89.7 445 Aldhalae 76.0 251 Reimah 63.1 246 Education No education 68.2 5,475 Fundamental 76.4 3,463 Secondary 84.9 1,025 Higher 92.4 407 Wealth quintile Lowest 59.2 2,097 Second 71.4 2,136 Middle 74.7 2,107 Fourth 78.9 2,016 Highest 84.0 2,014 Total 73.5 10,369 ORS = Oral rehydration salts 10.6 DISPOSAL OF CHILDREN’S STOOLS The proper disposal of children’s feces is important in preventing the spread of disease. If feces are left uncontained, disease may spread by direct contact or through animal contact. Children’s stools are considered to be safely disposed of if the child uses a toilet or latrine, the child’s stool is put or rinsed into a toilet or latrine, or the stool is buried. Child Health • 121 Table 10.10 presents information on the disposal of fecal matter of children under 5, according to background characteristics. The information was derived from asking ever-married women what was done to dispose of the stools the last time their youngest child under age 5 passed stools. Overall, 37 percent of children had their last stool disposed of safely. As expected, the stools of older children are much more likely to be disposed of safely than those of younger children, mainly because older children are more likely to use a toilet or latrine. Children in urban areas were more likely than those in rural areas to have had their last stool safely disposed of (40 and 23 percent, respectively). At the governorate level, the proportion of children whose last stool was properly disposed of ranged broadly: more than half of children in Aden, Hadramout, and Al-Mhrah governorates had their stools disposed of safely; in contrast, only 20 percent of children from Hajjah Governorate had their stools disposed of safely, ranking it last among all governorates. The proportion of children whose last stool was disposed of safely rises with the mother’s education and the wealth quintile. Table 10.10 Disposal of children’s stools Percent distribution of youngest children under age five living with the mother by the manner of disposal of the child’s last fecal matter, and percentage of children whose stools are disposed of safely, according to background characteristics, Yemen 2013 Manner of disposal of children’s stools Total Percentage of children whose stools are disposed of safely1 Number of children Background characteristic Child used toilet or latrine Put/rinsed into toilet or latrine Buried Put/rinsed into drain or ditch Thrown into garbage Left in the open Other Missing Age in months <6 0.9 12.9 0.3 15.1 60.9 8.1 0.3 1.3 100.0 14.2 1,643 6-11 1.4 16.5 0.3 13.0 55.5 11.5 0.3 1.5 100.0 18.2 1,534 12-23 6.8 14.5 1.0 11.1 47.4 16.8 0.5 2.0 100.0 22.2 2,729 24-35 37.3 11.2 0.7 5.3 23.9 20.1 0.0 1.4 100.0 49.3 1,947 36-47 61.6 8.3 0.8 3.4 8.0 15.9 0.1 1.9 100.0 70.8 1,284 48-59 70.2 6.6 0.8 2.5 4.6 13.6 0.0 1.7 100.0 77.6 998 Residence Urban 38.3 8.4 0.1 3.5 47.4 1.2 0.1 1.0 100.0 46.9 3,010 Rural 18.0 14.0 0.9 11.5 32.7 20.6 0.3 2.0 100.0 32.9 7,125 Governorate Ibb 29.2 6.1 0.3 9.7 45.1 9.4 0.0 0.2 100.0 35.7 1,121 Abyan 24.9 11.1 2.7 8.0 41.2 11.1 0.3 0.6 100.0 38.7 204 Sana’a City 41.2 3.7 0.0 2.6 51.2 0.0 0.0 1.4 100.0 44.8 917 Al-Baidha 19.1 13.7 0.1 3.4 49.9 12.6 0.0 1.2 100.0 32.8 436 Taiz 25.4 15.6 0.0 5.1 32.1 18.4 0.6 2.8 100.0 41.0 1,250 Al-Jawf 14.5 8.8 0.2 20.2 36.4 18.1 0.0 1.8 100.0 23.4 93 Hajjah 8.7 10.8 0.7 21.3 16.6 40.6 0.0 1.4 100.0 20.2 609 Al-Hodiedah 14.8 12.2 2.4 5.0 50.7 13.1 0.2 1.7 100.0 29.4 1,215 Hadramout 40.2 10.9 0.3 3.1 38.1 5.9 0.8 0.6 100.0 51.5 530 Dhamar 16.3 23.9 0.9 23.9 18.0 13.7 0.7 2.6 100.0 41.1 779 Shabwah 33.2 10.0 0.2 2.7 45.3 4.6 0.0 4.0 100.0 43.4 189 Sadah 21.9 10.9 0.5 9.7 39.2 15.5 0.0 2.3 100.0 33.3 315 Sana’a 22.2 13.4 0.2 13.1 24.9 24.8 0.5 0.9 100.0 35.8 584 Aden 39.4 12.6 0.0 0.4 44.3 0.3 0.0 3.1 100.0 52.0 288 Lahj 18.8 19.7 0.3 8.6 37.3 13.9 0.0 1.5 100.0 38.8 273 Mareb 31.5 3.9 0.0 7.3 45.1 11.2 0.0 0.9 100.0 35.5 77 Al-Mhweit 13.1 14.5 1.2 12.0 20.5 38.5 0.0 0.2 100.0 28.8 294 Al-Mhrah 28.6 22.6 0.0 0.0 39.0 8.1 0.0 1.7 100.0 51.2 41 Amran 22.0 17.4 2.0 16.1 23.1 17.4 0.2 1.8 100.0 41.4 433 Aldhalae 26.8 10.2 0.0 6.7 38.7 11.8 0.7 5.0 100.0 37.1 248 Reimah 14.6 11.6 0.0 8.0 40.5 22.9 0.5 1.9 100.0 26.2 239 Mother’s education No education 20.1 13.2 1.0 12.2 28.9 22.5 0.2 1.9 100.0 34.3 5,336 Fundamental 27.2 12.3 0.4 6.2 44.3 7.6 0.3 1.7 100.0 39.9 3,387 Secondary 29.8 9.4 0.2 4.4 50.7 4.2 0.3 1.1 100.0 39.4 1,017 Higher 35.9 8.6 0.0 3.6 50.4 0.2 0.8 0.5 100.0 44.5 396 Wealth quintile Lowest 6.4 9.1 1.8 15.3 25.6 39.6 0.2 1.9 100.0 17.3 2,055 Second 16.0 15.5 0.9 13.1 29.5 22.3 0.3 2.3 100.0 32.4 2,071 Middle 24.0 17.7 0.5 9.2 37.7 9.0 0.2 1.7 100.0 42.1 2,064 Fourth 34.4 13.2 0.1 6.1 43.2 1.7 0.3 0.9 100.0 47.7 1,959 Highest 40.6 6.1 0.0 1.3 50.2 0.2 0.2 1.4 100.0 46.7 1,986 Total 24.1 12.3 0.7 9.1 37.1 14.8 0.3 1.7 100.0 37.1 10,135 1 Children’s stools are considered to be disposed of safely if the child used a toilet or latrine, if the fecal matter was put/rinsed into a toilet or latrine, or if it was buried. Nutrition of Children and Women • 123 NUTRITION OF CHILDREN AND WOMEN 11 his chapter describes the nutritional status of children under age 5; infant and young child feeding practices, including breastfeeding and feeding with solid/semisolid foods; diversity of foods fed and frequency of feeding; and micronutrient status, supplementation, and fortification. The discussion also covers the nutritional status of women age 15-49 and the prevalence of iodized salt in households. Finally, both children age 6-59 months and all women age 15-49 were eligible to provide a finger prick drop of blood that was tested in the field to determine the prevalence of anemia. 11.1 NUTRITIONAL STATUS OF CHILDREN The anthropometric data on height and weight collected in the 2013 YNHDS permit an evaluation of the nutritional status of young children in Yemen. This assessment allows identification of subgroups of the child population that are at increased risk of faltered growth, disease, impaired mental development, and death. Marked differences, especially with regard to height-for-age, weight-for-height, and weight-for-age, are often seen among subgroups of children. 11.1.1 Measurement of Nutritional Status among Young Children The 2013 YNHDS collected data on the nutritional status of children by measuring the height and weight of children under age 5 listed in the sampled household. Data were collected to calculate three indices: height-for-age, weight-for-height, and weight-for-age. Weight measurements were obtained using a SECA 872 digital scale, designed for weighing children and adults. Height measurements were carried out using T Key Findings • Almost half of children under age 5 (47 percent) are stunted (short for their age), 16 percent are wasted (thin for their height), and 39 percent are underweight (thin for their age). • Although there has been a decline in stunting, the level of wasting and underweight has not changed over the past decade. • Almost all children (97 percent) are breastfed at some time; however, only 10 percent of children under age 6 months are exclusively breastfed. The median duration of breastfeeding is 18 months. • Only 15 percent of children age 6-23 months are fed in accordance with all three infant and young child feeding (IYCF) practices. • Almost nine in ten children (86 percent) age 6-59 months are anemic. • Fifty-five percent of Yemeni children age 6-59 months received vitamin A supplements in the six months prior to the survey, 6 percent received iron supplements in the preceding seven days, and 12 percent received deworming medication in the preceding six months. • Half of households in Yemen use iodized salt. • About half of women have a body mass index (BMI) in the normal range, one-quarter are thin, and about one-quarter are overweight or obese. • Seven in ten women age 15-49 are anemic. • Among women with a child born in the past five years, 17 percent received a vitamin A dose postpartum; during the pregnancy of their last birth, 6 percent of women took iron tablets for the recommended period of time, and 3 percent took deworming medication. 124 • Nutrition of Children and Women locally manufactured measuring boards. Children younger than age 24 months were measured lying down on the board (recumbent length), and standing height was measured for older children. For the 2013 YNHDS, the nutritional status of children was calculated using growth standards published by WHO in 2006. These standards were generated through data collected in the WHO Multicentre Growth Reference Study (WHO, 2006). That study, which involved a sample of 8,440 children drawn from six countries across the world, was designed to describe how children should grow under optimal conditions. The WHO child growth standards can therefore be used to assess children all over the world, regardless of ethnicity, social and economic influences, and feeding practices. Each of the three nutritional status indicators described below is expressed in standard deviation units from the median of the Multicentre Growth Reference Study sample. Each of these indices—height-for-age, weight-for-height, and weight-for-age—provides different information about growth and body composition that can be used to assess nutritional status. The height-for- age index is an indicator of linear growth retardation and cumulative growth deficits. Children whose height- for-age Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age (stunted), or chronically malnourished. Children who are below minus three standard deviations (-3 SD) are considered severely stunted. Stunting reflects failure to receive adequate nutrition over a long period and is also affected by recurrent and chronic illness. Height-for age, therefore, represents the long-term effects of malnutrition (specifically, undernutrition) in a population and is not sensitive to recent, short-term changes in dietary intake. The weight-for-height index measures body mass in relation to body height or length and describes current nutritional status. Children whose Z-scores are below -2 SD from the median of the reference population are considered thin (wasted), or acutely malnourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey. It may result from inadequate food intake or a recent episode of illness causing loss of weight and the onset of malnutrition. Children whose weight- for-height is below -3 SD from the reference median are considered severely wasted. Overweight and obesity are other forms of malnutrition that are becoming concerns for some children in developing countries. Children whose Z-scores are +2 SD above the median for weight-for-height are considered overweight. Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account both acute and chronic malnutrition. Children whose weight-for-age is below -2 SD from the median of the reference population are classified as underweight. Children whose weight-for-age is below -3 SD from the median are considered severely underweight. Data are also presented on the percentage of children who are +2 SD above the median of weight-for-age. Z-score means are also calculated as summary statistics representing the nutritional status of children in a population. These mean scores describe the nutritional status of the entire population without the use of a cutoff. A mean Z-score of less than 0 (i.e., a negative value for stunting, wasting, or underweight) suggests that the distribution of an index has shifted downward and, on average, children in the population are less well nourished than children in the WHO Multicentre Growth Reference Study. While 16,100 children were eligible for anthropometric measurements, data on nutritional status are available for only 87 percent of the eligible children: among almost 9 percent of children weight and/or height was not measured, and among 4 percent of children the measurements were obviously incorrect (out of possible range) and/or information on the age of the child was incomplete. The proportion of children with correct anthropometric data was not uniform across the country; several governorates—notably Hadramout, Shabwah, and Sadah governorates—had credible data for less than 80 percent of children. Consequently, the information from these areas should be interpreted with caution. Nutrition of Children and Women • 125 11.1.2 Levels of Child Malnutrition Table 11.1 shows the percentage of children under age 5 classified as malnourished according to the three anthropometric indices of nutritional status (height-for-age, weight-for-height, and weight-for-age). Forty-seven percent of children are stunted (below -2 SD from the reference median), and about half of these children (23 percent) are severely stunted. Table 11.1 Nutritional status of children Percentage of children under age 5 classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for- height, and weight-for-age, by background characteristics, Yemen 2013 Height-for-age1 Weight-for-height Weight-for-age Number of children Background characteristic Percent- age below -3 SD Percent- age below -2 SD2 Mean Z-score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z-score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z-score (SD) Age in months <6 7.9 19.2 -0.7 9.2 20.1 6.1 -0.7 8.5 24.6 1.5 -1.1 1,421 6-8 10.4 27.6 -1.1 11.0 28.4 2.8 -1.2 17.3 37.0 0.2 -1.6 723 9-11 11.3 26.4 -1.1 8.6 21.9 1.8 -1.1 9.1 30.7 0.3 -1.4 661 12-17 18.5 38.0 -1.6 6.8 23.3 1.9 -1.0 12.6 36.0 0.7 -1.5 1,649 18-23 24.9 49.8 -2.0 4.8 14.6 1.4 -0.8 12.8 36.7 0.4 -1.6 1,130 24-35 30.2 55.5 -2.2 3.8 13.6 1.4 -0.8 14.8 40.0 0.2 -1.8 2,782 36-47 28.5 57.8 -2.3 3.6 12.8 1.4 -0.8 15.0 43.4 0.2 -1.9 2,664 48-59 25.6 54.0 -2.2 2.9 12.4 1.4 -0.9 14.5 46.4 0.1 -1.9 2,793 Sex Male 24.4 47.6 -1.9 5.7 17.8 2.0 -0.9 13.9 39.9 0.3 -1.7 7,019 Female 21.3 45.4 -1.8 4.7 14.7 2.1 -0.8 13.2 38.2 0.5 -1.7 6,804 Birth interval in months3 First birth4 18.6 40.0 -1.7 4.4 15.1 2.0 -0.8 9.6 34.1 0.3 -1.5 2,687 <24 29.8 55.1 -2.2 5.4 17.6 1.4 -0.9 18.5 46.6 0.3 -1.9 3,103 24-47 24.1 48.1 -1.9 5.6 16.7 1.9 -0.9 14.4 40.9 0.5 -1.7 5,093 48+ 16.3 39.3 -1.6 4.9 15.7 3.1 -0.8 10.0 31.1 0.3 -1.5 2,564 Size at birth3 Smaller than average 25.3 49.2 -2.0 6.9 21.4 1.4 -1.1 18.2 47.8 0.2 -1.9 4,280 Average or larger 21.7 45.0 -1.8 4.4 14.1 2.3 -0.8 11.4 34.8 0.5 -1.6 9,069 Missing 21.4 53.9 -2.0 6.6 13.3 0.9 -1.0 9.1 39.1 0.0 -1.9 97 Mother’s interview status Interviewed 22.8 46.4 -1.9 5.2 16.4 2.0 -0.9 13.6 39.0 0.4 -1.7 13,447 Not interviewed but in household 23.9 50.7 -2.0 4.9 13.2 3.3 -0.8 13.0 40.2 0.8 -1.7 262 Not interviewed and not in the household5 26.5 46.8 -2.0 5.5 13.8 1.9 -0.8 16.9 41.6 0.5 -1.7 115 Mother’s nutritional status6 Thin (BMI <18.5) 28.8 52.7 -2.2 8.3 24.6 1.3 -1.2 22.0 53.5 0.3 -2.1 2,458 Normal (BMI 18.5-24.9) 22.9 47.2 -1.9 5.1 16.1 1.9 -0.8 13.2 38.1 0.2 -1.7 5,731 Overweight/obese (BMI ≥25) 15.3 35.8 -1.5 3.7 11.3 2.6 -0.6 6.7 26.9 0.7 -1.3 2,703 Residence Urban 13.1 33.7 -1.5 4.4 14.4 2.4 -0.8 7.7 28.9 0.6 -1.4 3,813 Rural 26.6 51.4 -2.0 5.5 17.0 1.9 -0.9 15.8 42.9 0.3 -1.8 10,010 Governorate Ibb 23.2 47.3 -1.8 2.7 10.9 3.5 -0.6 10.4 30.7 0.3 -1.5 1,555 Abyan 7.6 23.4 -1.1 3.9 21.6 1.1 -1.0 4.8 26.4 0.8 -1.3 284 Sana’a City 10.4 30.7 -1.3 3.5 11.2 2.6 -0.6 4.6 22.8 0.6 -1.2 1,180 Al-Baidha 17.1 35.6 -1.5 6.1 13.6 0.9 -0.8 9.7 29.5 0.2 -1.4 543 Taiz 19.3 46.8 -1.8 3.8 14.6 1.2 -1.0 13.4 40.1 0.7 -1.7 1,873 Al-Jawf 31.7 57.1 -2.2 4.9 12.1 2.7 -0.7 11.3 37.0 0.1 -1.7 130 Hajjah 33.9 58.8 -2.3 6.5 21.1 1.3 -1.1 23.3 55.0 0.3 -2.2 926 Al-Hodiedah 24.4 48.6 -2.1 9.8 26.2 1.0 -1.3 20.5 54.4 0.0 -2.1 1,798 Hadramout 12.2 30.1 -1.2 6.0 18.0 3.6 -0.8 7.3 26.5 0.2 -1.3 519 Dhamar 34.4 59.2 -2.3 4.6 15.1 2.6 -0.7 18.2 45.0 0.9 -1.8 1,101 Shabwah 14.9 28.6 -1.1 9.7 21.5 5.6 -0.8 6.8 25.3 0.8 -1.2 215 Sadah 35.1 58.5 -2.3 7.9 17.0 1.9 -0.8 20.4 49.7 0.4 -1.9 365 Sana’a 23.4 47.8 -1.9 4.8 14.0 2.5 -0.7 10.7 34.1 0.2 -1.6 735 Aden 6.9 23.7 -1.1 3.7 18.2 1.8 -0.9 8.0 27.2 0.6 -1.3 347 Lahj 14.5 37.9 -1.6 2.6 14.3 2.1 -0.9 8.9 34.2 0.0 -1.6 330 Mareb 18.9 41.3 -1.7 5.1 13.8 1.8 -0.7 10.6 31.3 0.4 -1.5 101 Al-Mhweit 28.0 54.9 -2.1 5.1 16.2 2.2 -0.8 13.9 41.0 0.2 -1.8 450 Al-Mhrah 9.0 23.1 -1.0 4.3 17.2 1.3 -0.8 3.9 22.8 0.5 -1.1 48 Amran 30.4 57.7 -2.2 3.7 13.2 1.1 -0.7 13.6 40.4 0.1 -1.8 602 Aldhalae 27.5 51.9 -2.1 4.0 13.6 2.5 -0.7 12.5 39.4 0.3 -1.7 333 Reimah 36.1 62.7 -2.4 5.4 15.3 1.8 -0.8 20.8 50.9 0.1 -2.0 388 Continued… 126 • Nutrition of Children and Women Table 11.1—Continued Height-for-age1 Weight-for-height Weight-for-age Number of children Background characteristic Percent- age below -3 SD Percent- age below -2 SD2 Mean Z-score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z-score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z-score (SD) Mother’s education7 No education 28.5 53.7 -2.1 5.7 17.4 1.9 -0.9 16.6 44.7 0.3 -1.9 7,571 Fundamental 17.5 40.1 -1.6 4.7 15.3 2.4 -0.8 10.8 33.3 0.3 -1.5 4,396 Secondary 14.3 34.4 -1.5 4.4 14.8 1.4 -0.8 8.3 31.0 0.7 -1.5 1,272 Higher 4.7 23.7 -1.1 3.6 13.8 2.9 -0.7 3.2 22.2 1.1 -1.1 466 Wealth quintile Lowest 33.2 59.2 -2.3 7.7 20.7 1.3 -1.1 23.6 54.0 0.1 -2.1 3,118 Second 28.8 55.5 -2.1 5.4 17.8 2.0 -0.9 15.8 45.1 0.2 -1.9 2,976 Middle 24.7 48.1 -1.9 3.9 14.2 1.9 -0.8 12.4 37.9 0.4 -1.6 2,791 Fourth 15.3 38.3 -1.6 4.2 15.0 2.8 -0.8 8.1 31.0 0.6 -1.5 2,516 Highest 8.1 25.9 -1.2 4.2 12.5 2.4 -0.7 4.8 22.1 0.7 -1.2 2,422 Total8 22.9 46.5 -1.9 5.2 16.3 2.0 -0.9 13.6 39.0 0.4 -1.7 13,823 Note: Table is based on children who stayed in the household on the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the median of the WHO child growth standards adopted in 2006. The indices in this table are NOT comparable to those based on the previously used NCHS/CDC/WHO reference. Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. 1 Recumbent length is measured for children under age 2, or in the few cases when the age of the child is unknown and the child is less than 85 cm; standing height is measured for all other children. 2 Includes children who are below -3 standard deviations (SD) from the WHO child growth standards population median 3 Excludes children whose mothers were not interviewed 4 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval. 5 Includes children whose mothers are deceased 6 Excludes children whose mothers were not weighed and measured, children whose mothers were not interviewed, and children whose mothers are pregnant or gave birth within the preceding 2 months. Mother’s nutritional status in terms of BMI (body mass index) is presented in Table 11.10. 7 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire. 8 Total includes 3 children with missing information on mother’s education. The percentage of children who are stunted initially increases with age, with the prevalence peaking in the age range of 36-47 months (58 percent) before declining somewhat as children approach their fifth birthday (54 percent of children age 48-59 months are stunted) (Figure 11.1). The proportion of children who are stunted decreases as the interval between births lengthens; 55 percent of children born less than 24 months after a previous birth are stunted, as compared with only 39 percent of those born 48 months or more after a previous birth. A slightly higher proportion of male children (48 percent) than female children (45 percent) are stunted. In rural areas, 51 percent of children are stunted, compared with 34 percent of children in urban areas. Stunting steadily decreases with increasing mother’s education, from a high of 54 percent among children of mothers with no education to a low of 24 percent among children of mothers with a higher education. There is a similar pattern by wealth quintile; the proportion of children under age 5 who are stunted ranges from 26 percent in the highest quintile to 59 percent in the lowest quintile. Overall, 16 percent of children under age 5 are wasted, and 5 percent are severely wasted. The prevalence of wasting is highest among children age 6-8 months (28 percent). The results show a slightly higher proportion of male than female children who are wasted (18 percent versus 15 percent). Also, children who were reported to have been smaller than average at birth are more likely to be wasted than children who were average or larger at birth (21 percent and 14 percent, respectively). In addition, the prevalence of wasting is higher among children born to underweight mothers than among those born to normal-weight or overweight mothers. In rural areas, 17 percent of children are wasted, as compared with 14 percent of children in urban areas. Only 2 percent of children are overweight. Nutrition of Children and Women • 127 Figure 11.1 Nutritional status of children by age Overall, 39 percent of children are underweight, and about one-third of them (14 percent) are severely underweight. The proportion of children who are underweight generally rises with age, to a high of 46 percent among those age 48-59 months. A slightly higher percentage of male than female children are underweight (40 percent and 38 percent, respectively). Forty-three percent of rural children are underweight, as compared with 29 percent of urban children. Children born to uneducated mothers are twice as likely to be underweight as children born to mothers with a higher education (45 percent versus 22 percent). Similarly, children in the highest wealth quintile are less than half as likely to be underweight as those in the lowest wealth quintile (22 percent and 54 percent, respectively). The mean stunting, wasting, and underweight Z-scores for children under age 5 are -1.9, -0.9, and - 1.7, respectively. Scores of less than 0 on these indices suggest that nutritional status is poorer on average than that of the reference population. 11.1.3 Trends in Child Malnutrition The three indices presented in this report are expressed in standard deviation units from the median of the WHO child growth standards adopted in 2006. These indices are not comparable to those reported in the 1997 YDMCHS and the 2003 YFHS, which were based on the previously used 1977 NCHS/CDC/WHO reference. In order to compare the current results with those of the previous surveys, the 2013 indices have been recalculated using the 1977 reference. The findings are presented in Figure 11.2. The results show that the prevalence of stunting has greatly decreased in the past 10 years, from 53 percent in 2003 to 41 percent in 2013. However, the percentage of children who are underweight (which decreased from 46 percent to 44 percent) and the prevalence of wasting (which increased from 13 percent to 14 percent) have not significantly changed since 1997. 0 10 20 30 40 50 60 70 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 Percentage Age (in months) Stunted Wasted Underweight Note: Plotted values are smoothed by a 5-month moving average YNHDS 2013 128 • Nutrition of Children and Women Figure 11.2 Trends in nutritional status of children, Yemen 1997-2013 11.2 BREASTFEEDING The YNHDS data can be used to evaluate infant feeding practices, including breastfeeding duration, introduction of complementary weaning foods, and use of feeding bottles. The pattern of infant feeding has important influences on both the child and the mother. Feeding practices are the principal determinants of a child’s nutritional status. Poor nutritional status in young children exposes them to a greater risk of morbidity. Biologically, breastfeeding suppresses the mother’s return to fertile status and affects the length of the birth interval as well as the level of fertility. These effects are influenced by both the duration and frequency of breastfeeding and the age at which the child receives foods and liquids to complement breast milk. 11.2.1 Initiation of Breastfeeding Early breastfeeding practices determine the successful establishment and duration of breastfeeding. Moreover, during the first three days after delivery, colostrum, an important source of nutrition and protection for the newborn, is produced and should be given to the newborn while awaiting the letdown of regular breast milk. Thus, it is recommended that children be put to the breast immediately or within one hour after birth and that prelacteal feeding (i.e., feeding newborns anything other than breast milk before breast milk is regularly given) be discouraged. Table 11.2 shows that 97 percent of last-born children who were born in the two years preceding the survey were breastfed at some time. Differences by background characteristics are small. Fifty-three percent of infants were breastfed within one hour of birth, and 76 percent began breastfeeding within one day of birth. The proportion of children breastfed within one hour of birth is slightly lower among those delivered in a health facility (46 percent) than among those born at home (57 percent). Early initiation of breastfeeding has increased over the past few years. The proportion of newborns breastfed within one hour of birth increased from 30 percent in 2006 to 53 percent in 2013, and the proportion breastfed in the first day of life increased from 65 percent to 76 percent over the same period (Ministry of Public Health and Population [MOPHP] and UNICEF, 2008). The practice of giving prelacteal feeds limits the frequency of suckling by the infant and exposes the baby to the risk of infection. Table 11.2 shows that two-thirds of newborns in Yemen received prelacteal feeds, with the practice being more common among infants born in health facilities than those born at home. 52 13 46 53 12 46 41 14 44 Height-for-age (Stunting) Weight-for-height (Wasting) Weight-for-age (Underweight) 1997 YDMCHS 2003 YFHS 2013 YNHDS Percentage Note: For comparison purpose, the 2013 indices have been recalculated using the 1977 NCHS/CDC/WHO Reference Nutrition of Children and Women • 129 The proportion of infants given prelacteal feeds increases steadily with increasing mother’s education and wealth quintile. Table 11.2 Initial breastfeeding Among last-born children who were born in the two years preceding the survey, the percentage who were ever breastfed and the percentages who started breastfeeding within one hour and within one day of birth; and among last-born children born in the two years preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by background characteristics, Yemen 2013 Among last-born children born in the past two years: Among last-born children born in the past two years who were ever breastfed: Background characteristic Percentage ever breastfed Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Number of last- born children Percentage who received a prelacteal feed2 Number of last- born children ever breastfed Sex Male 96.3 52.2 74.6 3,092 66.9 2,978 Female 97.1 53.2 76.4 3,018 67.3 2,931 Assistance at delivery Health professional3 96.0 49.5 74.4 2,897 70.5 2,783 Traditional birth attendant 96.8 54.5 75.7 701 66.3 678 Other 98.3 56.4 77.7 2,402 63.3 2,362 No one 100.0 57.6 76.5 76 67.9 76 Place of delivery Health facility 95.0 45.6 70.8 1,905 72.0 1,810 At home 98.2 56.5 78.2 4,093 64.9 4,017 Other 92.9 45.5 75.7 88 68.5 81 Residence Urban 96.2 55.2 78.0 1,590 70.9 1,529 Rural 96.9 51.8 74.6 4,520 65.8 4,380 Governorate Ibb 95.0 49.7 75.2 686 61.0 651 Abyan 98.4 52.9 83.9 126 74.9 124 Sana’a City 96.1 67.5 80.4 473 68.7 455 Al-Baidha 94.8 32.5 69.9 247 81.3 234 Taiz 97.6 34.8 52.4 762 84.8 743 Al-Jawf 97.0 67.6 82.8 54 64.7 52 Hajjah 97.1 58.3 81.9 390 46.9 379 Al-Hodiedah 96.5 48.3 78.0 757 70.4 730 Hadramout 96.1 56.4 84.5 255 60.8 245 Dhamar 98.5 63.5 80.8 557 67.0 549 Shabwah 98.4 51.8 86.3 102 84.8 100 Sadah 97.1 65.9 89.0 183 46.1 177 Sana’a 96.6 62.3 75.3 374 72.4 361 Aden 94.6 58.2 75.6 153 78.4 145 Lahj 98.7 66.2 77.3 168 50.1 166 Mareb 98.5 62.0 83.1 45 55.8 44 Al-Mhweit 98.0 43.5 78.1 199 63.1 195 Al-Mhrah 96.5 63.5 92.9 23 77.3 22 Amran 96.6 51.6 83.4 261 68.5 252 Aldhalae 94.2 42.4 64.2 147 56.7 138 Reimah 97.0 58.9 78.6 150 40.8 146 Mother’s education No education 96.8 54.2 76.1 3,194 64.3 3,091 Fundamental 96.5 50.7 74.3 2,101 69.3 2,027 Secondary 97.1 50.9 76.2 605 71.9 587 Higher 97.2 54.2 76.8 210 74.7 204 Wealth quintile Lowest 96.5 55.2 74.7 1,350 62.4 1,303 Second 97.6 49.1 73.3 1,375 64.5 1,342 Middle 97.1 52.8 75.7 1,274 68.3 1,238 Fourth 96.9 52.4 77.9 1,114 70.2 1,079 Highest 95.1 54.5 76.7 996 72.3 948 Total4 96.7 52.7 75.5 6,110 67.1 5,909 Note: Table is based on last-born children born in the two years preceding the survey regardless of whether the children are living or dead at the time of interview. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life 3 Doctor, nurse, midwife, or auxiliary midwife 4 Total includes children with missing information on assistance at delivery and place of delivery. 130 • Nutrition of Children and Women 11.2.2 Breastfeeding Status by Age Breast milk contains all of the nutrients needed by children in the first six months of life and is an uncontaminated nutritional source. Therefore, complementing breast milk before age 6 months is discouraged as the likelihood of contamination and resulting risk of diarrheal disease are high. Early initiation of complementary feeding also reduces breast milk output because the production and release of breast milk is modulated by the frequency and intensity of suckling. Table 11.3 shows breastfeeding status among the youngest children under age 2 who live with their mothers. Only 10 percent of infants under age 6 months are exclusively breastfed, about the same as the 12 percent reported in the 2003 YFHS. Table 11.3 shows that, contrary to the recommendation that children under age 6 months be exclusively breastfed, 27 percent of infants consume plain water, 3 percent consume non-milk liquids, 32 percent consume other milk, and 21 percent consume complementary foods in addition to breast milk. Sixty percent of children age 6-8 months receive timely complementary foods, and almost half of children age 18-23 months have been weaned. Table 11.3 Breastfeeding status by age Percent distribution of youngest children under age 2 who are living with their mother by breastfeeding status and the percentage currently breastfeeding; and the percentage of all children under age 2 using a bottle with a nipple, according to age in months, Yemen 2013 Not breast- feeding Breastfeeding status Total Percentage currently breast- feeding Number of youngest child under age 2 living with their mother Percentage using a bottle with a nipple Number of all children under age 2 Age in months Exclusively breastfed Breast- feeding and consuming plain water only Breast- feeding and consuming non-milk liquids1 Breast- feeding and consuming other milk Breast- feeding and consuming comple- mentary foods 0-1 6.3 21.0 37.8 4.7 26.1 4.2 100.0 93.7 445 32.9 445 2-3 5.5 7.5 28.0 2.1 38.8 18.0 100.0 94.5 645 46.9 648 4-5 8.2 5.0 18.4 3.2 27.3 37.9 100.0 91.8 554 49.0 561 6-8 12.5 1.0 9.3 1.4 16.2 59.7 100.0 87.5 794 49.5 806 9-11 19.8 0.1 4.3 1.7 5.3 68.9 100.0 80.2 739 45.2 743 12-17 30.0 0.2 2.0 0.5 2.5 64.8 100.0 70.0 1,697 40.2 1,797 18-23 49.0 0.5 0.6 0.3 0.8 48.9 100.0 51.0 1,032 31.7 1,231 0-3 5.8 13.0 32.0 3.2 33.6 12.4 100.0 94.2 1,089 41.2 1,093 0-5 6.6 10.3 27.4 3.2 31.5 21.0 100.0 93.4 1,643 43.8 1,654 6-9 14.1 0.8 8.2 1.5 12.9 62.6 100.0 85.9 1,112 48.2 1,124 12-15 28.8 0.3 2.2 0.7 2.4 65.5 100.0 71.2 1,234 41.6 1,299 12-23 37.2 0.3 1.5 0.4 1.8 58.8 100.0 62.8 2,729 36.8 3,028 20-23 54.7 0.7 0.7 0.3 0.8 42.8 100.0 45.3 664 31.6 812 Note: Breastfeeding status refers to a “24-hour” period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non- milk liquids, other milk, and complementary foods (solids and semisolids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and non-milk liquids and who do not receive other milk and who do not receive complementary foods are classified in the non-milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Non-milk liquids include juice, juice drinks, clear broth, or other liquids. Feeding children using a bottle with a nipple is discouraged. However, bottle feeding is a common practice in Yemen; 44 percent of children below age 6 months are fed using a bottle with a nipple, very similar to the figure of 46 percent reported in 2006. Even among the youngest infants under age 2 months, one-third are fed using a bottle with a nipple. Figure 11.3 depicts the transition of feeding practices among children up to age 2. The very low level of exclusive breastfeeding is notable. Nutrition of Children and Women • 131 Figure 11.3 Infant feeding practices by age Figure 11.4 presents the 2013 YNHDS results on infant and young child feeding (IYCF) indicators related to breastfeeding status. Detailed descriptions of these indicators can be found in WHO publications (WHO, 2008; WHO, 2010). Figure 11.4 IYCF indicators on breastfeeding status 11.2.3 Median Duration of Breastfeeding Table 11.4 shows that the median duration of any breastfeeding (i.e., the length of time in months for which half of children are breastfed) is 18.4 months. Large differences are observed by governorate, with median duration of any breastfeeding being highest in Hajjah Governorate (23 months) and lowest in Mareb and Aldhalae governorates (15 months each). Median durations of any breastfeeding are shorter for children whose mothers have some education (17-18 months) than for children of mothers with no education (20 months). Median duration of breastfeeding generally declines as wealth quintile increases. 41 41 47 45 69 71 5 10 Bottle feeding (0-23 months) Predominant breastfeeding (0-5 months) Age-appropriate breastfeeding (0-23 months) Continued breastfeeding at 2 years Introduction of solid, semisolid, or soft foods (6-8 months) Continued breastfeeding at 1 year Exclusive breastfeeding at 4-5 months Exclusive breastfeeding under 6 months Percentage YNHDS 2013 132 • Nutrition of Children and Women The median duration of any breastfeeding has fluctuated over time, increasing from 17.8 months in the 1997 YDMCHS to 21.7 months in the 2003 YFHS and then decreasing to 18.4 months in the 2013 YNHDS. 11.3 DIETARY DIVERSITY AMONG YOUNG CHILDREN In the 2013 YNHDS, women who had at least one child living with them who was born in 2011 or later were asked questions about the types of liquids and foods the child had consumed during the day or night preceding the interview. Mothers who had more than one child born in 2011 or later were asked questions about the youngest child living with them. Mothers were also asked about the number of times the child had eaten solid or semisolid food during the period. Dietary data on children are subject to recall errors on the mother’s part, especially if the child was fed by other individuals during the 24 hours before the interview. 11.3.1 Foods and Liquids Consumed by Infants and Young Children Appropriate nutrition includes feeding children a variety of foods to ensure that nutrient requirements are met. Fruits and vegetables rich in vitamin A should be consumed daily. Although eating a range of fruits and vegetables, especially those rich in vitamin A, is important, studies have shown that plant-based complementary foods by themselves are insufficient to meet the needs for certain micronutrients. Therefore, it has been recommended that meat, poultry, fish, or eggs be eaten daily or as often as possible (WHO, 1998). Table 11.5 is based on information from mothers about the foods and liquids consumed by their youngest child during the day or night preceding the interview. As expected, the proportions of children consuming foods or liquids in the various food groups generally increase with age, except for infant formula and baby foods. Children who are still breastfed are less likely than children who are not being breastfed to consume other types of liquids and solid/semisolid foods. For example, 84 percent of nonbreastfeeding children age 6-23 months consumed foods made from grains the day or night preceding the interview, as compared with 72 percent of breastfeeding children in that age group. Similarly, 33 percent of nonbreastfeeding children age 6-23 months consumed foods rich in vitamin A, compared with 26 percent of breastfeeding children in the same age group. Over one-third of nonbreastfeeding children (37 percent) and 23 percent of breastfeeding children age 6-23 months consumed meat, fish, and poultry, and 56 percent of nonbreastfeeding children and 47 percent of breastfeeding children consumed cheese, yogurt, or other milk products. Table 11.4 Median duration of breastfeeding Median duration of any breastfeeding among children born in the three years preceding the survey, by background characteristics, Yemen 2013 Background characteristic Median duration (months) of any breastfeeding among children born in the past three years1 Sex Male 18.5 Female 18.3 Residence Urban 18.3 Rural 18.4 Governorate Ibb 16.9 Abyan 18.7 Sana’a City 17.4 Al-Baidha 15.7 Taiz 17.8 Al-Jawf 17.2 Hajjah 23.0 Al-Hodiedah 20.2 Hadramout 20.7 Dhamar 16.8 Shabwah 18.8 Sadah (20.6) Sana’a 18.9 Aden (17.9) Lahj 20.6 Mareb 14.6 Al-Mhweit 18.1 Al-Mhrah (20.7) Amran 19.4 Aldhalae 14.7 Reimah 18.2 Mother’s education No education 19.8 Fundamental 17.3 Secondary 17.4 Higher (17.8) Wealth quintile Lowest 20.8 Second 18.3 Middle 17.2 Fourth 18.1 Highest 17.7 Total 18.4 Mean for all children 18.0 Note: Median and mean durations are based on the distributions at the time of the survey of the proportion of births by months since birth. Includes children living and deceased at the time of the survey. Figures in parentheses are based on 25-49 unweighted cases. 1 It is assumed that non-last-born children and last-born children not currently living with their mother are not currently breastfeeding. N ut rit io n of C hi ld re n an d W om en • 1 33 Ta bl e 11 .5 F oo ds a nd li qu id s co ns um ed b y ch ild re n in th e da y or n ig ht p re ce di ng th e in te rv ie w P er ce nt ag e of y ou ng es t c hi ld re n un de r a ge 2 w ho a re li vi ng w ith th ei r m ot he r b y ty pe o f f oo ds c on su m ed in th e da y or n ig ht p re ce di ng th e in te rv ie w , a cc or di ng to b re as tfe ed in g st at us a nd a ge , Y em en 2 01 3 Li qu id s S ol id o r s em is ol id fo od s A ny s ol id o r se m is ol id fo od N um be r o f ch ild re n A ge in m on th s In fa nt fo rm ul a O th er m ilk 1 O th er liq ui ds 2 Fo rti fie d ba by fo od s Fo od m ad e fro m gr ai ns 3 Fr ui ts a nd ve ge ta bl es ric h in vi ta m in A 4 O th er fr ui ts an d ve ge - ta bl es Fo od m ad e fro m ro ot s an d tu be rs Fo od m ad e fro m le gu m es an d nu ts M ea t, fis h, po ul try Eg gs C he es e, yo gu rt, ot he r m ilk pr od uc ts O il, fa t, bu tte r BR EA ST FE ED IN G C H IL D R EN 0- 1 21 .9 10 .8 10 .3 1. 1 1. 3 0. 2 0. 4 0. 3 0. 2 0. 6 0. 0 2. 0 0. 4 5. 4 41 7 2- 3 36 .0 21 .0 10 .6 12 .1 2. 4 2. 0 0. 0 2. 0 0. 0 0. 0 0. 1 3. 6 1. 4 21 .6 60 9 4- 5 33 .7 22 .0 14 .6 19 .5 17 .9 6. 7 1. 0 11 .8 1. 7 0. 7 2. 2 12 .9 9. 1 42 .5 50 8 6- 8 30 .9 30 .7 35 .2 19 .8 44 .9 13 .1 3. 9 30 .4 4. 9 7. 7 7. 1 30 .8 17 .1 65 .1 69 5 9- 11 21 .6 36 .4 56 .0 17 .5 69 .3 29 .8 11 .2 44 .9 16 .2 18 .6 11 .7 45 .2 28 .3 80 .1 59 3 12 -1 7 17 .1 35 .8 65 .9 9. 1 82 .7 30 .2 12 .1 44 .5 23 .4 28 .9 16 .1 53 .1 39 .4 81 .8 1, 18 8 18 -2 3 15 .3 35 .1 73 .0 7. 1 88 .5 30 .5 17 .8 51 .2 29 .5 37 .0 15 .7 56 .0 38 .4 84 .9 52 7 6- 23 20 .9 34 .6 58 .1 12 .9 72 .3 26 .2 11 .0 42 .5 18 .8 23 .4 13 .1 46 .9 31 .9 78 .1 3, 00 4 To ta l 24 .4 29 .2 42 .4 12 .4 50 .3 18 .4 7. 4 29 .8 12 .6 15 .6 8. 9 33 .1 22 .3 59 .9 4, 53 7 N O N BR EA ST FE ED IN G C H IL D R EN 0- 1 (3 8. 0) (1 8. 1) (1 8. 8) (0 .0 ) (1 6. 5) (3 .1 ) (0 .0 ) (9 .4 ) (1 .7 ) (7 .1 ) (1 .7 ) (1 5. 1) (7 .1 ) (9 .4 ) 28 2- 3 (4 5. 8) (1 3. 7) (1 1. 8) (8 .3 ) (6 .0 ) (0 .0 ) (0 .0 ) (2 .2 ) (0 .0 ) (2 .2 ) (0 .0 ) (2 .2 ) (0 .0 ) (2 6. 3) 36 4- 5 64 .7 40 .4 20 .6 22 .8 26 .1 9. 4 3. 3 9. 5 1. 0 7. 8 7. 9 17 .0 6. 4 51 .2 46 6- 8 51 .7 46 .6 45 .1 22 .3 48 .5 19 .2 6. 1 22 .4 9. 0 16 .5 7. 2 43 .6 22 .6 67 .3 99 9- 11 51 .8 44 .5 62 .2 28 .4 77 .8 33 .9 14 .3 48 .4 7. 4 34 .3 20 .7 45 .1 41 .6 80 .0 14 6 12 -1 7 37 .1 45 .8 72 .6 9. 8 84 .2 31 .8 12 .8 44 .8 29 .1 33 .8 15 .7 58 .4 40 .8 83 .7 50 9 18 -2 3 18 .6 43 .5 86 .4 5. 7 91 .7 36 .4 19 .0 53 .2 36 .5 44 .3 20 .3 59 .3 44 .1 88 .5 50 5 6- 23 32 .6 44 .8 74 .8 11 .3 83 .7 32 .9 14 .9 46 .8 28 .0 36 .7 17 .4 56 .0 40 .8 83 .9 1, 25 9 To ta l 34 .1 43 .3 70 .2 11 .4 78 .4 30 .6 13 .8 43 .6 25 .8 34 .2 16 .3 52 .5 37 .9 79 .8 1, 36 9 N ot e: B re as tfe ed in g st at us a nd fo od c on su m ed re fe r t o a 24 -h ou r p er io d (y es te rd ay a nd la st n ig ht ). Fi gu re s in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 1 O th er m ilk in cl ud es fr es h, ti nn ed , a nd p ow de re d co w o r o th er a ni m al m ilk . 2 D oe s no t i nc lu de p la in w at er 3 I nc lu de s fo rti fie d ba by fo od 4 I nc lu de s pu m pk in , c ar ro ts , s qu as h, s w ee t p ot at oe s th at a re y el lo w o r o ra ng e in si de , d ar k gr ee n le af y ve ge ta bl es , r ip e m an go es , p ap ay as , m el on s, a nd o th er fr ui ts th at a re ri ch in v ita m in A Nutrition of Women and Children • 133 134 • Nutrition of Children and Women 11.3.2 Infant and Young Child Feeding (IYCF) Practices Appropriate IYCF practices include breastfeeding through age 2, introduction of solid and semisolid foods at age 6 months, and gradual increases in the amount of food given and frequency of feeding as the child gets older. According to recommendations, breastfed children age 6-23 months should receive animal- source foods and vitamin A-rich fruits and vegetables daily (PAHO/WHO, 2003). Because first foods almost always include a grain- or tuber-based staple, it is unlikely that young children who eat food from less than three groups will receive both an animal-source food and a vitamin A-rich fruit or vegetable. Therefore, three food groups are considered the minimum number appropriate for breastfed children (Arimond and Ruel, 2004). Breastfed infants age 6-8 months should receive complementary foods two to three times a day with one or two snacks; breastfed children age 9-23 months should receive meals three to four times a day with one or two snacks (PAHO/WHO, 2003; WHO, 2008; WHO, 2010). Nonbreastfed children age 6-23 months should receive milk or milk products two or more times a day to ensure that their calcium needs are met. In addition, they need animal-source foods and vitamin A- rich fruits and vegetables. Four food groups are considered the minimum number appropriate for nonbreastfed young children. Nonbreastfed children age 12-23 months should be fed meals four to five times each day, with one or two snacks (WHO, 2005; WHO, 2008; WHO, 2010). The results presented in the right-hand columns of Table 11.6 indicate that 87 percent of Yemeni children age 6-23 months received breast milk or breast milk substitutes during the day or night preceding the interview. Twenty-seven percent of children had an adequately diverse diet—that is, they had been given foods from at least four food groups—and 59 percent had been fed the minimum number of times appropriate for their age. Only 15 percent of Yemeni children age 6-23 months are fed in accordance with all three IYCF practices. Children age 9-23 months are more likely than children age 6-8 months to be fed according to all three recommended IYCF guidelines. Urban children (27 percent) are more than twice as likely as rural children (12 percent) to be fed according to the guidelines. Variations in the percentage of children fed according to the recommended IYCF feeding practices are also observed at the governorate level, but these results should be interpreted with caution because of the relatively small number of children in some governorates with reported data. There is a steady increase in the proportion of children fed according to IYCF practices as mother’s education increases. As expected, children in the highest wealth quintile (28 percent) are more likely to be fed according to the recommended three IYCF practices than children in the lower two wealth quintiles (9 percent each). N ut rit io n of C hi ld re n an d W om en • 1 35 Ta bl e 11 .6 I nf an t a nd y ou ng c hi ld fe ed in g (IY C F) p ra ct ic es P er ce nt ag e of y ou ng es t c hi ld re n ag e 6- 23 m on th s liv in g w ith th ei r m ot he r w ho a re fe d ac co rd in g to th re e IY C F fe ed in g pr ac tic es b as ed o n br ea st fe ed in g st at us , n um be r o f f oo d gr ou ps , a nd ti m es th ey a re fe d du rin g th e da y or n ig ht p re ce di ng th e su rv ey , b y ba ck gr ou nd c ha ra ct er is tic s, Y em en 2 01 3 A m on g br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g no n- br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g al l c hi ld re n 6- 23 m on th s, pe rc en ta ge fe d: B ac kg ro un d ch ar ac te ris tic 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 2 B ot h 4+ fo od gr ou ps a nd m in im um m ea l fre qu en cy N um be r o f br ea st fe d ch ild re n 6- 23 m on th s M ilk o r m ilk pr od uc ts 3 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 4 W ith 3 IY C F pr ac tic es 5 N um be r o f no n- br ea st fe d ch ild re n 6- 23 m on th s B re as t m ilk , m ilk , o r m ilk pr od uc ts 6 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 7 W ith 3 IY C F pr ac tic es N um be r o f al l c hi ld re n 6- 23 m on th s A ge in m on th s 6- 8 7. 7 49 .9 7. 0 69 5 70 .7 13 .0 61 .2 2. 8 99 96 .3 8. 4 51 .3 6. 4 79 4 9- 11 22 .1 48 .4 15 .6 59 3 65 .6 27 .7 74 .8 11 .8 14 6 93 .2 23 .2 53 .6 14 .8 73 9 12 -1 7 26 .8 57 .0 21 .1 1, 18 8 65 .5 36 .9 73 .6 10 .3 50 9 89 .6 29 .9 62 .0 17 .9 1, 69 7 18 -2 3 32 .4 60 .4 24 .4 52 7 42 .7 43 .4 63 .5 12 .8 50 5 72 .0 37 .8 61 .9 18 .7 1, 03 2 Se x M al e 20 .9 52 .7 15 .5 1, 54 5 57 .2 36 .2 68 .2 10 .3 61 8 87 .8 25 .3 57 .1 14 .0 2, 16 3 Fe m al e 24 .0 56 .0 19 .3 1, 45 8 56 .4 36 .9 69 .3 11 .4 64 1 86 .7 28 .0 60 .0 16 .9 2, 10 0 R es id en ce U rb an 37 .3 60 .9 27 .7 75 2 68 .3 58 .4 80 .3 24 .3 36 7 89 .6 44 .2 67 .3 26 .6 1, 11 9 R ur al 17 .5 52 .1 13 .9 2, 25 1 52 .0 27 .6 64 .0 5. 4 89 2 86 .4 20 .4 55 .4 11 .5 3, 14 4 G ov er no ra te Ib b 11 .2 48 .3 10 .5 30 7 60 .5 18 .0 60 .8 2. 1 16 3 86 .3 13 .6 52 .6 7. 6 46 9 A by an 22 .1 41 .7 11 .5 65 (6 0. 3) (5 0. 5) (6 3. 6) (2 3. 9) 22 90 .1 29 .2 47 .2 14 .6 86 S an a’ a C ity 46 .3 68 .0 36 .4 21 7 72 .7 64 .1 86 .0 35 .6 12 1 90 .2 52 .7 74 .4 36 .1 33 8 A l-B ai dh a 12 .8 67 .5 11 .7 10 4 58 .6 43 .1 85 .5 20 .8 65 84 .0 24 .5 74 .4 15 .2 16 9 Ta iz 22 .1 68 .8 19 .3 36 1 51 .5 35 .6 76 .5 1. 2 16 7 84 .6 26 .4 71 .2 13 .5 52 8 A l-J aw f 26 .4 56 .6 21 .2 23 (7 3. 0) (3 0. 4) (7 2. 9) (1 0. 3) 15 89 .5 28 .0 62 .9 17 .0 38 H aj ja h 15 .1 47 .4 12 .2 22 0 (4 0. 2) (2 2. 5) (5 6. 9) (1 .6 ) 50 89 .0 16 .5 49 .1 10 .2 27 0 A l-H od ie da h 28 .9 58 .1 24 .9 43 9 (5 5. 0) (6 0. 8) (7 6. 2) (2 1. 2) 94 92 .0 34 .6 61 .3 24 .3 53 4 H ad ra m ou t 19 .9 28 .2 12 .6 12 8 75 .8 23 .2 73 .2 10 .0 61 92 .2 20 .9 42 .7 11 .8 18 9 D ha m ar 16 .1 42 .1 9. 3 26 0 46 .4 29 .1 50 .8 5. 8 12 7 82 .4 20 .4 44 .9 8. 1 38 6 S ha bw ah 19 .3 45 .9 8. 6 50 72 .4 44 .8 54 .8 11 .9 22 91 .5 27 .1 48 .7 9. 6 72 S ad ah 30 .1 64 .7 26 .0 10 0 (3 9. 4) (4 7. 8) (6 3. 7) (7 .3 ) 26 87 .6 33 .7 64 .5 22 .2 12 6 S an a’ a 27 .8 62 .6 22 .3 17 7 57 .6 36 .5 68 .1 11 .0 85 86 .2 30 .7 64 .4 18 .6 26 2 A de n 45 .9 46 .4 24 .6 70 (6 4. 1) (4 5. 4) (7 8. 5) (1 0. 7) 32 88 .8 45 .7 56 .4 20 .3 10 1 La hj 27 .3 43 .9 14 .1 78 (6 6. 4) (4 0. 0) (7 1. 5) (1 5. 0) 30 90 .6 30 .8 51 .6 14 .3 10 9 M ar eb 16 .4 66 .0 12 .9 19 52 .0 35 .4 64 .3 6. 6 12 81 .2 23 .8 65 .3 10 .4 31 A l-M hw ei t 13 .0 54 .4 9. 1 10 8 49 .1 35 .1 71 .4 7. 4 37 87 .1 18 .6 58 .7 8. 7 14 4 A l-M hr ah 44 .9 48 .0 25 .1 13 (6 8. 7) (3 9. 6) (5 2. 9) (6 .3 ) 4 91 .9 43 .5 49 .3 20 .2 17 A m ra n 12 .8 49 .2 8. 9 13 2 43 .0 27 .4 45 .4 6. 3 51 84 .2 16 .9 48 .2 8. 2 18 3 A ld ha la e 11 .1 54 .3 11 .1 56 44 .5 24 .1 73 .4 9. 1 48 74 .5 17 .1 63 .1 10 .2 10 3 R ei m ah 12 .5 42 .9 9. 7 78 62 .0 24 .8 63 .1 3. 1 28 89 .8 15 .8 48 .3 7. 9 10 6 M ot he r’s e du ca tio n N o ed uc at io n 15 .6 51 .5 12 .6 1, 65 5 51 .0 24 .6 64 .1 5. 3 59 0 87 .1 17 .9 54 .8 10 .7 2, 24 5 Fu nd am en ta l 28 .4 56 .1 21 .0 97 6 62 .7 41 .2 69 .9 14 .6 47 4 87 .8 32 .6 60 .6 18 .9 1, 44 9 S ec on da ry 33 .7 59 .5 24 .9 27 8 55 .2 53 .4 76 .1 15 .1 14 7 84 .5 40 .5 65 .3 21 .5 42 5 H ig he r 48 .6 69 .1 39 .4 95 (7 3. 9) (8 6. 6) (9 0. 6) (2 9. 8) 49 91 .2 61 .5 76 .4 36 .2 14 3 C on tin ue d… Nutrition of Women and Children • 135 13 6 • N ut rit io n of C hi ld re n an d W om en Ta bl e 11 .6 — C on tin ue d A m on g br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g no n- br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g al l c hi ld re n 6- 23 m on th s, pe rc en ta ge fe d: B ac kg ro un d ch ar ac te ris tic 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 2 B ot h 4+ fo od gr ou ps a nd m in im um m ea l fre qu en cy N um be r o f br ea st fe d ch ild re n 6- 23 m on th s M ilk o r m ilk pr od uc ts 3 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 4 W ith 3 IY C F pr ac tic es 5 N um be r o f no n- br ea st fe d ch ild re n 6- 23 m on th s B re as t m ilk , m ilk , o r m ilk pr od uc ts 6 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 7 W ith 3 IY C F pr ac tic es N um be r o f al l c hi ld re n 6- 23 m on th s W ea lth q ui nt ile Lo w es t 12 .8 49 .8 10 .4 74 4 41 .9 19 .5 51 .8 2. 6 19 5 87 .9 14 .2 50 .2 8. 8 93 9 S ec on d 13 .9 50 .1 11 .1 68 4 48 .5 20 .2 58 .3 3. 5 27 7 85 .1 15 .7 52 .5 8. 9 96 1 M id dl e 22 .6 58 .9 19 .5 60 6 53 .5 30 .4 70 .2 5. 3 26 9 85 .7 25 .0 62 .4 15 .1 87 5 Fo ur th 32 .1 55 .4 22 .8 50 8 59 .7 51 .2 79 .2 15 .0 25 1 86 .7 38 .5 63 .3 20 .2 75 9 H ig he st 39 .8 60 .3 28 .9 46 3 76 .8 58 .5 80 .6 26 .4 26 6 91 .5 46 .7 67 .7 28 .0 72 9 To ta l 22 .5 54 .3 17 .3 3, 00 4 56 .8 36 .6 68 .7 10 .9 1, 25 9 87 .2 26 .6 58 .5 15 .4 4, 26 3 N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 1 F oo d gr ou ps : a ) i nf an t f or m ul a, m ilk o th er th an b re as t m ilk , c he es e or y og ur t o r o th er m ilk p ro du ct s; b ) f oo ds m ad e fro m g ra in s, ro ot s, a nd tu be rs , i nc lu di ng p or rid ge a nd fo rti fie d ba by fo od fr om g ra in s; c ) v ita m in A -ri ch fru its a nd v eg et ab le s; d ) o th er fr ui ts a nd v eg et ab le s; e ) e gg s; f) m ea t, po ul try , f is h, a nd s he llf is h (a nd o rg an m ea ts ); g) le gu m es a nd n ut s. 2 F or b re as tfe d ch ild re n, m in im um m ea l f re qu en cy is re ce iv in g so lid o r s em is ol id fo od a t l ea st tw ic e a da y fo r i nf an ts a ge 6 -8 m on th s an d at le as t t hr ee ti m es a d ay fo r c hi ld re n ag e 9- 23 m on th s. 3 I nc lu de s tw o or m or e fe ed in gs o f c om m er ci al in fa nt fo rm ul a, fr es h, ti nn ed , a nd p ow de re d an im al m ilk , a nd y og ur t 4 F or n on br ea st fe d ch ild re n ag e 6- 23 m on th s, m in im um m ea l f re qu en cy is re ce iv in g so lid o r s em is ol id fo od o r m ilk fe ed s at le as t f ou r t im es a d ay . 5 N on br ea st fe d ch ild re n ag e 6- 23 m on th s ar e co ns id er ed to b e fe d w ith a m in im um s ta nd ar d of th re e in fa nt a nd y ou ng c hi ld fe ed in g pr ac tic es if th ey re ce iv e ot he r m ilk o r m ilk p ro du ct s at le as t t w ic e a da y, re ce iv e th e m in im um m ea l f re qu en cy , a nd re ce iv e so lid o r s em is ol id fo od s fro m a t l ea st fo ur fo od g ro up s no t i nc lu di ng th e m ilk o r m ilk p ro du ct s fo od g ro up . 6 B re as tfe ed in g, o r n ot b re as tfe ed in g an d re ce iv in g tw o or m or e fe ed in gs o f c om m er ci al in fa nt fo rm ul a, fr es h, ti nn ed , a nd p ow de re d an im al m ilk , a nd y og ur t 7 C hi ld re n ar e fe d th e m in im um re co m m en de d nu m be r o f t im es p er d ay a cc or di ng to th ei r a ge a nd b re as tfe ed in g st at us a s de sc rib ed in fo ot no te s 2 an d 4. 136 • Nutrition of Women and Children Nutrition of Children and Women • 137 11.4 PREVALENCE OF ANEMIA IN CHILDREN Anemia, characterized by a low level of hemoglobin in the blood, is a major health problem in Yemen, especially among young children and pregnant women. Anemia may be an underlying cause of maternal mortality, spontaneous abortions, premature births, and low birth weight. The most common cause of anemia is inadequate dietary intake of nutrients necessary for synthesis of hemoglobin, such as iron, folic acid, and vitamin B12. Anemia also results from sickle cell disease, malaria, and parasitic infections. Measurement of hemoglobin (Hb) is the standardized method of screening for anemia. To measure Hb, the 2013 YNHDS used a new rapid testing methodology, the AVIE™ Total Hb analyzer, instead of the HemoCue analyzer widely used in DHS surveys. The AVIE system consists of a battery-operated, portable analyzer and a disposable microcuvette, a small transparent laboratory vessel that serves as the blood collection device. For the test, a drop of capillary blood was taken from a child’s fingertip or heel (in the case of young children with small fingers) and drawn into the microcuvette. The microcuvette was placed in the analyzer, which takes about one minute to display the hemoglobin concentration. Results were recorded on the questionnaire and explained verbally to the child’s parent or caretaker. Parents of children whose hemoglobin level was lower than the recommended cutoff point for severe anemia were advised to take the child to a health facility for follow-up testing and/or treatment. Given that hemoglobin requirements differ substantially depending on altitude, information on the altitude of each selected cluster from the 2004 census was used to make adjustments to sea-level equivalents before classifying children according to level of anemia; CDC formulas were used in making these adjustments (CDC, 1998). Hemoglobin testing was carried out among children age 6-59 months in one-third of the households selected for the survey. Only children whose parent or caretaker gave voluntary, verbal consent were tested. Hemoglobin levels were successfully measured for 84 percent of the children eligible for testing. However, less than 80 percent of eligible children were tested in Sana’a City (79 percent) and the governorates of Al- Mhrah (71 percent), Lahj (63 percent), Shabwah (57 percent), and Hadramout (55 percent), and thus the results for these areas should be interpreted with caution. Table 11.7 shows the anemia status of children according to selected background characteristics. Almost nine in ten children (86 percent) suffer from some level of anemia (Hb <11.0 g/dl); 14 percent have mild anemia (Hb 10.0–10.9 g/dl), 57 percent have moderate anemia, (Hb 7.0—9.9 g/dl) and 16 percent have severe anemia (Hb < 7.0 g/dl). The prevalence of anemia peaks at age 9-23 months (92-96 percent). Rural children are more likely to be anemic than urban children. Anemia prevalence generally declines as mother’s education and wealth increase. Variations by governorate are large: 74 percent of children in Ibb Governorate suffer from some level of anemia, as compared with 99 percent of those in Al-Jawf and Sadah governorates. 138 • Nutrition of Children and Women Table 11.7 Prevalence of anemia in children Percentage of children age 6-59 months classified as having anemia, by background characteristics, Yemen 2013 Anemia status by hemoglobin level Background characteristic Any anemia (<11.0 g/dl) Mild anemia (10.0-10.9 g/dl) Moderate anemia (7.0-9.9 g/dl) Severe anemia (<7.0 g/dl) Number of children Age in months 6-8 87.8 11.8 59.8 16.2 227 9-11 95.8 10.1 63.9 21.7 204 12-17 92.0 10.4 60.6 21.0 503 18-23 93.4 13.1 60.0 20.3 342 24-35 88.0 14.0 57.4 16.6 874 36-47 84.0 16.9 54.4 12.6 780 48-59 78.0 16.8 51.3 10.0 855 Sex Male 85.9 13.5 56.5 16.0 1,899 Female 86.7 15.2 56.7 14.9 1,887 Mother’s interview status Interviewed 86.5 14.3 56.8 15.5 3,681 Not interviewed but in household 80.2 15.5 51.0 13.7 70 Not interviewed and not in the household1 (76.6) (19.6) (42.1) (14.9) 35 Residence Urban 81.2 17.2 53.7 10.3 1,063 Rural 88.3 13.2 57.7 17.5 2,722 Governorate Ibb 74.3 18.7 48.0 7.6 358 Abyan 97.8 5.1 55.9 36.8 82 Sana’a City 76.1 18.7 49.7 7.7 318 Al-Baidha 83.7 14.7 49.9 19.1 184 Taiz 79.0 19.4 51.8 7.8 513 Al-Jawf 98.7 5.6 68.0 25.1 35 Hajjah 92.2 9.9 65.9 16.4 287 Al-Hodiedah 94.0 12.4 59.8 21.8 478 Hadramout 90.1 12.0 67.6 10.5 124 Dhamar 87.0 18.6 51.8 16.5 312 Shabwah 93.6 7.4 62.3 23.9 46 Sadah 99.0 6.7 68.8 23.5 127 Sana’a 83.5 15.1 52.7 15.6 205 Aden 94.0 12.9 70.2 10.9 82 Lahj 95.0 2.7 61.1 31.1 65 Mareb 83.3 15.7 55.4 12.2 31 Al-Mhweit 95.8 10.1 64.4 21.3 137 Al-Mhrah 92.5 12.3 68.4 11.7 14 Amran 91.4 9.1 56.3 26.0 165 Aldhalae 80.7 12.3 58.2 10.3 106 Reimah 89.4 16.5 62.4 10.6 116 Mother’s education2 No education 88.7 12.9 57.9 17.9 2,104 Fundamental 84.6 15.7 55.9 13.0 1,133 Secondary 84.7 18.4 53.2 13.0 382 Higher 72.1 12.4 54.5 5.3 133 Wealth quintile Lowest 90.7 9.8 60.9 20.0 897 Second 90.8 14.3 59.4 17.0 836 Middle 86.6 14.9 53.4 18.2 719 Fourth 83.7 15.7 56.6 11.5 667 Highest 77.3 18.5 50.4 8.4 665 Total 86.3 14.3 56.6 15.5 3,785 Note: Table is based on children who stayed in the household on the night before the interview and who were tested for anemia. Prevalence of anemia, based on hemoglobin levels, is adjusted for altitude using formulas in CDC, 1998. Hemoglobin is in grams per deciliter (g/dl). Figures in parentheses are based on 25-49 unweighted cases. 1 Includes children whose mothers are deceased 2 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire. 11.5 MICRONUTRIENT INTAKE AND SUPPLEMENTATION AMONG CHILDREN Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Micro- nutrients are available in foods and can also be provided through direct supplementation. Breastfeeding children benefit from supplements given to their mother. Nutrition of Children and Women • 139 Iron deficiency is one of the primary causes of anemia, which has serious health consequences for both women and children. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage and is the leading cause of childhood blindness. VAD also increases the severity of infections, such as measles and diarrheal disease in children, and slows recovery from illness. VAD is common in dry environments where fresh fruits and vegetables are not readily available. Vitamin A supplementation is an important tool in preventing VAD among young children. In the 2013 YNHDS, information was collected on food consumption during the day and night preceding the interview among the youngest children under age 2 living with their mothers; these data are useful in assessing the extent to which children are consuming food groups rich in two key micronutrients— vitamin A and iron—in their daily diet. In addition, the survey included questions designed to ascertain whether young children had received vitamin A supplements or deworming medication in the six months preceding the survey or iron supplements in the seven days preceding the survey. Table 11.8 presents data on intake of foods rich in vitamin A and iron among the youngest children age 6-23 months living with their mother. Less than half (47 percent) of children consumed vitamin A-rich foods in the 24 hours preceding the interview, and 35 percent consumed iron-rich foods. As expected, intake of both vitamin A-rich and iron-rich foods increases as children get older and are weaned. Nonbreastfeeding children are more likely to consume foods rich in vitamin A and iron than breastfeeding children. Also, urban children are more likely than rural children to consume foods rich in vitamin A and iron. Intake of these two micronutrients increases with increasing mother’s education and wealth quintile. Among all children age 6-59 months, 55 percent received a vitamin A supplement in the six months preceding the survey. Variations by governorate are large. For example, only 18 percent of children in Al- Jawf Governorate received a vitamin A supplement in the six months before the survey, as compared with 74 percent of those in Dhamar Governorate. The likelihood of a child being given a vitamin A dose rises with increasing mother’s education and wealth quintile. The survey results indicate that iron supplementation is not common among children. Only 6 percent of children age 6-59 months received iron supplements in the seven days before the survey. Differences by background characteristics are not large, although children whose mothers have a higher education and those in the highest wealth quintile are somewhat more likely to receive iron supplements than other children. Twelve percent of children age 6-59 months received deworming medication in the six months preceding the survey, with only minimal differences by background characteristics. Almost half (49 percent) of children age 6-59 months live in households using iodized salt. This proportion is higher among urban (71 percent) than rural (40 percent) children. It also increases substantially as mother’s education and wealth quintile increase. 140 • Nutrition of Children and Women Table 11.8 Micronutrient intake among children Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, and among all children age 6-59 months, the percentages who were given vitamin A supplements in the six months preceding the survey, who were given iron supplements in the past seven days, and who were given deworming medication in the six months preceding the survey, and among all children age 6-59 months who live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by background characteristics, Yemen 2013 Among youngest children age 6-23 months living with their mother: Among all children age 6-59 months: Among children age 6-59 months living in households tested for iodized salt Background characteristic Percentage who consumed foods rich in vitamin A in last 24 hours1 Percentage who consumed foods rich in iron in last 24 hours2 Number of children Percentage given vitamin A supplements in last 6 months Percentage given iron supplements in last 7 days Percentage given deworming medication in last 6 months3 Number of children Percentage living in households with iodized salt4 Number of children Age in months 6-8 22.8 14.0 794 36.2 6.5 4.6 806 47.1 767 9-11 44.2 29.4 739 59.5 6.4 5.7 743 47.7 713 12-17 52.7 38.5 1,697 61.9 6.9 6.5 1,797 48.5 1,705 18-23 59.4 48.2 1,032 60.4 6.2 9.8 1,231 49.6 1,167 24-35 na na na 57.0 5.5 13.4 3,066 48.6 2,931 36-47 na na na 52.0 5.5 15.2 2,894 48.4 2,762 48-59 na na na 54.1 5.7 15.5 2,978 50.6 2,867 Sex Male 47.8 34.8 2,163 55.2 5.9 12.2 6,942 49.2 6,628 Female 46.8 34.6 2,100 55.1 5.9 11.9 6,574 48.7 6,283 Breastfeeding status Breastfeeding 43.7 30.9 3,004 55.2 6.1 7.5 3,527 46.1 3,360 Not breastfeeding 55.6 43.8 1,249 55.3 5.7 13.7 9,774 50.0 9,361 Missing * * 11 48.0 10.6 13.3 215 45.4 190 Mother’s age at birth 15-19 45.1 31.7 267 52.8 4.3 7.5 426 51.4 404 20-29 48.5 35.4 2,364 55.8 6.2 11.6 7,091 49.9 6,769 30-39 46.1 34.7 1,355 55.0 5.8 13.2 4,817 49.3 4,600 40-49 44.6 31.3 277 52.8 5.1 11.9 1,183 41.2 1,139 Residence Urban 66.3 49.7 1,119 60.7 9.5 14.6 3,696 71.4 3,563 Rural 40.5 29.3 3,144 53.1 4.6 11.1 9,820 40.4 9,349 Governorate Ibb 31.2 19.3 469 46.8 4.1 10.9 1,459 46.7 1,383 Abyan 51.4 45.8 86 31.3 6.0 14.6 260 89.5 258 Sana’a City 74.1 52.6 338 59.0 11.9 9.6 1,115 73.4 1,089 Al-Baidha 39.3 35.0 169 61.5 1.9 9.1 537 75.1 516 Taiz 46.9 31.2 528 67.4 5.2 15.3 1,698 59.5 1,630 Al-Jawf 41.0 39.4 38 18.1 4.2 6.0 125 30.8 89 Hajjah 40.7 23.3 270 41.7 2.4 9.3 877 17.6 858 Al-Hodiedah 59.2 44.5 534 64.3 10.3 19.5 1,737 41.9 1,614 Hadramout 46.1 38.5 189 48.8 5.0 3.2 655 42.4 636 Dhamar 39.6 30.7 386 73.7 3.8 8.7 1,096 53.2 1,077 Shabwah 51.5 41.0 72 28.0 4.0 6.4 239 29.0 223 Sadah 55.6 42.7 126 42.4 4.6 12.9 407 56.8 384 Sana’a 48.8 32.7 262 55.7 5.0 8.9 777 34.6 752 Aden 74.7 61.0 101 67.0 11.6 16.6 326 76.8 318 Lahj 55.8 48.3 109 61.8 7.8 18.4 347 74.0 324 Mareb 42.0 38.1 31 32.6 5.5 8.3 102 34.9 100 Al-Mhweit 33.0 24.1 144 42.3 4.9 14.2 443 37.5 420 Al-Mhrah 61.8 56.4 17 53.3 7.6 15.4 55 77.6 51 Amran 32.5 24.7 183 52.7 3.7 10.2 565 23.1 532 Aldhalae 31.8 26.3 103 30.9 4.3 11.9 333 41.5 313 Reimah 40.7 27.1 106 46.8 3.7 11.8 363 22.0 345 Mother’s education No education 38.9 28.2 2,245 51.4 4.7 11.0 7,519 39.2 7,164 Fundamental 53.1 39.2 1,449 57.6 6.1 13.2 4,296 58.5 4,114 Secondary 61.9 46.4 425 63.3 9.0 13.0 1,230 65.6 1,180 Higher 74.9 55.3 143 71.6 14.4 16.3 471 73.1 453 Wealth quintile Lowest 34.0 23.6 939 47.4 5.0 10.4 3,046 26.9 2,871 Second 36.9 25.7 961 55.0 4.4 11.4 2,892 37.0 2,741 Middle 45.7 35.5 875 55.6 4.1 11.4 2,709 53.4 2,624 Fourth 59.0 46.0 759 58.2 6.7 13.2 2,499 62.5 2,381 Highest 67.6 48.2 729 61.6 10.2 14.7 2,370 71.8 2,295 Total 47.3 34.7 4,263 55.2 5.9 12.1 13,516 48.9 12,912 Note: Information on vitamin A is based on both mother’s recall and the immunization card (where available). Information on iron supplements and deworming medication is based on the mother’s recall. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, carrots, squash, sweet potatoes that are yellow or orange inside, dark green leafy vegetables, ripe mangoes, papayas, melons, and other fruits that are rich in vitamin A 2 Includes meat (and organ meat), fish, poultry, and eggs 3 Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis. 4 Excludes children in households in which salt was not tested Nutrition of Children and Women • 141 11.6 PRESENCE OF IODIZED SALT IN HOUSEHOLDS Iodine is an essential micronutrient, and iodized salt prevents goiter among children and adults. Salt used in the household is the most common vehicle for iodine fortification to prevent iodine deficiency disorders. In 1996, the government regulated the iodine content in salt, mandating a minimum content of 40 parts per million (Qaed, 2014). According to the World Health Organization, a country’s salt iodization program is considered to be on a good track toward eliminating iodine deficiency when 90 percent of households use iodized salt. In the 2013 YNHDS, salt was tested for iodine in 95 percent of all households interviewed (Table 11.9). Among households in which salt was tested, 50 percent were consuming iodized salt. It should be noted that household salt was tested for the presence or absence of iodine only; the iodine level of the salt was not measured. There are large variations in the percentages of households with iodized salt by residence, governorate, and wealth quintile. Urban households are more likely to consume iodized salt than rural households (72 percent and 40 percent, respectively). Abyan and Al-Mhrah governorates have the highest proportion of households consuming iodized salt (88 percent and 83 percent, respectively), while Hajjah Governorate has the lowest (16 percent). The percentage of households with iodized salt increases with increasing wealth, from 25 percent of households in the lowest quintile to 74 percent of those in the highest quintile. Table 11.9 Presence of iodized salt in household Among all households, the percentage with salt tested for iodine content and the percentage with no salt in the household; and among households with salt tested, the percentage with iodized salt, according to background characteristics, Yemen 2013 Among all households, the percentage: Among households with tested salt: Background characteristic With salt tested With no salt in the household Number of households Percentage with iodized salt Number of households Residence Urban 95.6 4.4 5,413 71.9 5,175 Rural 94.1 5.9 11,938 39.8 11,231 Governorate Ibb 95.8 4.2 1,827 45.2 1,751 Abyan 97.6 2.4 374 87.8 365 Sana’a City 95.3 4.7 1,640 75.3 1,562 Al-Baidha 96.8 3.2 533 76.2 516 Taiz 93.9 6.1 2,306 56.1 2,164 Al-Jawf 71.8 28.2 142 30.5 102 Hajjah 96.8 3.2 1,094 15.6 1,059 Al-Hodiedah 90.6 9.4 2,487 41.2 2,254 Hadramout 97.7 2.3 822 49.2 803 Dhamar 97.2 2.8 1,246 54.6 1,211 Shabwah 93.3 6.7 271 28.7 253 Sadah 94.1 5.9 493 53.3 464 Sana’a 95.7 4.3 779 34.2 745 Aden 96.0 4.0 620 77.1 595 Lahj 94.3 5.7 601 73.8 567 Mareb 96.9 3.1 103 30.8 100 Al-Mhweit 92.4 7.6 488 36.8 451 Al-Mhrah 94.0 6.0 85 82.9 80 Amran 94.3 5.7 622 27.2 587 Aldhalae 94.6 5.4 397 42.7 376 Reimah 95.4 4.6 423 20.6 403 Wealth quintile Lowest 91.1 8.9 3,849 25.3 3,506 Second 94.4 5.6 3,493 38.2 3,296 Middle 96.3 3.7 3,286 50.4 3,163 Fourth 94.5 5.5 3,220 64.1 3,043 Highest 97.0 3.0 3,503 73.6 3,398 Total 94.6 5.4 17,351 49.9 16,406 142 • Nutrition of Children and Women 11.7 NUTRITIONAL STATUS OF WOMEN The 2013 YNHDS collected anthropometric data on height and weight for 94 percent of all women age 15-49 in interviewed households. Data on height and body mass index (BMI) were used to assess women’s nutritional status. Height is an outcome of genetics combined with the effects of nutrition during childhood and adolescence. For women, height helps to predict risk of difficult delivery because small stature is frequently associated with small pelvic size. The risk of low birthweight babies is also higher for short women. The cutoff point—that is, the height below which a woman is considered to be at risk for poor birth outcomes and obstetric complications—is defined as 145 centimeters. Table 11.10 shows that 7 percent of Yemeni women age 15-49 are below this height. Information on BMI is also presented in Table 11.10. BMI is calculated by dividing weight in kilograms by height in meters squared (kg/m2). Pregnant women and women who had a birth in the two months preceding the survey were excluded from BMI calculations. A BMI cutoff point of 18.5 has been recommended for assessing chronic energy deficiency among nonpregnant women. At the other end of the BMI scale, women are considered overweight if their BMI falls between 25.0 and 29.9 and obese if their BMI is 30.0 or greater. Overall, half of women (51 percent) have a BMI in the normal range, 25 percent are thin, and 24 percent are overweight or obese. Fourteen percent of women are classified as mildly thin and 11 percent as moderately or severely thin. Eight percent are classified as obese. Hence, among Yemeni women of reproductive age, overweight and obesity may be as much of a concern as underweight. Women in the 15- 19 age group are more likely than other women to be thin (BMI below 18.5). The proportion of women who are overweight or obese increases with age. For example, only 7 percent of women age 15-19 are overweight or obese, as compared with 44 percent of women age 40-49. Thirty-six percent of urban women are overweight or obese, compared with 17 percent of rural women. Conversely, rural women are more likely than urban women to be thin. Al-Mhrah Governorate (46 percent) has the highest proportion of overweight or obese women, and Reimah and Hajjah governorates (10 percent each) have the lowest. The proportion of women who are overweight or obese increases with increasing wealth, from 6 percent among those in the lowest quintile to 39 percent among those in the highest quintile. In addition to height and weight, women’s mid-upper-arm circumference (MUAC) was also measured in the 2013 YNHDS, using UNICEF tapes. This measure—taken from midway between the elbow and shoulder—can provide an indicator of level of undernutrition. Although there is controversy as to what cutoff points to use to best distinguish undernutrition (Tang et al., 2011), the survey categorized women with an MUAC of less than 21 cm as having severe acute malnutrition and those with an MUAC of 21-22.9 cm as having moderate acute malnutrition; the nutritional status of women with an MUAC of 23 cm or more was considered to be normal. Nutrition of Children and Women • 143 Table 11.10 Nutritional status of women Among all women age 15-49, the percentage with height under 145 cm, mean body mass index (BMI), and the percentage with specific BMI levels, by background characteristics, Yemen 2013 Height Body mass index1 Background characteristic Percent- age below 145 cm Number of women Mean body mass index (BMI) 18.5-24.9 (total normal) <18.5 (total thin) 17.0-18.4 (mildly thin) <17 (moder- ately and severely thin) ≥25.0 (total over- weight or obese) 25.0-29.9 (over- weight) ≥30.0 (obese) Number of women Age 15-19 9.4 6,135 19.9 56.9 36.4 20.5 15.9 6.7 4.9 1.8 5,852 20-29 5.9 9,595 21.6 55.3 25.4 14.5 10.9 19.3 13.9 5.4 8,142 30-39 6.8 5,828 23.8 45.1 17.3 9.4 7.9 37.6 25.0 12.6 5,125 40-49 7.7 3,200 24.7 41.4 14.5 7.5 7.0 44.1 25.4 18.7 3,088 Residence Urban 6.5 8,354 23.8 46.9 17.1 9.0 8.1 35.9 21.9 14.0 7,672 Rural 7.6 16,404 21.2 53.8 29.0 16.5 12.5 17.2 12.4 4.8 14,535 Governorate Ibb 7.9 2,691 22.3 55.2 20.2 12.4 7.8 24.6 17.2 7.4 2,410 Abyan 3.7 533 23.2 45.4 21.3 10.2 11.0 33.3 21.3 12.0 493 Sana’a City 6.1 2,452 23.8 48.0 15.7 9.3 6.5 36.3 23.4 12.9 2,235 Al-Baidha 2.4 1,066 24.1 54.7 10.9 8.4 2.5 34.4 19.5 14.9 958 Taiz 6.8 3,488 21.6 50.5 28.6 16.2 12.5 20.9 14.0 7.0 3,153 Al-Jawf 5.7 174 22.2 56.3 20.3 12.4 7.9 23.4 16.9 6.5 158 Hajjah 7.3 1,359 20.3 50.6 40.0 21.8 18.1 9.5 5.9 3.6 1,202 Al-Hodiedah 10.5 3,193 20.7 43.8 40.3 18.5 21.8 15.9 10.0 6.0 2,880 Hadramout 4.7 1,293 23.4 44.6 20.1 10.2 9.9 35.2 21.9 13.4 1,187 Dhamar 8.4 1,621 21.5 58.8 23.2 14.8 8.4 18.0 13.7 4.3 1,418 Shabwah 4.8 495 22.7 52.2 20.6 11.6 9.1 27.1 19.2 8.0 450 Sadah 6.0 773 21.6 63.8 19.2 10.9 8.2 17.0 14.2 2.8 675 Sana’a 6.1 1,236 22.0 56.0 21.7 14.9 6.8 22.3 16.3 6.0 1,094 Aden 5.0 877 24.3 44.6 15.7 6.9 8.7 39.8 23.4 16.3 807 Lahj 5.6 645 22.6 50.9 21.4 12.6 8.7 27.8 18.8 8.9 587 Mareb 3.7 177 22.9 51.5 20.7 14.0 6.7 27.8 18.1 9.7 159 Al-Mhweit 8.7 622 20.8 54.2 32.1 19.0 13.1 13.7 10.7 3.0 543 Al-Mhrah 5.1 92 25.1 37.2 17.3 10.5 6.8 45.5 22.6 22.8 82 Amran 8.7 834 21.3 58.5 25.0 15.0 10.0 16.5 11.3 5.1 711 Aldhalae 5.5 620 22.1 56.2 21.0 12.3 8.7 22.8 15.7 7.1 556 Reimah 18.8 516 20.6 64.7 25.5 15.7 9.8 9.8 8.6 1.2 448 Education No education 7.8 10,433 22.0 51.1 25.8 14.1 11.7 23.1 15.4 7.7 9,153 Fundamental 7.6 9,061 22.2 51.8 24.2 13.9 10.3 24.0 15.6 8.3 8,161 Secondary 6.2 3,687 21.7 51.5 27.7 15.5 12.2 20.8 14.5 6.2 3,419 Higher 3.5 1,577 23.2 51.4 16.7 8.9 7.8 31.9 20.5 11.3 1,474 Wealth quintile Lowest 9.5 4,334 19.6 51.4 42.2 21.5 20.7 6.4 5.0 1.4 3,771 Second 8.6 4,725 20.7 56.7 30.5 17.6 12.9 12.8 10.0 2.9 4,149 Middle 6.6 4,897 21.9 55.2 23.8 14.7 9.1 20.9 14.8 6.1 4,348 Fourth 6.7 5,140 23.2 49.1 18.3 10.4 8.0 32.5 21.8 10.7 4,690 Highest 5.3 5,662 24.2 46.3 14.8 8.0 6.8 38.9 23.1 15.8 5,248 Total 7.2 24,758 22.1 51.4 24.9 13.9 11.0 23.6 15.7 8.0 22,207 Note: Body mass index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). 1 Excludes pregnant women and women with a birth in the preceding 2 months As shown in Table 11.11, the mean MUAC among women age 15-49 was 25 cm. Twelve percent of women have severe acute malnutrition, and 20 percent have moderate acute malnutrition. More than three- fifths of women (68 percent) have an MUAC that falls in the normal range and are not considered malnourished. Younger women, rural women, women in Hajjah Governorate, and women in the lowest wealth quintile are most likely to have severe acute malnutrition. 144 • Nutrition of Children and Women Table 11.11 Mid-upper-arm circumference among women Among all women age 15-49, mean and standard deviation of mid-upper-arm circumference (MUAC) and percent distribution by specific MUAC levels, by background characteristics, Yemen 2013 Mean MUAC Standard deviation Mid-upper-arm circumference Number of women Background characteristic <21 cm (severe acute malnutrition) 21-22.9 cm (moderate acute malnutrition) ≥23 cm (normal) Total Age 15-19 23.4 3.4 18.7 28.9 52.4 100.0 6,079 20-29 25.0 4.0 11.0 21.4 67.6 100.0 9,505 30-39 26.5 4.8 7.4 14.7 77.9 100.0 5,766 40-49 27.2 4.7 7.4 11.7 80.9 100.0 3,176 Residence Urban 26.6 4.7 8.2 13.9 77.9 100.0 8,253 Rural 24.5 4.0 13.3 23.7 63.0 100.0 16,273 Maternity status Pregnant 24.8 3.7 10.3 23.9 65.8 100.0 2,061 Breastfeeding 25.1 4.1 10.5 20.4 69.1 100.0 4,660 Neither 25.3 4.5 12.0 20.0 68.0 100.0 17,804 Nutritional status1 Thin (BMI <18.5) 24.4 3.9 14.5 24.7 60.8 100.0 3,779 Normal (BMI 18.5-24.9) 25.2 4.2 11.5 20.7 67.8 100.0 9,718 Overweight/obese (BMI ≥25) 26.1 4.7 9.1 16.3 74.6 100.0 5,442 Governorate Ibb 25.3 4.2 8.2 20.4 71.5 100.0 2,674 Abyan 26.5 4.8 8.9 14.8 76.3 100.0 526 Sana’a City 26.6 4.4 6.8 14.4 78.7 100.0 2,419 Al-Baidha 27.2 4.2 3.0 11.9 85.0 100.0 1,046 Taiz 24.9 4.1 13.2 22.1 64.7 100.0 3,494 Al-Jawf 25.0 4.3 8.9 19.9 71.1 100.0 173 Hajjah 23.1 4.1 23.8 32.4 43.8 100.0 1,357 Al-Hodiedah 24.8 4.5 14.2 21.1 64.6 100.0 3,197 Hadramout 25.9 4.6 11.0 15.1 74.0 100.0 1,288 Dhamar 25.0 4.3 10.0 18.9 71.1 100.0 1,610 Shabwah 25.1 4.3 15.5 19.9 64.6 100.0 451 Sadah 23.8 3.2 13.8 30.5 55.6 100.0 763 Sana’a 24.8 3.7 10.6 21.9 67.4 100.0 1,225 Aden 27.6 5.3 6.6 9.8 83.6 100.0 860 Lahj 25.9 4.3 8.8 17.1 74.0 100.0 618 Mareb 26.2 4.0 5.1 14.8 80.1 100.0 168 Al-Mhweit 24.3 3.5 11.6 26.1 62.2 100.0 619 Al-Mhrah 28.3 6.0 5.4 11.6 83.0 100.0 88 Amran 23.7 3.5 20.4 28.1 51.6 100.0 838 Aldhalae 25.4 4.1 11.3 18.6 70.2 100.0 597 Reimah 23.2 2.8 15.6 32.2 52.2 100.0 516 Education No education 25.1 4.3 11.7 21.7 66.6 100.0 10,343 Fundamental 25.4 4.5 11.2 19.6 69.3 100.0 8,955 Secondary 24.9 4.1 13.5 21.3 65.2 100.0 3,660 Higher 26.1 4.5 8.8 14.8 76.3 100.0 1,567 Wealth quintile Lowest 23.2 3.4 20.1 31.0 48.9 100.0 4,328 Second 24.2 3.5 12.7 25.3 62.1 100.0 4,689 Middle 25.0 4.3 11.2 20.5 68.3 100.0 4,867 Fourth 26.1 4.4 8.4 15.5 76.1 100.0 5,066 Highest 27.0 4.8 7.3 12.5 80.2 100.0 5,576 Total 25.2 4.4 11.6 20.4 68.0 100.0 24,526 1 Excludes women who are pregnant or who gave birth in the 2 months preceding the interview as well as those for whom BMI is not available 11.8 PREVALENCE OF ANEMIA IN WOMEN Anemia is a key health status indicator for maternal nutrition. It is estimated that one-fifth of perinatal mortality and one-tenth of maternal mortality are attributable to iron deficiency anemia. Anemia also results in an increased risk of premature delivery and low birth weight. Iron deficiency, a major cause of anemia, is one of the top 10 risk factors in developing countries for “lost years of healthy life” (Benoist et al., 2008). Information on the prevalence of anemia can be useful for the development of health intervention programs designed to prevent and control anemia, such as iron supplementation and fortification programs. Iron supplementation of women during pregnancy protects the mother and the infant. Nutrition of Children and Women • 145 Anemia was measured in the 2013 YNHDS among all consenting women age 15-49 in one-third of the survey households using a procedure similar to that used for children, with capillary blood collected from a finger prick. Anemia measurements were obtained from 87 percent of women age 15-49 (Appendix Table C.3). As with children, results were returned to the woman, and those with severe anemia were advised to seek medical attention. Table 11.12 shows anemia prevalence based on hemoglobin levels (adjusted for pregnancy status and altitude), by selected background characteristics. The formulas recommended by the CDC were used to adjust hemoglobin levels according to altitude (CDC, 1998). Table 11.12 Prevalence of anemia in women Percentage of all women age 15-49 with anemia, by background characteristics, Yemen 2013 Anemia status by hemoglobin level Background characteristic Not pregnant Any Mild Moderate Severe Number of women <12.0 g/dl 10.0-11.9 g/dl 7.0-9.9 g/dl <7.0 g/dl Pregnant <11.0 g/dl 10.0-10.9 g/dl 7.0-9.9 g/dl <7.0 g/dl Age 15-19 68.2 38.9 26.8 2.5 1,837 20-29 71.5 38.4 29.7 3.4 2,887 30-39 72.5 37.3 32.0 3.2 1,723 40-49 68.9 36.1 28.7 4.1 965 Number of children ever born 0 71.4 38.2 29.6 3.5 617 1 72.4 37.7 31.3 3.5 649 2-3 71.3 37.2 30.3 3.8 1,309 4-5 73.3 39.8 29.1 4.5 963 6+ 69.2 37.8 28.8 2.6 3,875 Maternity status Pregnant 78.2 20.6 49.2 8.5 595 Breastfeeding 74.6 39.1 31.4 4.1 1,421 Neither 68.7 39.6 26.7 2.4 5,396 Using IUD Yes 63.2 37.9 24.4 0.9 289 No 70.9 38.0 29.6 3.3 7,123 Residence Urban 65.5 40.3 23.7 1.5 2,490 Rural 73.2 36.8 32.3 4.1 4,922 Governorate Ibb 46.3 32.4 13.2 0.7 778 Abyan 92.4 27.1 54.3 10.9 155 Sana’a City 58.5 42.9 14.4 1.2 695 Al-Baidha 54.5 35.4 18.7 0.4 318 Taiz 63.3 37.8 22.8 2.7 1,017 Al-Jawf 88.2 46.5 38.2 3.4 59 Hajjah 81.5 38.2 39.7 3.5 462 Al-Hodiedah 84.9 33.8 45.5 5.7 1,014 Hadramout 75.2 38.1 35.0 2.1 345 Dhamar 65.5 39.2 24.0 2.2 509 Shabwah 89.2 36.2 49.2 3.8 126 Sadah 83.6 44.9 34.5 4.2 235 Sana’a 65.1 36.8 23.9 4.4 384 Aden 88.5 49.6 34.9 4.0 242 Lahj 90.3 38.9 42.6 8.8 172 Mareb 78.6 40.0 36.8 1.8 59 Al-Mhweit 86.6 42.4 41.0 3.2 201 Al-Mhrah 82.1 34.1 44.9 3.1 31 Amran 74.8 37.9 33.3 3.5 263 Aldhalae 67.8 44.8 20.7 2.4 193 Reimah 78.3 40.4 33.9 4.0 153 Education No education 74.8 36.5 33.8 4.5 3,085 Fundamental 68.0 38.5 26.9 2.6 2,650 Secondary 66.6 39.4 25.2 2.0 1,189 Higher 67.7 41.2 25.1 1.4 487 Wealth quintile Lowest 80.1 34.6 39.4 6.1 1,294 Second 72.2 35.5 32.5 4.2 1,457 Middle 71.9 40.4 28.7 2.8 1,501 Fourth 65.7 36.3 27.2 2.3 1,573 Highest 64.9 42.4 21.2 1.3 1,586 Total 70.6 38.0 29.4 3.2 7,412 Note: Prevalence is adjusted for altitude using formulas in CDC, 1998. 146 • Nutrition of Children and Women Table 11.12 shows that 71 percent of women age 15-49 are anemic; 38 percent are mildly anemic, 29 percent are moderately anemic, and 3 percent are severely anemic. There is no clear pattern in anemia levels by women’s age or number of children. The prevalence of anemia is associated with maternity status; pregnant (78 percent) and lactating (75 percent) women are somewhat more likely to be anemic than women who are neither pregnant nor lactating (69 percent). Interestingly, women using an intrauterine device (IUD) are less likely to be anemic than non-IUD users. Anemia is slightly more prevalent in rural areas (73 percent) than in urban areas (66 percent). Anemia levels are highest among women in Abyan Governorate (92 percent) and lowest among those in Ibb Governorate (46 percent). Anemia is most prevalent among women with no education and women in the lowest wealth quintile. 11.9 MICRONUTRIENT INTAKE AMONG MOTHERS Adequate micronutrient intake by women has important benefits for both women and their children. Breastfeeding children benefit from the micronutrient supplementation that mothers receive, especially vitamin A. The YNHDS included questions to ascertain whether mothers had received iron supplements during pregnancy and vitamin A supplements within two months postpartum. Table 11.13 includes measures of vitamin A and iron supplementation among recent mothers and also presents the proportion of women who took deworming medication while pregnant and who live in households with iodized salt. Table 11.13 shows that 17 percent of women with a child born in the five years before the survey received a vitamin A dose in the first two months after the birth of their last child. Supplementation rates were highest among urban women (27 percent), women living in Sana’a City (43 percent), women with a higher education (27 percent), and women in the highest wealth quintile (28 percent). As mentioned earlier, pregnant women are more likely to be anemic than other women. Iron status among pregnant women can be improved by means of iron supplements as well as by increased consumption of iron-rich foods and control of parasites and malaria. Table 11.13 shows the percent distribution of women who gave birth during the five years prior to the survey by the number of days they took iron tablets during the pregnancy for their last-born child. Seven in ten women (69 percent) did not take iron supplements at all. The majority of women who took supplements took them for less than 60 days; only 6 percent took iron supplements for the recommended period of time (90 days or more). Urban women, those with a higher education, and those in the highest wealth quintile were more likely than other women to take iron supplements for 90 days or more during their pregnancy. Three percent of women took deworming medication during their last pregnancy. Differences by background characteristics are minimal. Half of women with a child born in the past five years live in households using iodized salt. Urban women, those with a higher education, and those in the higher wealth quintiles are more likely than other women to live in households with iodized salt. Nutrition of Children and Women • 147 Table 11.13 Micronutrient intake among mothers Among women age 15-49 with a child born in the past five years, the percentage who received a vitamin A dose in the first two months after the birth of the last child, the percent distribution by number of days they took iron tablets or syrup during the pregnancy of the last child, and the percentage who took deworming medication during the pregnancy of the last child; and among women age 15-49 with a child born in the past five years and who live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by background characteristics, Yemen 2013 Percentage who received vitamin A dose postpartum1 Number of days women took iron tablets or syrup during pregnancy of last birth Percentage of women who took deworming medication during pregnancy of last birth Number of women Among women with a child born in the last five years who live in households that were tested for iodized salt: Background characteristic None <60 60-89 90+ Don’t know/ missing Total Percentage living in households with iodized salt2 Number of women Age 15-19 16.4 67.9 20.0 4.7 5.5 1.8 100.0 3.0 514 51.4 491 20-29 17.1 67.9 19.7 3.7 5.6 3.2 100.0 3.0 5,259 50.9 5,025 30-39 17.9 70.0 17.4 3.7 6.0 2.9 100.0 4.2 3,588 51.2 3,433 40-49 15.3 74.7 15.6 3.0 3.4 3.3 100.0 2.7 1,009 43.4 970 Residence Urban 26.6 54.9 24.1 5.9 11.7 3.5 100.0 2.2 3,077 71.6 2,971 Rural 13.2 75.3 16.2 2.7 2.9 2.9 100.0 4.0 7,292 41.1 6,947 Governorate Ibb 11.2 71.8 18.1 2.7 2.9 4.6 100.0 4.1 1,147 48.1 1,095 Abyan 14.7 61.6 25.9 5.4 5.4 1.7 100.0 3.2 207 89.9 205 Sana’a City 43.0 47.3 23.9 6.8 18.8 3.3 100.0 1.4 933 75.3 906 Al-Baidha 13.7 76.8 12.1 4.2 5.0 1.8 100.0 3.4 446 76.8 431 Taiz 14.7 65.4 22.0 3.7 7.2 1.7 100.0 5.4 1,274 59.9 1,223 Al-Jawf 6.1 73.6 10.2 5.5 8.1 2.6 100.0 4.2 95 34.3 69 Hajjah 10.5 81.2 11.2 1.3 1.5 4.8 100.0 3.0 620 17.8 605 Al-Hodiedah 14.3 74.6 18.0 2.3 3.2 1.9 100.0 2.3 1,257 43.5 1,173 Hadramout 13.1 56.0 26.8 6.0 2.8 8.4 100.0 1.3 543 41.4 526 Dhamar 25.7 80.9 14.1 1.3 2.5 1.2 100.0 4.0 802 53.1 787 Shabwah 13.2 43.3 35.8 10.6 8.9 1.4 100.0 1.0 194 27.6 181 Sadah 6.8 74.6 8.2 3.7 5.0 8.4 100.0 1.6 320 57.1 304 Sana’a 11.1 82.4 11.8 1.2 1.9 2.8 100.0 3.0 598 35.3 578 Aden 30.2 38.3 32.1 12.7 13.9 3.1 100.0 1.2 291 77.1 282 Lahj 21.9 55.9 26.8 7.3 8.3 1.7 100.0 4.1 276 72.6 259 Mareb 8.0 58.4 26.8 6.2 7.5 1.1 100.0 3.2 78 35.5 76 Al-Mhweit 6.8 83.7 10.6 1.3 1.5 2.9 100.0 5.9 304 36.5 288 Al-Mhrah 27.7 54.9 35.0 3.5 3.0 3.5 100.0 2.8 42 76.8 39 Amran 13.0 84.6 10.6 2.1 1.5 1.1 100.0 7.3 445 24.8 420 Aldhalae 16.0 61.0 29.1 2.6 4.7 2.6 100.0 2.1 251 42.7 236 Reimah 18.0 88.7 6.4 0.9 1.8 2.2 100.0 5.9 246 21.9 235 Education No education 13.9 77.3 14.9 2.5 2.6 2.7 100.0 3.9 5,475 39.8 5,226 Fundamental 19.0 65.0 22.0 4.2 5.5 3.3 100.0 3.1 3,463 58.9 3,319 Secondary 24.4 55.0 22.8 6.8 12.0 3.4 100.0 2.5 1,025 67.0 983 Higher 27.3 33.6 26.4 7.0 27.7 5.3 100.0 2.1 407 74.5 391 Wealth quintile Lowest 11.0 81.5 12.4 1.7 1.7 2.7 100.0 3.9 2,097 26.8 1,982 Second 13.2 80.1 14.4 1.8 2.2 1.5 100.0 4.3 2,136 38.3 2,027 Middle 13.8 74.0 15.8 3.3 3.6 3.3 100.0 4.4 2,107 52.0 2,038 Fourth 20.0 62.0 23.6 5.1 5.0 4.2 100.0 2.3 2,016 62.7 1,921 Highest 28.4 47.5 27.0 6.6 15.4 3.5 100.0 2.1 2,014 72.5 1,951 Total 17.2 69.3 18.5 3.7 5.5 3.1 100.0 3.4 10,369 50.3 9,919 1 In the first two months after delivery of last birth 2 Excludes women in households where salt was not tested 148 • Nutrition of Children and Women 11.10 HOUSEHOLD FOOD SECURITY In order to gather information about food security, households interviewed in the 2013 YNHDS were asked a series of three questions. Specifically, they were asked how often in the four weeks before the survey the household experienced times when (1) there was no food to eat because of lack of resources, (2) a family member went to bed hungry because there was not enough food, and (3) any family member spent the whole day without eating because there was not enough food. Results are shown in Table 11.14. The findings indicate that food insecurity is not widespread in Yemen. Three-quarters of households reported that they never experienced a time in the previous four weeks when there was no food to eat. Eight percent of households experienced such food shortages rarely, while 11 percent of households experienced shortages sometimes and 6 percent experienced them often in the previous four weeks. The vast majority of households (84 percent) reported that there was never a time in the four weeks before the survey when a member of the household went to bed hungry. Only 4 percent of households reported that such an event occurred often. Similarly, 90 percent of households reported that, in the previous four weeks, no family member went for a whole day without eating because there was not enough food. There are only small differentials in food security by urban-rural residence. By governorate, households in Hadramout Governorate appear to be the most secure in terms of availability of food, while those in Ibb Governorate are the least secure. As expected, wealthier households tend to experience food insecurity less frequently than poorer households. Ta bl e 11 .1 4 F oo d se cu rit y P er ce nt ag e of h ou se ho ld s th at d id n ot h av e an y fo od to e at a t a ny ti m e du rin g th e pa st fo ur w ee ks d ue to la ck o f r es ou rc es , p er ce nt ag e of h ou se ho ld s in w hi ch o ne o r m or e m em be rs w en t t o be d hu ng ry a t a ny ti m e du rin g th e fo ur p as t w ee ks b ec au se th er e w as n ot e no ug h fo od , a nd p er ce nt ag e of h ou se ho ld s in w hi ch o ne o r m or e m em be rs s pe nt a t l ea st o ne e nt ire d ay d ur in g th e pa st fo ur w ee ks w ith ou t e at in g be ca us e th er e w as n ot en ou gh fo od , b y ba ck gr ou nd c ha ra ct er is tic s, Y em en 2 01 3 H ou se ho ld h ad n o fo od to e at in th e pa st fo ur w ee ks O ne o r m or e m em be rs w en t t o be d hu ng ry in th e pa st fo ur w ee ks O ne o r m or e m em be rs w en t a t l ea st o ne e nt ire d ay w ith ou t f oo d in th e pa st fo ur w ee ks N um be r o f ho us eh ol ds B ac kg ro un d ch ar ac te ris tic N ot on ce R ar el y Fr om ti m e to ti m e O fte n M is si ng To ta l N ot on ce R ar el y Fr om ti m e to ti m e O fte n M is si ng To ta l N ot on ce R ar el y Fr om ti m e to ti m e O fte n M is si ng To ta l R es id en ce U rb an 78 .5 6. 2 11 .3 3. 9 0. 1 10 0. 0 85 .9 4. 2 6. 8 2. 9 0. 2 10 0. 0 90 .3 2. 5 5. 0 2. 0 0. 1 10 0. 0 5, 41 3 R ur al 74 .6 8. 2 10 .1 7. 0 0. 1 10 0. 0 82 .7 5. 4 6. 7 5. 0 0. 2 10 0. 0 90 .4 2. 3 3. 8 3. 4 0. 1 10 0. 0 11 ,9 38 G ov er no ra te Ib b 54 .3 8. 8 15 .7 21 .2 0. 0 10 0. 0 75 .3 4. 8 8. 0 11 .9 0. 0 10 0. 0 80 .0 2. 0 7. 1 10 .9 0. 0 10 0. 0 1, 82 7 A by an 71 .5 11 .1 13 .8 3. 6 0. 0 10 0. 0 83 .5 6. 5 5. 9 3. 7 0. 3 10 0. 0 94 .4 2. 9 1. 6 1. 1 0. 0 10 0. 0 37 4 S an a’ a C ity 78 .4 5. 2 13 .3 3. 1 0. 0 10 0. 0 80 .6 4. 4 11 .8 3. 2 0. 0 10 0. 0 83 .6 3. 8 10 .4 2. 3 0. 0 10 0. 0 1, 64 0 A l-B ai dh a 82 .2 2. 8 8. 3 6. 6 0. 0 10 0. 0 85 .9 1. 4 6. 4 6. 1 0. 1 10 0. 0 93 .7 0. 5 2. 3 3. 3 0. 1 10 0. 0 53 3 Ta iz 85 .2 6. 1 5. 1 3. 4 0. 2 10 0. 0 88 .9 3. 2 4. 0 3. 4 0. 4 10 0. 0 93 .9 0. 8 3. 2 1. 8 0. 3 10 0. 0 2, 30 6 A l-J aw f 90 .8 3. 3 2. 0 3. 4 0. 4 10 0. 0 92 .8 2. 6 2. 0 1. 7 0. 9 10 0. 0 95 .7 1. 6 0. 8 1. 3 0. 6 10 0. 0 14 2 H aj ja h 73 .2 6. 1 7. 1 13 .4 0. 1 10 0. 0 78 .2 4. 4 5. 1 12 .0 0. 3 10 0. 0 88 .3 2. 2 2. 3 7. 2 0. 1 10 0. 0 1, 09 4 A l-H od ie da h 80 .7 9. 0 9. 5 0. 6 0. 2 10 0. 0 86 .6 8. 0 4. 1 1. 1 0. 2 10 0. 0 95 .3 3. 2 0. 9 0. 5 0. 2 10 0. 0 2, 48 7 H ad ra m ou t 95 .1 1. 0 3. 2 0. 6 0. 1 10 0. 0 96 .1 0. 9 2. 4 0. 4 0. 2 10 0. 0 96 .0 0. 7 2. 8 0. 4 0. 1 10 0. 0 82 2 D ha m ar 60 .4 15 .0 16 .4 8. 1 0. 1 10 0. 0 81 .0 4. 6 9. 4 4. 7 0. 3 10 0. 0 89 .2 2. 4 5. 4 2. 8 0. 1 10 0. 0 1, 24 6 S ha bw ah 79 .7 5. 2 12 .2 2. 9 0. 0 10 0. 0 90 .2 2. 5 6. 1 1. 3 0. 0 10 0. 0 95 .9 2. 2 1. 2 0. 7 0. 0 10 0. 0 27 1 S ad ah 92 .6 4. 3 1. 9 1. 1 0. 2 10 0. 0 93 .5 1. 8 3. 3 0. 8 0. 5 10 0. 0 97 .3 0. 7 1. 1 0. 6 0. 3 10 0. 0 49 3 S an a’ a 76 .3 7. 0 11 .4 5. 0 0. 2 10 0. 0 86 .8 3. 9 5. 7 3. 4 0. 2 10 0. 0 92 .2 2. 4 3. 4 1. 8 0. 2 10 0. 0 77 9 A de n 72 .9 8. 4 14 .9 3. 8 0. 0 10 0. 0 83 .5 6. 9 7. 8 1. 8 0. 0 10 0. 0 92 .0 3. 0 4. 1 0. 8 0. 1 10 0. 0 62 0 La hj 73 .2 6. 2 15 .7 4. 8 0. 0 10 0. 0 78 .4 6. 0 10 .4 5. 2 0. 0 10 0. 0 82 .9 5. 8 7. 8 3. 5 0. 0 10 0. 0 60 1 M ar eb 64 .7 4. 7 25 .1 5. 2 0. 3 10 0. 0 75 .7 3. 9 15 .5 4. 6 0. 3 10 0. 0 87 .0 1. 2 7. 4 4. 1 0. 3 10 0. 0 10 3 A l-M hw ei t 78 .4 10 .1 6. 6 4. 9 0. 0 10 0. 0 81 .9 7. 1 6. 8 4. 2 0. 0 10 0. 0 90 .7 4. 1 3. 7 1. 5 0. 0 10 0. 0 48 8 A l-M hr ah 82 .6 7. 4 8. 1 1. 6 0. 4 10 0. 0 82 .8 7. 4 7. 0 2. 0 0. 7 10 0. 0 88 .6 5. 5 3. 5 2. 1 0. 2 10 0. 0 85 A m ra n 62 .2 13 .3 16 .6 7. 8 0. 2 10 0. 0 69 .2 11 .3 16 .9 2. 4 0. 2 10 0. 0 87 .3 2. 3 8. 2 2. 0 0. 2 10 0. 0 62 2 A ld ha la e 87 .4 2. 6 6. 4 3. 5 0. 0 10 0. 0 91 .4 2. 5 3. 4 2. 6 0. 1 10 0. 0 94 .1 2. 1 1. 9 1. 9 0. 0 10 0. 0 39 7 R ei m ah 77 .3 11 .2 8. 5 3. 0 0. 0 10 0. 0 83 .8 9. 4 3. 7 3. 2 0. 0 10 0. 0 97 .9 1. 3 0. 5 0. 2 0. 0 10 0. 0 42 3 W ea lth q ui nt ile Lo w es t 61 .6 11 .5 16 .1 10 .7 0. 1 10 0. 0 69 .1 10 .1 11 .6 9. 1 0. 2 10 0. 0 83 .1 4. 7 6. 4 5. 8 0. 1 10 0. 0 3, 84 9 S ec on d 73 .3 9. 1 9. 3 8. 2 0. 1 10 0. 0 83 .3 5. 0 6. 2 5. 4 0. 2 10 0. 0 90 .8 1. 8 3. 5 3. 8 0. 1 10 0. 0 3, 49 3 M id dl e 81 .5 6. 2 7. 8 4. 4 0. 0 10 0. 0 90 .9 2. 5 4. 2 2. 3 0. 1 10 0. 0 94 .5 1. 3 2. 5 1. 7 0. 1 10 0. 0 3, 28 6 Fo ur th 78 .7 6. 5 10 .6 4. 1 0. 1 10 0. 0 85 .3 5. 0 6. 1 3. 5 0. 2 10 0. 0 90 .4 2. 6 4. 6 2. 3 0. 1 10 0. 0 3, 22 0 H ig he st 86 .0 4. 1 7. 7 2. 0 0. 1 10 0. 0 92 .0 1. 9 4. 8 1. 1 0. 2 10 0. 0 94 .3 1. 2 3. 6 0. 8 0. 1 10 0. 0 3, 50 3 To ta l 75 .8 7. 6 10 .5 6. 0 0. 1 10 0. 0 83 .7 5. 0 6. 7 4. 4 0. 2 10 0. 0 90 .4 2. 3 4. 2 2. 9 0. 1 10 0. 0 17 ,3 51 Nutrition of Children and Women • 149 HIV/AIDS-Related Knowledge, Attitudes, and Behavior • 151 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 12 IV is not a major epidemic in Yemen. The prevalence among the adult population is estimated to be very low, at about 0.1 percent (UNICEF, 2014; UNAIDS, 2014; Index Mundi, 2014). However, the actual prevalence may be higher as a result of undetected infections and may be growing due to the recent influx of refugees, immigrants, and Yemenis returning from overseas. In Yemen, the main route of HIV transmission is heterosexual contact. The 2009-2015 strategy for controlling HIV/AIDS is being implemented through integrating HIV/AIDS control activities within existing health programs to enable the best use of existing human and financial resources. Fourteen health sites in selected governorates offer voluntary counseling and testing services (Ministry of Public Health and Population [MOPHP], 2011). Prevention of mother-to-child transmission (PMTCT) is also an important component of the HIV/AIDS strategy. In 2010, PMTCT services were available in Sana’a and Aden. These services are to be integrated into an antenatal care package (MOPHP, 2011). The future course of Yemen’s AIDS situation depends on many variables: levels of HIV/AIDS- related knowledge among the general population, social stigmatization, risk behavior modification, access to high-quality services for sexually transmitted infections (STIs), provision and uptake of HIV counseling and testing, and access to care and antiretroviral therapy (ART), including prevention and treatment of opportunistic infections. The principal objective of this chapter is to establish the prevalence of relevant knowledge, perceptions, and behaviors at the national level as well as within geographic and socioeconomic subpopulations. This information will help the government better target those groups of individuals most in need of information and most at risk of HIV infection. The 2013 YNHDS included a series of questions that addressed respondents’ knowledge about HIV and AIDS, their awareness of modes of HIV transmission, and their behaviors to prevent the spread of HIV. These questions were asked of both ever-married and never-married women age 15-49. H Key Findings • Awareness of AIDS is widespread in Yemen; 73 percent of all women age 15-49 have heard of AIDS. • Knowledge about AIDS transmission is limited: whereas two-thirds of all women know that HIV can be transmitted through blood transfusions, contaminated instruments, and sexual intercourse, only about one- quarter know that HIV is not spread by sharing food and only one-fifth know that it is not spread by mosquito bites. • Only about three in ten women know that HIV can be prevented by using condoms or that a healthy-looking person can have HIV. • Half of all women age 15-49 know that HIV can be transmitted by breastfeeding, and one-quarter know that the risk of mother-to-child transmission can be reduced by a mother taking special drugs during pregnancy. • Half of ever-married women believe a woman is justified in asking her husband to use a condom if she knows he has a sexually transmitted infection (STI). • Eighteen percent of women know where to get an HIV test. • Almost one-third of ever-married women reported having an STI or symptoms of an STI in the 12 months preceding the survey. 152 • HIV/AIDS-Related Knowledge, Attitudes, and Behavior 12.1 HIV/AIDS KNOWLEDGE, TRANSMISSION, AND PREVENTION METHODS Table 12.1 provides information on women’s awareness of AIDS. The table shows that just under three- quarters (73 percent) of women age 15-49 in Yemen have heard of AIDS. The proportion of women who have heard of HIV/AIDS is especially low among those in rural areas (64 percent versus 91 percent in urban areas) and those who have not attended school (57 percent versus 99 percent among those with a higher education). The percentage of women who have heard of AIDS increases with increasing wealth and ranges from a low of 27 percent among those in Sadah Governorate to 95 percent among those in Sana’a City and in Aden Governorate. Awareness of HIV/AIDS among ever-married women has increased over time, from 44 percent in 2003 and 61 percent in 2006 to 73 percent in 2013.1 Table 12.2 shows that about two-thirds of all women (65 percent) know that HIV can be transmitted through blood transfusions; 66 percent of women know that HIV can be transmitted by having sexual intercourse with an infected husband, and the same percentage know that it can be transmitted by using contaminated sharp instruments. Knowledge of means of HIV transmission varies widely by residence and education. Women residing in urban areas are more likely to be knowledgeable about means of HIV transmission (84-85 percent) than their counterparts residing in rural areas (55-56 percent). Similarly, women with a secondary or higher education are more likely to know means of HIV transmission (93-98 percent) than their counterparts with no education (47-49 percent). Women’s knowledge of means of HIV transmission increases with increasing wealth, from 38-40 percent among those in the lowest quintile to 89-90 percent among those in the highest quintile. Table 12.2 also shows that only 28 percent of women know that people can reduce their risk of getting HIV by using condoms every time they have sexual intercourse. Again, women residing in urban areas are more likely to be knowledgeable about this means of HIV prevention (39 percent) than their counterparts in rural areas (23 percent). Similarly, women with a higher education are more likely to know that using condoms reduces the risk of HIV transmission (49 percent) than their counterparts with no education (19 percent). Knowledge that using condoms can prevent HIV increases with increasing wealth. The proportion of ever-married women who know that using condoms reduces the risk of HIV transmission has increased from 21 percent in 2006 to 31 percent in 2013. 1 Previous surveys covered ever-married women only. Table 12.1 Knowledge of AIDS Percentage of all women age 15-49 who have heard of AIDS, by background characteristics, Yemen 2013 Background characteristic Has heard of AIDS Number of respondents Age 15-24 72.7 11,539 15-19 69.7 6,342 20-24 76.3 5,197 25-29 74.4 4,634 30-39 73.8 5,986 40-49 70.1 3,275 Marital status Never married 73.0 8,870 Married 72.6 15,566 Divorced/widowed 76.9 998 Residence Urban 90.6 8,619 Rural 63.9 16,815 Governorate Ibb 69.7 2,739 Abyan 71.7 551 Sana’a City 95.2 2,487 Al-Baidha 78.5 1,101 Taiz 79.9 3,512 Al-Jawf 62.2 181 Hajjah 58.9 1,374 Al-Hodiedah 73.6 3,261 Hadramout 74.1 1,427 Dhamar 67.0 1,670 Shabwah 72.7 528 Sadah 27.4 823 Sana’a 64.4 1,265 Aden 95.1 921 Lahj 75.7 678 Mareb 76.3 183 Al-Mhweit 65.7 623 Al-Mhrah 70.4 95 Amran 68.6 852 Aldhalae 62.8 641 Reimah 56.2 520 Education No education 57.1 10,705 Fundamental 77.1 9,339 Secondary 96.2 3,767 Higher 99.3 1,623 Wealth quintile Lowest 47.4 4,435 Second 59.6 4,808 Middle 71.4 5,046 Fourth 84.9 5,320 Highest 93.8 5,825 Total 72.9 25,434 HIV/AIDS-Related Knowledge, Attitudes, and Behavior • 153 Table 12.2 Knowledge of HIV transmission and prevention methods Percentage of all women age 15-49 who know that HIV can be transmitted through blood transfusions, sexual intercourse with an infected husband, and contaminated sharp instruments, and percentage who say that HIV can be prevented by using condoms, by background characteristics, Yemen 2013 Percentage of women who know that HIV can be transmitted through: Percentage who say HIV can be prevented by using condoms1 Number of women Background characteristic Blood transfusions Sexual intercourse with infected husband Contaminated sharp instruments Age 15-24 65.4 64.9 66.3 25.8 11,539 15-19 62.5 60.9 63.4 22.7 6,342 20-24 68.9 69.9 69.9 29.4 5,197 25-29 65.7 67.8 66.7 31.0 4,634 30-39 65.2 67.7 66.3 31.0 5,986 40-49 59.5 64.4 61.7 29.3 3,275 Marital status Never married 66.9 64.9 67.5 24.3 8,870 Married 63.2 66.3 64.7 30.6 15,566 Divorced/widowed 67.4 71.0 68.3 31.3 998 Residence Urban 83.9 85.2 85.1 39.1 8,619 Rural 54.8 56.2 55.9 22.9 16,815 Governorate Ibb 57.6 61.7 62.3 24.3 2,739 Abyan 62.4 61.9 61.0 31.1 551 Sana’a City 90.8 91.4 91.4 50.4 2,487 Al-Baidha 69.3 70.5 70.3 28.2 1,101 Taiz 72.8 75.1 74.7 36.7 3,512 Al-Jawf 55.0 57.1 55.6 20.7 181 Hajjah 50.4 49.8 48.1 15.3 1,374 Al-Hodiedah 64.4 66.9 68.0 22.2 3,261 Hadramout 66.2 65.8 62.8 29.1 1,427 Dhamar 58.4 57.1 57.4 26.7 1,670 Shabwah 67.9 70.0 69.4 30.8 528 Sadah 23.7 23.8 24.3 7.1 823 Sana’a 51.1 52.3 51.4 15.6 1,265 Aden 88.7 90.6 89.9 38.5 921 Lahj 64.2 61.3 64.2 30.2 678 Mareb 68.5 69.9 71.4 34.9 183 Al-Mhweit 51.2 56.4 56.9 24.9 623 Al-Mhrah 61.5 62.3 59.9 36.3 95 Amran 62.7 62.7 61.1 22.9 852 Aldhalae 59.0 60.9 60.9 31.6 641 Reimah 50.7 52.5 49.7 14.8 520 Education No education 46.6 49.0 47.9 19.0 10,705 Fundamental 68.0 69.2 69.7 30.6 9,339 Secondary 93.4 92.9 93.2 40.9 3,767 Higher 97.9 98.2 98.1 48.9 1,623 Wealth quintile Lowest 37.7 39.9 39.3 13.3 4,435 Second 49.7 50.7 50.5 19.9 4,808 Middle 62.6 64.3 64.3 27.1 5,046 Fourth 75.9 77.8 77.3 34.9 5,320 Highest 88.9 89.5 89.5 42.1 5,825 Total 64.7 66.0 65.8 28.4 25,434 1 Using condoms every time they have sexual intercourse 12.2 MISCONCEPTIONS ABOUT HIV/AIDS As part of the effort to assess HIV/AIDS knowledge, the 2013 YNHDS also obtained information on several common misconceptions about HIV transmission. Respondents were asked whether they think it is possible for a healthy-looking person to have HIV and whether HIV can be transmitted through mosquito bites, from sharing food with a person who has AIDS, or from swimming with an infected person. Table 12.3 shows the percentage of women who reject these misconceptions about HIV. Thirty percent of all women know that a healthy-looking person can be carrying the HIV virus. Nineteen percent of women know that HIV cannot be transmitted through mosquito bites, 27 percent know that people cannot 154 • HIV/AIDS-Related Knowledge, Attitudes, and Behavior be infected by sharing food with a person who has AIDS, and 24 percent know that HIV cannot be transmitted by swimming with an infected person. Table 12.3 Knowledge and misconceptions about AIDS Percentage of all women age 15-49 who say that a healthy-looking person can have the AIDS virus and who correctly reject local misconceptions about transmission of the AIDS virus, by background characteristics, Yemen 2013 Percentage of respondents who know that: Percentage who say that a healthy-looking person can have the AIDS virus and who reject the two most common local misconceptions1 Number of women Background characteristic A healthy-looking person can have the AIDS virus The AIDS virus cannot be transmitted by mosquito bites A person cannot become infected by sharing food with a person who has AIDS The AIDS virus cannot be transmitted by swimming with an infected person Age 15-24 29.8 19.8 27.1 24.3 6.1 11,539 15-19 28.4 18.0 25.1 22.7 5.3 6,342 20-24 31.5 22.0 29.6 26.3 7.1 5,197 25-29 29.5 20.2 27.9 24.8 6.5 4,634 30-39 30.6 18.8 29.1 24.5 6.6 5,986 40-49 27.0 16.0 23.8 18.2 5.2 3,275 Marital status Never married 31.7 22.0 30.8 27.7 7.2 8,870 Married 28.3 17.6 25.2 21.4 5.6 15,566 Divorced/widowed 31.2 17.8 29.3 24.2 7.0 998 Residence Urban 41.6 34.2 47.7 41.7 12.4 8,619 Rural 23.5 11.5 16.8 14.4 3.0 16,815 Governorate Ibb 21.1 11.4 17.1 15.1 1.8 2,739 Abyan 30.3 19.4 23.6 19.2 5.4 551 Sana’a City 46.8 36.7 53.6 45.8 14.3 2,487 Al-Baidha 38.5 30.0 32.4 29.7 11.9 1,101 Taiz 33.3 17.6 26.2 23.6 5.4 3,512 Al-Jawf 22.2 17.9 24.6 24.7 4.7 181 Hajjah 22.3 15.9 20.3 18.1 4.4 1,374 Al-Hodiedah 32.9 17.6 24.1 20.7 5.4 3,261 Hadramout 29.5 28.3 36.3 33.6 7.6 1,427 Dhamar 30.4 18.0 22.6 19.4 7.4 1,670 Shabwah 36.3 14.1 31.5 27.7 5.4 528 Sadah 8.7 7.6 8.2 6.7 2.6 823 Sana’a 13.5 9.5 13.0 10.6 1.2 1,265 Aden 46.8 32.1 53.3 47.1 14.7 921 Lahj 30.5 20.5 32.2 27.2 7.3 678 Mareb 29.6 13.3 20.5 17.1 2.8 183 Al-Mhweit 21.0 10.8 17.9 12.7 1.9 623 Al-Mhrah 38.9 33.1 39.5 36.4 15.9 95 Amran 18.5 12.8 20.7 16.3 1.8 852 Aldhalae 23.3 13.9 23.1 20.9 5.2 641 Reimah 14.4 9.8 21.7 12.9 2.4 520 Education No education 19.8 8.4 13.0 10.4 1.9 10,705 Fundamental 30.2 20.1 27.4 24.5 5.8 9,339 Secondary 44.4 34.1 48.9 42.7 12.5 3,767 Higher 56.9 50.0 71.0 62.7 22.5 1,623 Wealth quintile Lowest 17.1 6.5 9.4 7.4 1.5 4,435 Second 20.2 8.4 13.6 11.7 1.6 4,808 Middle 27.1 13.1 18.3 15.1 3.5 5,046 Fourth 34.4 25.9 34.4 30.0 7.6 5,320 Highest 44.6 36.8 53.5 47.6 14.6 5,825 Total 29.6 19.2 27.3 23.7 6.2 25,434 1 Two most common local misconceptions: AIDS can be transmitted through mosquito bites and by swimming with an infected person. Table 12.3 also includes a composite measure of HIV/AIDS knowledge. It indicates that only 6 percent of all women age 15-49 reject the two most common local misconceptions about HIV/AIDS (i.e., HIV can be transmitted by mosquito bites or by swimming with an infected person) and also are aware that a healthy-looking person can have HIV. Women residing in urban areas, women with a secondary or higher education, and women in the highest wealth quintile are much more likely than their counterparts to reject these misconceptions and to know that a healthy-looking person can have HIV. HIV/AIDS-Related Knowledge, Attitudes, and Behavior • 155 Comparison of the 2013 YNHDS results with those from the 2006 YMICS shows no increase in knowledge about misconceptions regarding HIV transmission. The proportion of ever-married women who know that a healthy-looking person can have HIV has increased from 22 percent in 2006 to 28 percent in 2013; however, the proportion of ever-married women who know that HIV cannot be transmitted through mosquito bites has decreased from 24 percent to 18 percent over the same period, and the proportion who know that a person cannot become infected by sharing food with someone who has HIV has decreased from 28 percent to 25 percent. 12.3 KNOWLEDGE ABOUT MOTHER-TO-CHILD TRANSMISSION As mentioned above, prevention of mother-to-child transmission is a component of Yemen’s HIV/AIDS strategy. One element in this strategy is to increase the level of general knowledge about PMTCT. To assess PMTCT knowledge, both ever-married and never-married women interviewed in the 2013 YNHDS were asked whether HIV can be transmitted from a mother to a child during pregnancy, during delivery, and through breastfeeding and whether a mother with HIV can reduce the risk of transmission to her baby by taking certain drugs during pregnancy. About half of all women know that HIV can be transmitted from mother to child: 58 percent know that HIV can be transmitted during pregnancy, 47 percent know that it can be transmitted during delivery, and 49 percent know that it can be transmitted through breastfeeding (Table 12.4). One-quarter of women know that the risk of mother-to-child transmission can be reduced if the mother takes special drugs during pregnancy. A composite indicator shows that 20 percent of women age 15-49 in Yemen know that HIV can be transmitted by breastfeeding and that transmission can be reduced if the mother takes drugs during pregnancy. This combined indicator of knowledge of mother-to-child transmission of HIV varies little by background characteristics, with the only sizeable differences being by governorate. A comparison of data from the 2013 YNHDS and the 2006 YMICS shows some improvement in knowledge about mother-to-child transmission of HIV. For example, the proportion of ever-married women who know that HIV can be transmitted during pregnancy has increased from 47 percent in 2006 to 57 percent in 2013. The proportion of ever-married women who know that HIV can be transmitted during delivery has increased from 39 percent to 48 percent, and the proportion who know that HIV can be transmitted through breastfeeding has increased from 41 percent to 49 percent. 156 • HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV Percentage of all women age 15-49 who know that HIV can be transmitted from mother to child during pregnancy, during delivery, and by breastfeeding and that the risk of mother-to-child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Yemen 2013 Percentage who know that: Number of women Background characteristic HIV can be transmitted during pregnancy HIV can be transmitted during delivery HIV can be transmitted by breastfeeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Age 15-24 58.5 46.1 50.4 26.8 21.9 11,539 15-19 56.8 44.6 49.7 26.5 22.0 6,342 20-24 60.5 47.9 51.4 27.1 21.9 5,197 25-29 59.0 48.3 48.2 24.8 19.3 4,634 30-39 58.1 48.9 47.8 23.2 18.4 5,986 40-49 55.1 47.2 46.8 22.9 18.5 3,275 Marital status Never married 59.6 46.9 49.2 27.5 21.5 8,870 Married 57.0 47.1 48.8 23.7 19.4 15,566 Divorced/widowed 60.7 53.8 50.1 24.5 19.7 998 Currently pregnant Pregnant 53.9 45.4 46.0 22.8 19.0 2,127 Not pregnant or not sure 57.7 47.8 49.3 23.9 19.5 14,436 Missing 59.6 46.9 49.2 27.5 21.5 8,870 Residence Urban 73.5 58.2 53.3 30.0 20.5 8,619 Rural 50.1 41.7 46.7 22.5 20.0 16,815 Governorate Ibb 54.9 45.7 53.6 25.2 23.4 2,739 Abyan 52.9 37.1 46.6 33.3 27.9 551 Sana’a City 79.3 67.4 49.8 30.4 18.5 2,487 Al-Baidha 63.3 46.8 59.4 32.7 27.1 1,101 Taiz 63.1 48.4 57.3 37.0 30.6 3,512 Al-Jawf 46.6 39.9 43.4 19.1 14.6 181 Hajjah 49.1 38.5 36.4 11.4 7.9 1,374 Al-Hodiedah 59.5 50.9 55.6 24.8 21.3 3,261 Hadramout 64.5 42.0 41.2 15.4 11.2 1,427 Dhamar 47.1 43.9 43.6 24.4 20.7 1,670 Shabwah 52.9 56.4 50.6 22.7 19.3 528 Sadah 21.3 19.0 16.6 7.7 6.7 823 Sana’a 46.5 39.9 43.8 17.7 15.3 1,265 Aden 76.3 58.9 51.1 29.6 19.8 921 Lahj 57.8 35.4 41.9 32.8 21.9 678 Mareb 63.2 56.2 62.1 32.7 29.2 183 Al-Mhweit 49.1 38.9 46.2 21.2 19.3 623 Al-Mhrah 56.9 34.8 48.1 23.6 18.6 95 Amran 59.1 54.5 52.6 22.8 19.0 852 Aldhalae 53.5 45.9 48.8 16.0 15.0 641 Reimah 42.4 39.9 36.5 8.7 7.6 520 Education No education 43.2 37.0 40.5 18.1 16.3 10,705 Fundamental 60.9 48.7 53.6 27.5 22.9 9,339 Secondary 81.5 64.2 61.5 35.2 25.4 3,767 Higher 85.3 67.7 48.6 33.0 17.7 1,623 Wealth quintile Lowest 36.2 31.8 35.1 15.6 14.8 4,435 Second 46.8 40.3 46.0 22.5 21.1 4,808 Middle 55.8 45.7 52.4 25.2 22.0 5,046 Fourth 67.4 53.1 54.8 29.3 22.8 5,320 Highest 77.4 60.9 53.6 30.4 19.5 5,825 Total 58.1 47.3 49.0 25.1 20.2 25,434 12.4 ATTITUDES TOWARD PEOPLE LIVING WITH HIV/AIDS Widespread stigma and discrimination against people living with HIV/AIDS can adversely affect both people’s willingness to be tested for HIV and their adherence to antiretroviral therapy (ART). Indeed, HIV/AIDS-related stigma and discrimination undermine HIV prevention efforts by making people afraid to seek out information about how to reduce their risk of exposure to HIV and adopt safer behaviors, given that such inquiries may raise suspicion about their HIV status. Thus, reductions in stigma and discrimination are an important indicator of the success of programs targeting HIV/AIDS prevention and control. HIV/AIDS-Related Knowledge, Attitudes, and Behavior • 157 In the 2013 YNHDS, both ever-married and never-married women who had heard of AIDS were asked a number of questions to assess the level of stigma associated with HIV/AIDS. Respondents were asked about their willingness or unwillingness to take care of a member of their family with AIDS in their own household, to buy vegetables from an infected shopkeeper or vendor, and to let others know the HIV status of family members. They were also asked whether an HIV-positive female teacher who is not sick should be allowed to continue teaching. Table 12.5 presents the results. Table 12.5 Accepting attitudes toward those living with HIV/AIDS Among all women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, Yemen 2013 Percentage of respondents who: Percentage expressing accepting attitudes on all four indicators Number of respondents who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent’s home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Age 15-24 88.2 20.7 30.1 40.3 4.4 8,389 15-19 87.6 20.8 29.4 42.3 4.5 4,422 20-24 89.0 20.5 30.7 38.1 4.2 3,967 25-29 88.4 18.3 27.3 36.3 4.1 3,448 30-39 86.5 17.8 24.8 36.7 4.2 4,416 40-49 88.4 16.1 21.7 35.9 3.9 2,294 Marital status Never married 88.0 24.0 33.7 40.0 5.6 6,479 Married 87.7 16.3 23.7 37.2 3.3 11,302 Divorced/widowed 88.6 17.0 25.6 36.8 5.0 767 Residence Urban 88.5 24.4 34.6 33.7 5.4 7,811 Rural 87.4 15.0 21.9 41.4 3.3 10,737 Governorate Ibb 91.6 18.9 24.5 32.3 3.0 1,909 Abyan 86.1 15.5 21.0 21.4 2.4 395 Sana’a City 86.0 27.0 35.6 35.7 6.1 2,369 Al-Baidha 93.8 14.2 28.8 29.3 4.0 864 Taiz 94.5 16.3 32.7 46.9 4.8 2,806 Al-Jawf 81.1 15.1 19.2 18.2 0.6 113 Hajjah 79.4 10.9 10.7 40.4 1.9 809 Al-Hodiedah 79.2 14.6 22.5 53.0 4.4 2,399 Hadramout 84.9 25.5 27.0 24.4 2.2 1,058 Dhamar 89.2 25.3 33.6 27.3 4.3 1,119 Shabwah 92.3 8.2 9.9 26.3 1.5 384 Sadah 76.4 11.8 12.4 25.6 5.9 226 Sana’a 83.2 16.8 20.4 37.3 3.8 814 Aden 92.5 32.7 42.4 31.2 6.9 876 Lahj 93.3 14.1 26.8 43.4 3.6 513 Mareb 88.4 13.3 16.8 43.7 3.4 139 Al-Mhweit 87.5 18.2 26.7 45.1 4.1 409 Al-Mhrah 82.6 12.2 22.1 42.3 4.1 67 Amran 94.4 14.8 17.3 32.7 3.2 584 Aldhalae 90.8 14.5 25.1 65.5 4.6 403 Reimah 80.7 23.8 32.1 31.3 6.1 292 Education No education 85.7 12.4 17.2 40.5 2.5 6,110 Fundamental 88.8 17.7 26.3 37.2 3.8 7,203 Secondary 88.9 24.6 36.1 39.2 5.5 3,623 Higher 89.8 36.8 49.9 31.2 9.5 1,612 Wealth quintile Lowest 84.9 11.4 15.7 45.7 2.4 2,101 Second 85.6 13.4 21.5 41.9 2.9 2,864 Middle 88.0 15.1 23.6 42.0 3.2 3,602 Fourth 88.0 20.2 27.4 36.9 4.6 4,518 Highest 90.1 26.4 37.0 31.8 5.9 5,462 Total 87.9 19.0 27.3 38.2 4.2 18,548 Women express more accepting attitudes toward HIV-infected relatives than toward shopkeepers or teachers. Eighty-eight percent of women would be willing to care for a relative with AIDS in their home. In contrast, only 19 percent of women indicate that they would buy vegetables from a shopkeeper with HIV, and 27 percent agree that a female teacher with HIV should be allowed to continue teaching. Almost four in ten women (38 percent) indicate that they would not want to keep secret that a family member was infected 158 • HIV/AIDS-Related Knowledge, Attitudes, and Behavior with HIV. Overall, only 4 percent of women express accepting attitudes with regard to all four situations (i.e., they would care for a family member with AIDS in their own home, they would buy fresh vegetables from a shopkeeper with HIV, they would allow an HIV-positive female teacher to continue teaching, and they would not want to keep the HIV-positive status of a family member a secret). These results are very similar to those reported in the 2006 YMICS. There is minimal variation in stigma levels by background characteristics. The proportion of women who express acceptance on all four indicators of stigma increases somewhat with increasing education and wealth, but the differences are not large. Accepting attitudes on two indicators (caring for a family member with AIDS in one’s own home and not wanting to keep secret that a family member is infected with HIV) vary remarkably little across background characteristics. Differences are more apparent for the other two indicators (buying fresh food from a shopkeeper with HIV and allowing an HIV- positive female teacher to continue teaching). The percentage of women who express accepting attitudes on these two indicators is higher in urban areas and increases with increasing education and wealth. Women in Shabwah Governorate appear to have the least accepting attitudes with respect to these two indicators of stigma. 12.5 ATTITUDES TOWARD NEGOTIATING SAFER SEXUAL RELATIONS WITH HUSBANDS Knowledge about HIV transmission and ways to prevent it is of little use if people feel powerless to negotiate safer sex practices with their partners. Therefore, in the 2013 YNHDS, ever-married women were asked if they thought a wife is justified in asking that her husband use condoms if she knows that he has a sexually transmitted infection (STI). Table 12.6 shows that half of ever- married women (51 percent) believe that a wife is justified in asking her husband to use a condom if she knows he has an STI. Differences by age and marital status are generally small. However, acceptance of women’s ability to advocate for condom use is higher among urban than rural women and increases with increasing education and wealth. Table 12.6 Attitudes toward negotiating safer sexual relations with husband Percentage of ever-married women age 15-49 who believe that a woman is justified in asking her husband to use a condom if she knows that he has a sexually transmitted infection (STI), by background characteristics, Yemen 2013 Background characteristic Woman is justified in asking that they use a condom if she knows that her husband has an STI Number of women Age 15-24 48.9 4,211 15-19 47.8 1,112 20-24 49.3 3,099 25-29 51.8 3,731 30-39 51.7 5,436 40-49 48.8 3,186 Marital status Married 50.5 15,566 Divorced/widowed 49.4 998 Residence Urban 63.0 5,322 Rural 44.5 11,242 Governorate Ibb 39.9 1,791 Abyan 58.7 345 Sana’a City 68.9 1,587 Al-Baidha 57.9 768 Taiz 68.9 2,196 Al-Jawf 36.6 141 Hajjah 33.9 895 Al-Hodiedah 29.1 2,023 Hadramout 53.5 958 Dhamar 47.1 1,188 Shabwah 74.4 315 Sadah 21.8 532 Sana’a 55.1 867 Aden 74.4 534 Lahj 49.2 425 Mareb 67.5 123 Al-Mhweit 40.9 445 Al-Mhrah 52.1 62 Amran 64.2 614 Aldhalae 40.0 404 Reimah 25.3 350 Education No education 40.2 8,887 Fundamental 58.4 5,416 Secondary 68.3 1,564 Higher 78.9 697 Wealth quintile Lowest 29.9 3,010 Second 41.4 3,248 Middle 47.8 3,330 Fourth 57.9 3,394 Highest 71.4 3,582 Total 50.5 16,564 HIV/AIDS-Related Knowledge, Attitudes, and Behavior • 159 12.6 AWARENESS OF HIV TESTING SERVICES Knowledge of HIV status helps HIV-negative individuals make specific decisions to reduce risk and increase safer sex practices so that they can remain disease free. Among those who are HIV infected, knowledge of their status allows them to take action to protect their sexual partners, to access treatment, and to plan for the future. To assess awareness of HIV testing services, both ever-married and never-married women who were interviewed in the 2013 YNHDS were asked whether they knew a place where people can go to get tested for the AIDS virus. Table 12.7 shows that only 18 percent of all women age 15-49 know of a place to get an HIV test. Urban women are more likely than rural women to know a place where they could go to be tested (26 percent and 15 percent, respectively). Knowledge of a place to get an HIV test increases with both increasing education and wealth quintile. The percentage of women who know of a place to get an HIV test is lowest in Reimah Governorate (6 percent) and highest in Al- Mhrah Governorate (53 percent). There has been a rise in awareness of HIV testing services in the past few years, with the proportion of ever-married women who know where to get an HIV test increasing from 12 percent in 2006 to 18 percent in 2013. 12.7 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS In the 2013 YNHDS, ever-married women age 15-49 were asked whether they had had a sexually transmitted infection or symptoms of an STI (a bad- smelling, abnormal discharge from the vagina or a genital sore or ulcer) in the 12 months preceding the survey. Table 12.8 shows the self-reported prevalence of STIs and STI symptoms. Eleven percent of ever-married women reported that they had an STI in the 12 months preceding the survey; 25 percent had a bad-smelling, abnormal discharge, and 8 percent had a genital sore or ulcer. In total, 32 percent of women reported having either an STI or STI symptoms. Variations in self-reported prevalence of STIs or STI symptoms by background characteristics are also presented in Table 12.8. The prevalence of STIs or STI symptoms is higher among currently married women than among those who are divorced or widowed. The prevalence varies only slightly by age, residence, education, and wealth quintile. The largest differences occur by governorate, with the prevalence of STIs or STI symptoms ranging from 8 percent among ever-married women in Hadramout Governorate to 51 percent among those in Taiz Governorate. Table 12.7 HIV testing Percentage of all women age 15-49 who know where to get an HIV test, according to background characteristics, Yemen 2013 Percentage who know where to get an HIV test Number of women Background characteristic Age 15-24 18.9 11,539 15-19 18.4 6,342 20-24 19.6 5,197 25-29 18.4 4,634 30-39 18.1 5,986 40-49 17.3 3,275 Marital status Never married 20.0 8,870 Married 17.3 15,566 Divorced/widowed 21.2 998 Residence Urban 26.0 8,619 Rural 14.5 16,815 Governorate Ibb 7.2 2,739 Abyan 6.9 551 Sana’a City 30.5 2,487 Al-Baidha 21.6 1,101 Taiz 23.5 3,512 Al-Jawf 17.1 181 Hajjah 12.2 1,374 Al-Hodiedah 22.2 3,261 Hadramout 17.5 1,427 Dhamar 19.9 1,670 Shabwah 9.1 528 Sadah 7.7 823 Sana’a 8.4 1,265 Aden 36.0 921 Lahj 16.6 678 Mareb 25.7 183 Al-Mhweit 20.2 623 Al-Mhrah 53.4 95 Amran 15.0 852 Aldhalae 13.2 641 Reimah 5.5 520 Education No education 11.1 10,705 Fundamental 18.7 9,339 Secondary 30.8 3,767 Higher 36.6 1,623 Wealth quintile Lowest 9.8 4,435 Second 13.4 4,808 Middle 17.1 5,046 Fourth 21.6 5,320 Highest 27.5 5,825 Total 18.4 25,434 160 • HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 12.8 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms Among ever-married women age 15-49, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Yemen 2013 Percentage of ever-married women who reported having in the past 12 months: Number of ever- married women Background characteristic STI Bad-smelling/abnormal genital discharge Genital sore/ulcer STI/genital discharge/sore or ulcer Age 15-24 11.7 25.8 6.7 31.7 4,211 15-19 10.4 22.9 5.9 27.9 1,112 20-24 12.1 26.8 7.0 33.1 3,099 25-29 11.0 26.8 8.5 33.7 3,731 30-39 11.9 25.7 9.0 32.3 5,436 40-49 9.0 22.1 8.3 27.3 3,186 Marital status Married 11.5 25.9 8.4 32.4 15,566 Divorced/widowed 4.3 15.0 5.1 17.5 998 Residence Urban 11.7 25.3 8.4 32.2 5,322 Rural 10.8 25.2 8.1 31.2 11,242 Governorate Ibb 5.9 22.1 6.2 27.1 1,791 Abyan 12.3 19.4 6.2 26.8 345 Sana’a City 6.7 30.4 12.0 35.8 1,587 Al-Baidha 10.2 24.7 11.5 34.3 768 Taiz 30.7 37.5 15.0 51.3 2,196 Al-Jawf 1.8 18.1 8.7 22.3 141 Hajjah 0.9 20.2 4.9 22.5 895 Al-Hodiedah 8.2 17.5 2.4 22.6 2,023 Hadramout 2.1 6.6 1.5 8.1 958 Dhamar 16.1 28.3 10.0 33.5 1,188 Shabwah 7.6 18.7 4.8 22.0 315 Sadah 8.2 42.6 6.8 43.3 532 Sana’a 10.0 38.3 7.9 43.9 867 Aden 15.6 16.0 2.9 24.2 534 Lahj 17.4 27.7 5.4 35.7 425 Mareb 13.9 23.8 10.8 33.1 123 Al-Mhweit 4.2 25.0 9.2 28.0 445 Al-Mhrah 7.4 14.3 2.4 20.6 62 Amran 11.2 30.0 18.0 40.4 614 Aldhalae 2.9 12.8 6.9 14.6 404 Reimah 2.8 17.5 7.7 20.7 350 Education No education 10.4 24.9 8.5 30.6 8,887 Fundamental 11.6 25.4 7.7 32.0 5,416 Secondary 12.4 25.8 8.9 32.6 1,564 Higher 13.2 28.6 7.0 36.9 697 Wealth quintile Lowest 11.7 26.2 8.6 31.9 3,010 Second 11.3 26.0 8.5 32.2 3,248 Middle 10.1 23.9 7.6 30.0 3,330 Fourth 10.2 24.9 7.8 30.5 3,394 Highest 12.1 25.4 8.4 33.0 3,582 Total 11.1 25.3 8.2 31.5 16,564 As shown in Figure 12.1, three-quarters of ever-married women (74 percent) who had an STI or STI symptoms sought advice or treatment from a clinic, hospital, private doctor, or other health professional. Few women sought advice or treatment from either a shop or pharmacy (2 percent) or any other source (1 percent). More than one in five women (22 percent) did not seek any treatment when they had an STI or STI symptoms. HIV/AIDS-Related Knowledge, Attitudes, and Behavior • 161 Figure 12.1 Percentage of women seeking treatment for STIs 12.8 INJECTIONS Injection overuse in a health care setting can contribute to the transmission of blood-borne pathogens because it amplifies the effect of unsafe practices such as reuse of injection equipment. To measure the potential risk of transmission of HIV associated with medical injections, both ever-married and never-married women interviewed in the 2013 YNHDS were asked whether they had received any injections from a health worker in the 12 months preceding the survey and, if so, whether their last injection was administered with a syringe from a new, unopened package. It should be noted that self-administered medical injections (e.g., insulin injections for diabetes) were not included in the calculations. Table 12.9 shows the reported prevalence of injections and of safe injection practices. Thirty-five percent of all women age 15-49 reported receiving an injection from a health worker during the 12 months preceding the survey. The prevalence of injections was lowest among those age 15-19 (28 percent) and those who had never been married (29 percent). Women in rural areas were less likely than those in urban areas to report receiving an injection. There was considerable variation by governorate; injection prevalence was highest in Al-Jawf Governorate (72 percent) and lowest in Al-Mhrah, Reimah, and Hadramout governorates (21 percent each). The reported prevalence of injections in the past 12 months varies little by education but increases somewhat with increasing wealth. In the past 12 months, the average number of medical injections per woman was 3.3. Ninety-two percent of recent injections among women were administered with a syringe taken from a newly opened package. 162 • HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 12.9 Prevalence of medical injections Percentage of all women age 15-49 who received at least one medical injection in the last 12 months, the average number of medical injections per person in the last 12 months, and among those who received a medical injection, the percentage of last medical injections for which the syringe and needle were taken from a new, unopened package, by background characteristics, Yemen 2013 Background characteristic Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respondents For last injection, syringe and needle taken from a new, unopened package Number of respondents receiving medical injections in the last 12 months Age 15-24 31.8 2.5 11,539 90.8 3,665 15-19 27.7 1.9 6,342 90.6 1,758 20-24 36.7 3.2 5,197 91.1 1,906 25-29 37.5 3.5 4,634 92.3 1,740 30-39 38.4 3.9 5,986 92.5 2,297 40-49 39.3 4.7 3,275 92.6 1,288 Marital status Never married 28.9 2.3 8,870 90.7 2,562 Married 38.9 3.8 15,566 92.2 6,059 Divorced/widowed 36.9 4.1 998 93.5 369 Residence Urban 40.9 3.8 8,619 92.1 3,527 Rural 32.5 3.0 16,815 91.6 5,463 Governorate Ibb 38.9 3.9 2,739 95.3 1,065 Abyan 27.6 2.8 551 97.4 152 Sana’a City 37.5 3.4 2,487 92.4 933 Al-Baidha 52.3 5.7 1,101 96.9 575 Taiz 34.1 3.6 3,512 91.0 1,199 Al-Jawf 72.4 9.7 181 89.7 131 Hajjah 34.2 3.2 1,374 89.8 470 Al-Hodiedah 44.5 3.9 3,261 92.8 1,451 Hadramout 20.9 1.2 1,427 88.7 298 Dhamar 23.4 1.4 1,670 75.7 390 Shabwah 24.4 1.4 528 92.6 129 Sadah 31.4 2.9 823 95.2 258 Sana’a 31.8 3.0 1,265 78.7 402 Aden 31.3 2.4 921 92.0 288 Lahj 33.2 3.3 678 98.9 225 Mareb 54.0 5.5 183 98.6 99 Al-Mhweit 36.0 4.2 623 94.4 224 Al-Mhrah 20.6 1.4 95 98.4 20 Amran 40.8 3.4 852 90.8 348 Aldhalae 34.9 4.1 641 95.8 224 Reimah 20.7 2.0 520 97.8 108 Education No education 35.0 3.6 10,705 90.7 3,744 Fundamental 34.9 3.2 9,339 92.6 3,256 Secondary 36.3 3.0 3,767 92.3 1,367 Higher 38.3 2.9 1,623 93.0 622 Wealth quintile Lowest 31.1 2.9 4,435 88.6 1,380 Second 33.7 3.1 4,808 91.4 1,621 Middle 32.7 3.2 5,046 93.0 1,648 Fourth 38.5 3.5 5,320 92.8 2,049 Highest 39.3 3.6 5,825 92.3 2,292 Total 35.3 3.3 25,434 91.8 8,989 Note: Medical injections are those given by a doctor, nurse, pharmacist, dentist, or other health worker. Female Circumcision • 163 FEMALE CIRCUMCISION 13 emale circumcision (also called female genital cutting) is practiced in some communities in Yemen. It involves partial or total removal of the external female genitalia or other injury to the female organs for cultural or other nontherapeutic reasons. The practice is often condemned as harmful, because it poses a potential risk to the health and well-being of the women and girls who are subjected to it. It is also generally recognized as a violation of children’s rights. In the 2013 YNHDS, both ever-married and never-married women were asked a series of questions about female circumcision, including whether they had ever heard of female circumcision; whether they were circumcised and, if so, how severe the circumcision was; how old they were at the time; and whether they believe the practice should continue. Women who have daughters were asked if their daughters had been circumcised, and never-married women were asked if they intended to have their future daughters circumcised. 13.1 AWARENESS OF FEMALE CIRCUMCISION Table 13.1 shows that two-thirds (67 percent) of all women age 15-49 have heard of female circumcision. Awareness of the practice is higher among older women, women who have ever been married, and urban women than among their counterparts in the other groups. The proportion of women who have heard of female circumcision generally increases with increasing education and wealth. Awareness of female circumcision varies substantially by governorate, from a low of 23 percent among women in Sadah Governorate to almost all women in Al-Hodiedah and Hadramout governorates (97 percent and 95 percent, respectively). Awareness of female circumcision has increased over time. In the 2003 YFHS, 56 percent of ever- married women had heard of the practice, as compared with 71 percent of ever-married women in 2013. F Key Findings • Two-thirds of all women age 15-49 have heard of female circumcision. • Fewer than one in five Yemeni women have been circumcised. • Female circumcision occurs at a young age, with more than 80 percent of procedures taking place during the first week of life. • Three-quarters of women who have heard of female circumcision say that the practice should be stopped. Even among those who are circumcised, opposition is common, with one-third saying the procedure should be stopped. 164 • Female Circumcision Table 13.1 Knowledge of female circumcision Percentage of all women age 15-49 who have heard of female circumcision, according to background characteristics, Yemen 2013 Background characteristic Have heard of female circumcision Number of respondents Age 15-19 55.9 6,342 20-24 67.6 5,197 25-29 70.8 4,634 30-34 72.1 3,225 35-39 73.7 2,761 40-44 75.0 1,807 45-49 73.3 1,468 Marital status Never married 61.4 8,870 Married 70.2 15,566 Divorced/widowed 75.5 998 Residence Urban 81.0 8,619 Rural 60.4 16,815 Governorate Ibb 44.6 2,739 Abyan 63.3 551 Sana’a City 80.7 2,487 Al-Baidha 55.2 1,101 Taiz 75.8 3,512 Al-Jawf 54.1 181 Hajjah 57.2 1,374 Al-Hodiedah 96.8 3,261 Hadramout 94.7 1,427 Dhamar 59.5 1,670 Shabwah 52.5 528 Sadah 22.8 823 Sana’a 41.7 1,265 Aden 91.1 921 Lahj 61.5 678 Mareb 67.9 183 Al-Mhweit 40.6 623 Al-Mhrah 91.1 95 Amran 65.7 852 Aldhalae 44.8 641 Reimah 65.1 520 Education No education 61.7 10,705 Fundamental 65.2 9,339 Secondary 78.1 3,767 Higher 92.5 1,623 Wealth quintile Lowest 60.1 4,435 Second 57.0 4,808 Middle 59.4 5,046 Fourth 74.0 5,320 Highest 82.2 5,825 Total 67.4 25,434 13.2 PREVALENCE OF FEMALE CIRCUMCISION Table 13.2 shows that 19 percent of all women age 15-49 in Yemen have undergone some form of circumcision. For the overwhelming majority of circumcised women, the procedure involved removing flesh (90 percent), while 7 percent said no flesh was removed and 3 percent did not provide details as to the type of circumcision they had. The proportion of circumcised women is slightly higher among those age 30-49 (21-23 percent) than among those under age 30 (16-17 percent). Differences in the prevalence of female circumcision by marital status and urban-rural residence are small. Women with no education or only a fundamental education are more likely to have been circumcised than women with a secondary or higher education. Wealth quintile is also somewhat related to circumcision status, with women in the lower two quintiles more likely to have undergone the procedure than those in the higher quintiles; however, the relationship is not uniform, with the prevalence being almost as high in the fourth quintile as in the second quintile. Female Circumcision • 165 Table 13.2 Prevalence of female circumcision Percentage of all women age 15-49 who have been circumcised, and percent distribution of circumcised women by type of circumcision, according to background characteristics, Yemen 2013 Percentage of women circumcised Number of women Type of circumcision Total Number of circumcised women Background characteristic Cut, no flesh removed Cut, flesh removed Don’t know/ missing Age 15-19 16.4 6,342 6.7 89.7 3.6 100.0 1,041 20-24 16.8 5,197 8.2 88.4 3.3 100.0 873 25-29 16.4 4,634 10.4 86.6 2.9 100.0 761 30-34 20.5 3,225 5.2 90.6 4.2 100.0 660 35-39 23.1 2,761 3.7 93.1 3.2 100.0 637 40-44 22.1 1,807 7.9 90.3 1.8 100.0 399 45-49 22.8 1,468 5.7 91.1 3.2 100.0 335 Marital status Never married 16.3 8,870 6.0 90.5 3.6 100.0 1,447 Married 19.7 15,566 7.1 89.8 3.1 100.0 3,067 Divorced/widowed 19.2 998 13.0 82.0 5.0 100.0 192 Residence Urban 17.1 8,619 4.5 91.8 3.8 100.0 1,470 Rural 19.2 16,815 8.2 88.8 3.1 100.0 3,235 Governorate Ibb 6.2 2,739 2.2 97.8 0.0 100.0 169 Abyan 5.1 551 (0.0) (100.0) (0.0) 100.0 28 Sana’a City 4.8 2,487 0.0 100.0 0.0 100.0 120 Al-Baidha 0.0 1,101 * * * 100.0 0 Taiz 13.2 3,512 0.0 99.5 0.5 100.0 464 Al-Jawf 0.4 181 * * * 100.0 1 Hajjah 7.7 1,374 0.0 100.0 0.0 100.0 106 Al-Hodiedah 62.3 3,261 9.8 89.8 0.4 100.0 2,030 Hadramout 79.9 1,427 7.8 83.4 8.8 100.0 1,140 Dhamar 13.5 1,670 1.8 95.4 2.8 100.0 225 Shabwah 0.6 528 * * * 100.0 3 Sadah 3.0 823 (2.5) (59.2) (38.2) 100.0 25 Sana’a 0.8 1,265 * * * 100.0 10 Aden 14.5 921 13.0 76.2 10.8 100.0 133 Lahj 3.9 678 (23.9) (70.0) (6.1) 100.0 27 Mareb 7.3 183 12.7 83.9 3.4 100.0 13 Al-Mhweit 0.3 623 * * * 100.0 2 Al-Mhrah 84.7 95 0.0 93.4 6.6 100.0 81 Amran 1.4 852 * * * 100.0 12 Aldhalae 0.5 641 * * * 100.0 3 Reimah 21.5 520 6.0 91.9 2.1 100.0 112 Education No education 22.5 10,705 6.5 90.5 3.1 100.0 2,405 Fundamental 18.0 9,339 7.3 89.3 3.4 100.0 1,681 Secondary 11.3 3,767 8.8 86.7 4.5 100.0 426 Higher 11.9 1,623 7.2 90.2 2.6 100.0 193 Wealth quintile Lowest 26.5 4,435 4.4 93.7 1.9 100.0 1,173 Second 21.0 4,808 9.0 89.1 1.9 100.0 1,010 Middle 13.3 5,046 8.5 88.5 3.0 100.0 672 Fourth 19.5 5,320 6.9 87.9 5.2 100.0 1,037 Highest 14.0 5,825 7.1 87.9 5.0 100.0 813 Total 18.5 25,434 7.0 89.7 3.3 100.0 4,705 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. The sharpest differentials in prevalence of female circumcision occur by governorate. As shown in Figure 13.1, the proportion of women who have been circumcised ranges from less than 1 percent in six governorates (Al-Baidha, Al-Jawf, Shabwah, Sana’a, Al-Mhweit, and Aldhalae) to 85 percent in Al-Mhrah Governorate. Levels are also relatively high in Hadramout (80 percent) and Al-Hodiedah (62 percent) governorates. 166 • Female Circumcision Figure 13.1 Prevalence of female circumcision by governorate A comparison with the 2003 YFHS indicates little change in the prevalence of female circumcision. The proportion of ever-married women who report having undergone circumcision has decreased only slightly, from 22 percent in 2003 to 20 percent in 2013. 13.3 AGE AT CIRCUMCISION Table 13.3 shows that female circumcision is performed at a very young age in Yemen. The overwhelming majority of circumcised women (84 percent) say that the procedure was performed during their first week of life. Eleven percent say they were circumcised as infants but after the first week of life, while only 1 percent say they had the procedure when they were older than age 1. Differences by background characteristics are negligible. Table 13.3 Age at circumcision Percent distribution of circumcised women age 15-49 by age at circumcision, according to background characteristics, Yemen 2013 Age at circumcision Total Number of circumcised women Background characteristic First week after birth After 1st week but before 1 year One year or older1 Don’t know/missing Age 15-19 87.4 8.9 0.2 3.5 100.0 1,041 20-24 83.9 11.7 1.4 3.0 100.0 873 25-29 84.3 8.9 1.9 4.9 100.0 761 30-34 82.4 14.0 0.8 2.8 100.0 660 35-39 84.9 9.8 1.0 4.3 100.0 637 40-44 79.8 8.4 2.4 9.4 100.0 399 45-49 76.8 13.1 2.2 7.9 100.0 335 Marital status Never married 84.1 11.2 0.9 3.8 100.0 1,447 Married 83.5 10.4 1.4 4.7 100.0 3,067 Divorced/widowed 86.5 6.4 1.1 6.0 100.0 192 Residence Urban 71.5 17.5 2.9 8.1 100.0 1,470 Rural 89.4 7.3 0.4 2.8 100.0 3,235 Governorate Ibb 91.3 0.0 1.1 7.6 100.0 169 Abyan (85.7) (12.6) (1.7) (0.0) 100.0 28 Sana’a City 81.7 3.1 15.2 0.0 100.0 120 Al-Baidha * * * * * 0 Taiz 95.9 2.0 1.3 0.8 100.0 464 Al-Jawf * * * * * 1 Continued… 0 0 0 1 1 1 1 3 4 5 5 6 7 8 13 14 15 22 62 80 85 Al-Baidha Al-Mhweit Al-Jawf Aldhalae Shabwah Sana'a Amran Sadah lahj Sana'a City Abyan Ibb Mareb Hajjah Taiz Dhamar Aden Reimah Al-Hodiedah Hadramout Al-Mhrah Percentage YNHDS 2013 Female Circumcision • 167 Table 13.3—Continued Age at circumcision Total Number of circumcised women Background characteristic First week after birth After 1st week but before 1 year One year or older1 Don’t know/Missing Governorate Hajjah 83.0 13.8 2.2 1.0 100.0 106 Al-Hodiedah 85.5 13.1 0.6 0.9 100.0 2,030 Hadramout 79.8 8.2 0.0 12.0 100.0 1,140 Dhamar 83.3 13.0 0.4 3.3 100.0 225 Shabwah * * * * * 3 Sadah (10.3) (54.0) (11.4) (24.2) 100.0 25 Sana’a * * * * * 10 Aden 60.8 24.5 7.4 7.3 100.0 133 Lahj (40.9) (46.8) (0.0) (12.3) 100.0 27 Mareb 85.9 5.8 4.3 4.0 100.0 13 Al-Mhweit * * * * * 2 Al-Mhrah 92.8 0.9 0.8 5.5 100.0 81 Amran * * * * * 12 Aldhalae * * * * * 3 Reimah 89.7 8.1 0.4 1.9 100.0 112 Wealth quintile Lowest 89.8 8.0 0.3 2.0 100.0 1,173 Second 88.0 9.7 0.4 2.0 100.0 1,010 Middle 91.6 3.4 1.8 3.3 100.0 672 Fourth 76.0 16.2 0.7 7.1 100.0 1,037 Highest 73.6 13.8 3.9 8.8 100.0 813 Total 83.8 10.5 1.2 4.5 100.0 4,705 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes women who reported they were circumcised during infancy but did not provide a specific age 13.4 CIRCUMCISION OF DAUGHTERS Young women under age 15 were not interviewed in the 2013 YNHDS. Consequently, in order to gain insight into recent trends with regard to female circumcision, ever-married women age 15-49 who were interviewed and who had any daughters were asked if any of their daughters had been circumcised. If so, they were asked several questions about their most recently circumcised daughter: how old she was when she was circumcised, who performed the circumcision, and the type of circumcision performed. The results imply that there has been only a slight decline in the practice of female circumcision. Among ever-married women who have a daughter, 16 percent say that at least one of their daughters has been circumcised (Table 13.4), only slightly less than the 19 percent of all women age 15-49 who say they have been circumcised. Differences by background characteristics in the proportion of women with a circumcised daughter mirror those mentioned above for prevalence of circumcision among all respondents. Similarly, Table 13.5 shows that results related to age at circumcision, person who performed the circumcision, and type of circumcision are similar for the most recently circumcised daughter and all circumcised women age 15-49. For example, 84 percent of circumcised women age 15-49 said they were circumcised within a week after birth, which is almost identical to the 85 percent of women who say their most recently circumcised daughter was circumcised at this age (Figure 13.2). There also seems to be no change in the type of operation performed, with 90 percent of circumcised women and 88 percent of circumcised daughters having been cut with flesh removed. Nevertheless, there does seem to be some evidence of a shift from traditional practitioners toward greater use of health professionals. Whereas 93 percent of circumcised women age 15-49 reported that a traditional practitioner performed their circumcision, only 85 percent of women reported that their daughters had the procedure performed by a traditional practitioner. In contrast, 13 percent of circumcised daughters were circumcised by health professionals, as compared with only 3 percent of circumcised women. In interpreting the data, it is important to remember that almost all women age 15-49 were circumcised during infancy and are therefore unlikely to remember the circumstances surrounding their own procedure. 168 • Female Circumcision Table 13.4 Daughter’s circumcision experience Among ever-married women with at least one living daughter, percentage with at least one circumcised daughter, according to background characteristics, Yemen 2013 Background characteristic Percentage of women with at least one daughter circumcised Number of women with at least one living daughter Age 15-19 13.4 287 20-24 12.0 1,536 25-29 12.8 2,669 30-34 15.6 2,324 35-39 18.6 2,299 40-44 19.4 1,553 45-49 19.0 1,338 Marital status Married 15.9 11,386 Divorced/widowed 16.3 619 Residence Urban 13.3 3,832 Rural 17.1 8,173 Governorate Ibb 5.7 1,295 Abyan 1.1 226 Sana’a City 3.2 1,145 Al-Baidha 0.0 555 Taiz 13.2 1,545 Al-Jawf 0.1 100 Hajjah 4.1 715 Al-Hodiedah 53.7 1,453 Hadramout 79.6 684 Dhamar 10.5 875 Shabwah 0.0 224 Sadah 1.3 397 Sana’a 0.4 617 Aden 9.4 365 Lahj 1.7 301 Mareb 4.7 91 Al-Mhweit 0.4 337 Al-Mhrah 88.1 48 Amran 1.1 450 Aldhalae 0.0 319 Reimah 18.2 263 Education No education 17.9 7,111 Fundamental 15.3 3,596 Secondary 7.3 898 Higher 5.1 401 Wealth quintile Lowest 22.4 2,304 Second 16.8 2,296 Middle 12.6 2,389 Fourth 16.5 2,471 Highest 11.8 2,545 Total 15.9 12,005 Female Circumcision • 169 Table 13.5 Aspects of circumcision among circumcised women and daughters Percent distribution of circumcised women age 15-49 and most recently circumcised daughters according to age at circumcision, person performing the circumcision, and type of circumcision, Yemen 2013 Background characteristic Most recently circumcised daughters Circumcised women age 15-49 Age at circumcision First week after birth 84.9 83.8 After 1st week but before 1 year 14.3 10.5 1 year or older 0.6 1.2 Don’t know/missing 0.2 4.5 Total 100.0 100.0 Person who performed the circumcision Traditional practitioner 84.7 92.8 Traditional circumciser 80.4 91.0 Traditional birth attendant/other 4.3 1.8 Health professional 12.8 2.9 Doctor 7.0 2.4 Nurse/midwife/other health professional 5.8 0.6 Don’t know/missing 2.5 4.3 Total 100.0 100.0 Type of circumcision Cut, no flesh removed 10.7 7.0 Cut, flesh removed 88.3 89.7 Don’t know/missing 1.0 3.3 Total 100.0 100.0 Number 1,909 4,705 Figure 13.2 Aspects of circumcision among circumcised women and daughters 3 93 1 11 84 13 85 1 14 85 Health professional Traditional practitioner PERSON WHO PERFORMED THE CIRCUMCISION 1 year or older After 1st week but before 1 year First week after birth AGE AT CIRCUMCISION Percentage Daughters Women YNHDS 2013 170 • Female Circumcision Another mechanism for obtaining insight into the future of female circumcision in Yemen is to determine whether women intend to have their daughters circumcised in the future. Table 13.6 shows that among never-married women who have heard of female circumcision, 16 percent say they intend to have their future daughters circumcised. As expected, the intention to circumcise future daughters is very low among never-married women who have not been circumcised (1 percent). However, it is interesting to note that only 57 percent of never-married women who have themselves been circumcised intend to circumcise their daughters. This implies some change in attitudes toward the practice. Otherwise, the intention to have future daughters circumcised follows similar patterns according to background characteristics as the prevalence of actual circumcision among women. For example, the proportion of never-married women who say they intend to circumcise their daughters in the future is highest in Al-Mhrah, Hadramout, and Al- Hodiedah governorates, as well as among women in the lower two education and wealth quintile categories. 13.5 ATTITUDES TOWARD FEMALE CIRCUMCISION Both ever-married and never-married women age 15-49 who were interviewed in the 2013 YNHDS and who had heard of female circumcision were asked several questions about their beliefs regarding the practice. Specifically, they were asked if they believe that female circumcision is required by their religion, whether they think the practice should be continued or stopped, and, if stopped, why they think it should be stopped. Table 13.7 shows that only one in five women age 15-49 who have heard of female circumcision believe that the practice is required by their religion. Seventy percent of women say female circumcision is not required by their religion, and 10 percent do not know. Circumcised women are 10 times more likely than uncircumcised women to say that the practice is required by their religion (60 percent and 6 percent, respectively). Differences by governorate tend to follow those for the proportion of women circumcised (Table 13.2); that is, the proportion of women who believe that female circumcision is required by their religion is highest in Hadramout, Al-Mhrah, Al-Hodiedah, and Reimah governorates, where the prevalence of female circumcision is also highest. Also mirroring the patterns found for circumcision prevalence, the proportion of women who believe that the practice is required by their religion is highest among those with no education or only a fundamental education and among those in the lower two wealth quintiles. Table 13.6 Intention to have daughter circumcised Percentage of never-married women who have heard of female circumcision and who intend to have their daughter circumcised in the future, according to background characteristics, Yemen 2013 Background characteristic Percentage who intend to have their daughter circumcised Number of never- married women who have heard of female circumcision Age 15-19 17.9 2,868 20-24 14.5 1,402 25-29 13.2 682 30-34 12.9 309 35-39 22.4 112 40-44 13.3 52 45-49 * 20 Female circumcision status Circumcised 57.4 1,447 Not circumcised 1.2 3,991 Residence Urban 10.2 2,509 Rural 21.3 2,936 Governorate Ibb 15.0 305 Abyan 3.1 130 Sana’a City 0.9 663 Al-Baidha 0.3 153 Taiz 7.2 871 Al-Jawf 0.0 18 Hajjah 5.7 251 Al-Hodiedah 32.5 1,175 Hadramout 62.3 415 Dhamar 12.9 290 Shabwah 0.0 102 Sadah 1.0 58 Sana’a 0.0 122 Aden 7.6 331 Lahj 1.7 139 Mareb 8.8 35 Al-Mhweit 0.0 56 Al-Mhrah 72.3 27 Amran 1.1 116 Aldhalae 0.4 93 Reimah 16.5 98 Education No education 31.6 940 Fundamental 19.9 2,105 Secondary 8.0 1,567 Higher 4.7 832 Wealth quintile Lowest 27.0 796 Second 27.9 790 Middle 14.5 875 Fourth 14.7 1,303 Highest 7.5 1,682 Total1 16.2 5,445 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Total includes 13 women with missing information on circumcision status. Female Circumcision • 171 Table 13.7 Opinions of women about whether circumcision is required by religion Percentage of all women age 15-49 who have heard of female circumcision, by opinion on whether their religion requires female circumcision, according to background characteristics, Yemen 2013 Background characteristic Required Not required Don’t know/missing Total Number of respondents Age 15-19 20.9 70.5 8.6 100.0 3,548 20-24 19.0 72.7 8.3 100.0 3,512 25-29 19.2 71.9 8.8 100.0 3,281 30-34 20.1 70.3 9.5 100.0 2,326 35-39 22.9 65.3 11.8 100.0 2,034 40-44 24.1 62.8 13.1 100.0 1,355 45-49 23.6 61.6 14.8 100.0 1,075 Marital status Never married 18.8 73.6 7.6 100.0 5,445 Married 21.9 67.3 10.8 100.0 10,933 Divorced/widowed 18.8 69.1 12.1 100.0 754 Female circumcision status Circumcised 59.8 29.9 10.3 100.0 4,705 Not circumcised 6.0 84.4 9.6 100.0 12,413 Residence Urban 15.7 77.0 7.3 100.0 6,977 Rural 24.2 64.2 11.6 100.0 10,155 Governorate Ibb 11.9 73.1 15.1 100.0 1,222 Abyan 6.6 70.0 23.4 100.0 349 Sana’a City 7.2 86.9 5.9 100.0 2,007 Al-Baidha 1.2 88.8 10.0 100.0 608 Taiz 11.9 82.1 6.1 100.0 2,663 Al-Jawf 1.0 91.1 7.9 100.0 98 Hajjah 5.3 85.8 8.9 100.0 787 Al-Hodiedah 41.4 49.6 9.0 100.0 3,157 Hadramout 71.9 20.5 7.6 100.0 1,351 Dhamar 20.8 67.6 11.6 100.0 993 Shabwah 2.5 86.6 10.9 100.0 277 Sadah 2.4 79.5 18.1 100.0 188 Sana’a 5.9 79.1 15.0 100.0 528 Aden 12.2 80.1 7.7 100.0 839 Lahj 8.1 80.0 11.9 100.0 417 Mareb 13.1 77.7 9.2 100.0 124 Al-Mhweit 4.6 84.9 10.4 100.0 253 Al-Mhrah 64.6 16.2 19.2 100.0 87 Amran 4.5 79.0 16.4 100.0 560 Aldhalae 9.9 86.0 4.1 100.0 287 Reimah 22.1 53.2 24.6 100.0 339 Education No education 27.5 58.5 14.0 100.0 6,600 Fundamental 21.4 70.1 8.5 100.0 6,089 Secondary 9.9 83.7 6.4 100.0 2,941 Higher 9.7 86.4 3.9 100.0 1,502 Wealth quintile Lowest 30.4 55.7 14.0 100.0 2,666 Second 27.5 60.0 12.5 100.0 2,740 Middle 18.2 71.1 10.7 100.0 2,999 Fourth 19.2 71.4 9.4 100.0 3,939 Highest 14.4 79.8 5.8 100.0 4,787 Total1 20.8 69.4 9.8 100.0 17,132 1 Total includes 13 women with missing information on circumcision status. Table 13.8 provides information about whether women feel that female circumcision should be continued or stopped. Among all women age 15-49 who have heard of female circumcision, 19 percent believe the practice should be continued, 75 percent believe it should be stopped, and 6 percent are unsure. As expected, circumcised women are far more likely than uncircumcised women to support continuing the practice (62 percent and 3 percent, respectively). However, it is particularly interesting that one-third of women who have themselves been circumcised believe that the practice should be stopped. Differences by other background characteristics tend to follow those found for the prevalence of female circumcision. 172 • Female Circumcision Table 13.8 Opinions of women about whether the practice of circumcision should continue Percent distribution of all women age 15-49 who have heard of female circumcision by their opinion on whether the practice of circumcision should be continued, by background characteristics, Yemen 2013 Background characteristic Continued Not continued Don’t know/missing/ depends Total Number of respondents Age 15-19 20.0 73.5 6.5 100.0 3,548 20-24 17.3 78.0 4.7 100.0 3,512 25-29 16.9 77.7 5.4 100.0 3,281 30-34 17.1 77.1 5.8 100.0 2,326 35-39 21.0 73.3 5.8 100.0 2,034 40-44 21.8 71.0 7.2 100.0 1,355 45-49 21.6 71.9 6.5 100.0 1,075 Marital status Never married 17.1 77.2 5.7 100.0 5,445 Married 19.7 74.5 5.8 100.0 10,933 Divorced/widowed 19.1 75.3 5.6 100.0 754 Female circumcision status Circumcised 61.5 33.4 5.1 100.0 4,705 Not circumcised 2.7 91.4 6.0 100.0 12,413 Residence Urban 12.7 82.2 5.1 100.0 6,977 Rural 23.1 70.7 6.2 100.0 10,155 Governorate Ibb 12.1 82.4 5.6 100.0 1,222 Abyan 4.5 87.1 8.4 100.0 349 Sana’a City 3.0 89.8 7.2 100.0 2,007 Al-Baidha 0.6 95.4 3.9 100.0 608 Taiz 11.9 84.7 3.3 100.0 2,663 Al-Jawf 0.4 95.2 4.4 100.0 98 Hajjah 5.0 91.0 4.0 100.0 787 Al-Hodiedah 38.7 56.9 4.4 100.0 3,157 Hadramout 74.1 19.8 6.2 100.0 1,351 Dhamar 14.8 76.1 9.1 100.0 993 Shabwah 0.6 91.0 8.4 100.0 277 Sadah 2.6 81.2 16.2 100.0 188 Sana’a 1.6 93.5 4.9 100.0 528 Aden 8.1 86.3 5.6 100.0 839 Lahj 5.7 90.1 4.3 100.0 417 Mareb 9.3 82.7 8.0 100.0 124 Al-Mhweit 2.7 89.6 7.6 100.0 253 Al-Mhrah 70.4 15.5 14.1 100.0 87 Amran 1.5 94.6 3.8 100.0 560 Aldhalae 2.1 96.8 1.1 100.0 287 Reimah 21.5 56.3 22.2 100.0 339 Education No education 25.8 66.8 7.4 100.0 6,600 Fundamental 19.6 75.2 5.3 100.0 6,089 Secondary 8.7 87.0 4.3 100.0 2,941 Higher 5.1 91.4 3.5 100.0 1,502 Wealth quintile Lowest 29.1 63.1 7.8 100.0 2,666 Second 26.3 67.0 6.7 100.0 2,740 Middle 16.9 78.3 4.8 100.0 2,999 Fourth 18.0 76.4 5.7 100.0 3,939 Highest 10.7 84.5 4.8 100.0 4,787 Total1 18.8 75.4 5.8 100.0 17,132 1 Total includes 13 women with missing information on circumcision status. Among ever-married women who have heard of female circumcision, there has been a sharp decline in the proportion who believe that it should be continued, from 32 percent in the 2006 YFHS to 20 percent in the 2013 YNHDS. As shown in Table 13.9, over half of women who are in favor of stopping female circumcision say that it is against their religion, while half say it is a bad tradition. Almost one-quarter of women say they are in favor of stopping female circumcision because it causes medical complications, and 15 percent want to stop the practice because they feel it is against a woman’s dignity. Female Circumcision • 173 Table 13.9 Reason for stopping female circumcision Among all women who have heard of female circumcision and who think that this practice should be stopped, percentage who provide different reasons to explain why circumcision should be stopped, by background characteristics, Yemen 2013 Background characteristic Bad tradition Against religion Causes medical compli- cations Painful personal experience Against a woman’s dignity Circum- cision is for boys Other Don’t know/ missing Number of women who think that female circumcision should be stopped Age 15-19 48.6 56.6 21.0 3.1 15.5 2.6 0.6 0.0 2,609 20-24 48.4 56.0 24.7 3.4 15.3 1.9 1.3 0.1 2,740 25-29 48.8 53.4 24.6 3.5 15.6 1.6 0.9 0.3 2,550 30-34 49.9 53.2 26.4 4.2 16.3 0.9 1.2 0.3 1,792 35-39 50.4 55.8 24.8 3.5 14.6 1.8 1.2 0.1 1,491 40-44 56.4 49.5 27.4 3.7 13.5 1.7 2.2 0.3 962 45-49 47.1 49.0 22.0 2.7 15.6 2.1 2.7 0.4 773 Female circumcision status Circumcised 42.8 50.6 32.5 8.6 8.3 0.2 2.4 0.5 1,570 Not circumcised 50.4 54.8 23.1 2.7 16.3 2.0 1.0 0.1 11,341 Residence Urban 44.1 53.4 32.6 3.5 15.2 2.0 1.3 0.2 5,735 Rural 53.7 55.0 17.6 3.5 15.5 1.6 1.1 0.2 7,183 Governorate Ibb 57.8 45.4 9.4 1.7 25.9 5.7 2.0 0.2 1,006 Abyan 55.3 49.9 15.2 4.5 20.1 0.7 0.7 0.9 304 Sana’a City 42.5 57.9 30.8 4.0 14.0 0.3 0.6 0.2 1,802 Al-Baidha 44.2 57.8 21.2 1.3 9.2 4.4 0.5 0.0 580 Taiz 45.0 55.9 21.8 5.9 15.7 3.0 0.9 0.0 2,257 Al-Jawf 59.6 69.9 12.2 7.7 15.2 0.0 0.4 0.4 93 Hajjah 61.3 32.3 18.4 2.9 16.7 0.0 0.0 0.0 716 Al-Hodiedah 37.8 57.0 36.9 1.5 4.8 1.1 3.1 0.5 1,798 Hadramout 54.6 45.4 53.3 12.6 16.4 0.0 1.2 1.7 267 Dhamar 51.5 63.7 14.0 1.6 11.5 0.2 1.0 0.0 756 Shabwah 47.4 68.0 15.5 3.2 22.2 0.2 0.9 0.0 252 Sadah 56.3 60.6 12.0 3.0 3.6 0.0 0.0 0.0 152 Sana’a 71.2 38.8 12.3 2.4 15.1 3.2 0.7 0.0 493 Aden 53.1 57.4 44.0 4.1 16.3 3.8 2.3 0.0 724 Lahj 44.7 56.0 33.5 2.8 14.6 0.0 0.5 0.3 376 Mareb 55.3 62.3 10.1 1.3 21.6 1.5 0.6 0.4 103 Al-Mhweit 57.7 50.5 20.8 1.1 20.2 0.3 0.8 0.0 227 Al-Mhrah 78.5 31.9 52.2 3.8 0.8 0.0 0.0 3.6 13 Amran 61.1 61.0 9.5 2.4 22.9 1.6 0.2 0.0 530 Aldhalae 52.2 61.0 22.3 5.4 40.9 0.0 0.0 0.0 278 Reimah 62.0 43.0 13.2 2.7 20.3 0.0 1.8 0.0 191 Education No education 54.0 50.7 17.9 3.0 12.5 1.7 1.5 0.3 4,408 Fundamental 49.6 54.9 22.3 3.6 14.5 2.3 1.4 0.2 4,578 Secondary 47.1 58.7 28.1 4.0 18.6 1.6 0.6 0.0 2,558 Higher 38.8 55.6 43.5 3.5 21.2 0.9 0.8 0.2 1,373 Wealth quintile Lowest 53.9 51.8 18.1 2.6 10.0 1.4 1.2 0.2 1,682 Second 52.6 54.3 16.3 3.7 13.5 1.6 1.7 0.2 1,836 Middle 55.1 55.9 16.2 3.1 17.1 2.1 0.9 0.1 2,348 Fourth 48.9 52.5 25.2 4.3 16.2 1.4 1.2 0.4 3,008 Highest 43.3 55.7 34.2 3.3 16.7 2.3 1.1 0.1 4,044 Total1 49.5 54.3 24.2 3.5 15.3 1.8 1.2 0.2 12,918 Note: Women may report multiple reasons, so the sum may exceed 100 percent. 1 Total includes 7 women with missing information on circumcision status Among women who want to stop female circumcision, those who have been circumcised are more likely than those who have not to report that the practice causes medical complications and is a painful personal experience; however, they are less likely to say that it is against a woman’s dignity. The proportion of women who say female circumcision should be stopped because it causes medical complications increases uniformly with increasing education. Women’s Empowerment and Demographic and Health Outcomes • 175 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 14 his chapter explores women’s empowerment in terms of earnings, control over earnings, and magnitude of earnings relative to those of their partners. In addition, responses to specific questions are used to define two different indicators of women’s empowerment: women’s participation in household decision making and women’s attitudes toward wife beating. The extent to which women’s empowerment relates to maternal health, contraceptive use, and child mortality is also examined. 14.1 WOMEN’S EMPLOYMENT Table 14.1 shows the percentage of currently married women who were employed in the 12 months preceding the survey by age and also the percent distribution of employed women by type of earnings. Employment is assumed to go hand in hand with payment for work. However, not all women receive earnings for the work they do, and among those who do receive earnings, not all receive cash. Table 14.1 Employment and cash earnings of currently married women Percentage of currently married women age 15-49 who were employed at any time in the past 12 months and the percent distribution of currently married women employed in the past 12 months by type of earnings, according to age, Yemen 2013 Among currently married respondents: Percent distribution of currently married respondents employed in the past 12 months, by type of earnings Total Number of women Age Percentage employed in past 12 months Number of respon- dents Cash only Cash and in-kind In-kind only Not paid Missing/ don’t know 15-19 5.1 1,084 28.1 0.9 7.9 63.1 0.0 100.0 55 20-24 6.0 2,968 29.9 3.2 2.7 62.8 1.5 100.0 179 25-29 9.7 3,574 42.4 4.5 4.4 48.6 0.1 100.0 347 30-34 12.6 2,675 61.1 2.1 3.8 33.0 0.0 100.0 337 35-39 12.0 2,409 57.8 2.2 3.8 35.8 0.3 100.0 289 40-44 13.0 1,579 45.2 3.8 3.9 47.1 0.0 100.0 205 45-49 13.3 1,277 50.4 5.6 6.3 37.7 0.0 100.0 171 Total 10.2 15,566 48.5 3.3 4.2 43.7 0.2 100.0 1,582 T Key Findings • Only 10 percent of currently married women age 15-49 were employed at some point in time in the 12 months preceding the survey. • Fifty-four percent of married women who receive cash earnings report deciding on their own how to use their earnings; 39 percent say they jointly decide with their husbands. • Regarding who usually makes decisions about women’s own health care and about making major household purchases, married women are roughly about as likely to say that these decisions are made by the husband and wife jointly as to say they are made mainly by the husband alone. Only 8-9 percent of married women say they make these decisions themselves. • Half of all women believe that a husband is justified in beating his wife for at least one of five specified reasons (if she burns the food, if she goes out without telling him, if she neglects the children, if she argues with him, or if she refuses to have sexual intercourse with him). • Over 90 percent of all women understand domestic violence as including rape, forced marriage, sexual harassment, physical abuse, and denial of education. Women are most likely to think that fathers and mothers commit the most violence against women. 176 • Women’s Empowerment and Demographic and Health Outcomes One in ten currently married women reported being employed at any time in the 12 months preceding the survey. The percentage of currently married women who are employed increases with age, from 5 percent among those age 15-19 to a peak of 12-13 percent among those age 30-49. Almost half of employed women receive cash earnings only; 3 percent receive both cash and in- kind earnings, and 4 percent receive in-kind earnings only. Forty-four percent do not receive any form of earnings for their work. Younger women are more likely than older women not to be paid for their work. 14.2 WOMEN’S CONTROL OVER THEIR OWN EARNINGS AND RELATIVE MAGNITUDE OF WOMEN’S EARNINGS To assess women’s autonomy, currently married women who earned cash for their work in the 12 months preceding the survey were asked who the main decision maker is with regard to the use of their earnings. This information allows an assessment of women’s control over their own earnings. Women who earned cash for their work were also asked about the magnitude of their earnings relative to those of their husband. It is expected that employment and earnings are more likely to empower women if women themselves control their own earnings and perceive them as significant relative to those of their husband. Table 14.2 shows the degree of control women have over the use of their earnings and their perception of the magnitude of their earnings relative to those of their husband, according to background characteristics. Fifty-four percent of currently married women who receive cash earnings report that they alone mainly decide how their earnings are used, while 39 percent say they decide jointly with their husband. Only 5 percent of women report that their husband mainly decides how their earnings will be used. Table 14.2 Control over women’s cash earnings and relative magnitude of women’s cash earnings Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how wife’s cash earnings are used and by whether she earned more or less than her husband, according to background characteristics, Yemen 2013 Person who decides how the wife’s cash earnings are used: Total Wife’s cash earnings compared with husband’s cash earnings: Total Number of women Background characteristic Mainly wife Wife and husband jointly Mainly husband Other Missing More Less About the same Husband has no earnings Don’t know/ missing Age 15-19 * * * * * * * * * * * 100.0 16 20-24 51.1 35.9 9.3 2.2 1.4 100.0 5.3 77.5 8.7 4.6 3.8 100.0 59 25-29 51.7 38.6 6.8 0.0 2.8 100.0 10.9 73.0 5.0 7.9 3.2 100.0 163 30-34 46.0 44.9 5.3 0.3 3.4 100.0 19.0 58.5 12.6 3.8 6.0 100.0 213 35-39 55.4 38.7 4.2 0.0 1.8 100.0 18.9 66.8 7.9 4.0 2.3 100.0 173 40-44 63.5 29.9 4.3 0.0 2.3 100.0 24.8 47.7 9.6 12.7 5.1 100.0 100 45-49 62.6 34.9 1.6 0.0 0.8 100.0 22.1 52.0 7.3 12.0 6.5 100.0 95 Number of living children 0 53.5 41.6 1.7 0.3 3.0 100.0 19.1 66.7 5.5 4.5 4.2 100.0 78 1-2 54.5 40.5 3.0 0.3 1.7 100.0 18.7 65.8 7.5 4.6 3.5 100.0 231 3-4 53.0 38.2 5.2 0.0 3.6 100.0 18.9 62.1 8.6 4.4 6.0 100.0 268 5+ 54.0 35.8 8.2 0.8 1.2 100.0 14.6 59.1 11.0 11.9 3.4 100.0 243 Residence Urban 57.4 38.5 2.2 0.0 1.9 100.0 21.8 61.7 7.7 5.6 3.2 100.0 470 Rural 48.9 38.4 9.1 0.8 2.8 100.0 11.8 64.0 10.1 8.2 5.9 100.0 350 Education No education 48.0 37.8 9.6 1.1 3.6 100.0 11.3 59.3 7.6 13.9 7.9 100.0 233 Fundamental 57.3 33.9 7.1 0.0 1.7 100.0 12.7 68.1 11.2 4.7 3.3 100.0 211 Secondary 59.0 37.4 2.0 0.0 1.6 100.0 25.6 57.6 9.9 4.6 2.3 100.0 119 Higher 53.7 43.4 0.9 0.1 2.0 100.0 23.6 63.6 7.0 2.8 3.0 100.0 257 Wealth quintile Lowest 49.6 34.4 9.8 0.0 6.2 100.0 11.8 48.7 15.6 11.8 12.1 100.0 79 Second 51.5 32.2 12.8 1.0 2.7 100.0 10.9 61.5 11.0 8.9 7.7 100.0 77 Middle 49.2 35.7 10.7 2.0 2.3 100.0 11.1 65.6 9.0 9.2 5.1 100.0 101 Fourth 48.7 46.0 3.4 0.0 1.9 100.0 16.3 65.4 6.7 7.3 4.2 100.0 203 Highest 59.3 37.3 1.8 0.0 1.6 100.0 22.8 63.7 7.7 4.1 1.8 100.0 359 Total 53.8 38.5 5.1 0.3 2.3 100.0 17.6 62.7 8.7 6.7 4.4 100.0 820 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Women’s Empowerment and Demographic and Health Outcomes • 177 Older women are generally somewhat more likely than younger women to make independent decisions on their earnings. There is a modest difference in control over women’s cash earnings by residence: 57 percent of urban and 49 percent of rural women report that they mainly decide how to spend their earnings. Women with no education are slightly less likely than women with any education to decide themselves how to spend their earnings and slightly more likely to have their husbands make such decisions. For example, only 1 percent of women with a higher education report that their husband mainly makes decisions about how their cash earnings will be spent; in contrast, 10 percent of women with no education report that their husband mainly decides how their earnings will be used. There are only minor differences by wealth quintile in women’s control over their own earnings. Regarding the comparative magnitude of women’s earnings with those of their husbands, 18 percent report that they earn more than their husband, 63 percent earn less than their husband, and 9 percent earn about the same as their husband. Seven percent of women report that their husband has no earnings, and 4 percent report that they do not know their husband’s earnings. Older women, urban women, women with a secondary or higher education, and women in the highest two wealth quintiles are more likely than other women to earn more than their husbands. Table 14.3 shows who decides how the husband’s cash earnings are used, as reported by currently married women age 15-49. Seven percent of women report that they mainly decide how their husband’s earnings are used, 38 percent say that they and their husband jointly make the decision, and 53 percent report that their husband mainly decides. The proportion of women who say their husbands mainly decide themselves how to use their own earnings is higher in rural than urban areas and decreases with increasing education and wealth. Better educated and wealthier women are more likely to report that decisions are made jointly as to how to use the husband’s cash earnings. The results in Tables 14.2 and 14.3 show remarkable consistency. Regardless of whether it is the wife’s or the husband’s earnings, just over half of women (53-54 percent) say that the person who earns the money mainly makes the decisions as to how those earnings are used, and 38-39 percent say that decisions are made jointly. Table 14.3 Control over men’s cash earnings Percent distribution of currently married women age 15-49 whose husbands receive cash earnings by person who decides how husband’s cash earnings are used, according to background characteristics, Yemen 2013 Person who decides how husband’s cash earnings are used: Total Number Background characteristic Mainly wife Husband and wife jointly Mainly husband Other Missing Age 15-19 2.7 33.7 56.6 7.0 0.0 100.0 1,027 20-24 5.0 37.7 52.3 4.7 0.2 100.0 2,895 25-29 4.5 38.8 52.5 4.0 0.2 100.0 3,499 30-34 7.5 39.2 51.7 1.5 0.1 100.0 2,632 35-39 8.3 37.4 53.4 0.8 0.1 100.0 2,374 40-44 9.8 34.6 54.7 0.7 0.2 100.0 1,539 45-49 10.6 36.3 50.9 1.8 0.4 100.0 1,230 Number of living children 0 4.7 36.7 52.4 6.1 0.1 100.0 1,783 1-2 5.3 38.7 51.4 4.4 0.1 100.0 4,422 3-4 6.6 38.4 52.6 2.2 0.3 100.0 3,881 5+ 8.5 36.0 54.4 1.0 0.2 100.0 5,108 Residence Urban 7.9 44.0 45.1 2.9 0.1 100.0 4,856 Rural 6.0 34.4 56.5 2.9 0.2 100.0 10,339 Continued… 178 • Women’s Empowerment and Demographic and Health Outcomes Table 14.3—Continued Person who decides how husband’s cash earnings are used: Total Number Background characteristic Mainly wife Husband and wife jointly Mainly husband Other Missing Governorate Ibb 6.3 51.8 38.8 2.8 0.4 100.0 1,631 Abyan 1.8 41.3 55.7 1.2 0.0 100.0 314 Sana’a City 6.9 48.5 42.2 2.2 0.1 100.0 1,481 Al-Baidha 5.8 23.7 58.1 12.3 0.2 100.0 683 Taiz 9.2 40.3 46.1 4.4 0.0 100.0 1,996 Al-Jawf 2.2 35.9 61.3 0.5 0.2 100.0 119 Hajjah 1.8 25.0 72.9 0.3 0.0 100.0 847 Al-Hodiedah 8.4 38.6 52.1 0.8 0.1 100.0 1,884 Hadramout 2.4 25.1 71.0 0.9 0.6 100.0 850 Dhamar 16.6 38.4 43.1 1.9 0.1 100.0 1,099 Shabwah 0.8 40.8 54.5 3.7 0.2 100.0 272 Sadah 1.6 25.9 72.1 0.1 0.3 100.0 493 Sana’a 4.3 25.7 64.4 5.5 0.0 100.0 806 Aden 10.2 47.5 40.7 1.5 0.0 100.0 472 Lahj 4.0 42.3 53.0 0.6 0.0 100.0 400 Mareb 1.3 30.7 65.5 2.4 0.1 100.0 102 Al-Mhweit 7.0 28.5 55.9 8.6 0.0 100.0 415 Al-Mhrah 2.9 42.5 53.6 1.0 0.0 100.0 61 Amran 3.2 26.6 64.9 4.8 0.5 100.0 577 Aldhalae 4.6 35.3 57.4 1.8 0.9 100.0 373 Reimah 5.3 36.9 57.2 0.4 0.2 100.0 320 Education No education 7.0 32.2 58.3 2.4 0.2 100.0 8,117 Fundamental 6.0 40.1 49.8 3.8 0.2 100.0 4,984 Secondary 7.2 48.0 41.7 3.0 0.1 100.0 1,479 Higher 5.7 60.7 31.4 2.2 0.0 100.0 616 Wealth quintile Lowest 6.4 27.7 64.0 1.8 0.1 100.0 2,747 Second 7.6 32.6 56.6 3.0 0.3 100.0 2,990 Middle 5.4 37.9 53.6 2.9 0.2 100.0 3,074 Fourth 5.8 40.3 50.4 3.3 0.2 100.0 3,077 Highest 7.9 46.9 41.6 3.5 0.2 100.0 3,307 Total 6.6 37.5 52.8 2.9 0.2 100.0 15,195 Cross tabulations by the person in the household who decides how the wife’s cash earnings are used and how the husband’s cash earnings are used are presented in Table 14.4. These data provide some insight into a woman’s empowerment in the family and the extent of her control over decision making in the household. Table 14.4 shows that currently married women who earn more than their husband are only very slightly more likely to decide by themselves how their own earnings are used (55 percent) than those who earn less than (53 percent) or the same as (53 percent) their husband. However, among the small number of women who earn cash and whose husbands do not, the vast majority (75 percent) report that they mainly make decisions as to how to use their own earnings. Women’s Empowerment and Demographic and Health Outcomes • 179 Table 14.4 Women’s control over their own earnings and over those of their husbands Percent distribution of currently married women age 15-49 with cash earnings in the last 12 months by person who decides how the wife’s cash earnings are used and percent distribution of currently married women age 15-49 whose husbands have cash earnings by person who decides how the husband’s cash earnings are used, according to the relation between wife’s and husband’s cash earnings, Yemen 2013 Person who decides how the wife’s cash earnings are used: Total Number of currently married women with cash earnings Person who decides how the husband’s cash earnings are used: Total Number of currently married women whose husbands have cash earnings Women’s earnings relative to husband’s earnings Mainly wife Wife and husband jointly Mainly husband Other Missing Mainly wife Wife and husband jointly Mainly husband Other Missing More than husband 55.1 41.0 3.9 0.0 0.0 100.0 144 15.8 53.7 30.4 0.2 0.0 100.0 144 Less than husband 52.7 41.1 5.9 0.4 0.0 100.0 514 8.6 54.3 35.0 2.2 0.0 100.0 514 Same as husband 53.3 43.7 1.9 1.0 0.0 100.0 71 9.0 49.6 40.3 1.0 0.0 100.0 71 Husband has no cash earnings or did not work 75.2 16.5 8.3 0.0 0.0 100.0 55 na na na na na na 0 Woman worked but has no cash earnings na na na na na na 0 6.1 30.2 58.5 5.1 0.2 100.0 736 Woman did not work na na na na na na 0 6.4 37.0 53.5 2.8 0.2 100.0 13,694 Don’t know/missing (32.3) (14.4) (0.0) (0.7) (52.7) 100.0 36 (20.7) (36.4) (38.8) (4.2) (0.0) 100.0 36 Total1 53.8 38.5 5.1 0.3 2.3 100.0 820 6.6 37.5 52.8 2.9 0.2 100.0 15,195 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 Includes cases where a woman does not know whether she earned more or less than her husband 14.3 WOMEN’S PARTICIPATION IN DECISION MAKING Decision making can be a complex process, and the ability of women and men to make decisions that affect the circumstances of their own lives is essential to their status in the household and in society. The number of decisions in which a woman either alone or jointly with her husband has the final say is assumed to be directly related to the woman’s empowerment and reflects the degree of decision-making control the woman is able to exercise in areas that affect her life and environment. To assess women’s decision-making autonomy, the 2013 YNHDS sought information on women’s participation in two types of household decisions: the respondent’s own health care and making major household purchases. Table 14.5 shows the percent distribution of currently married women according to the person in the household who usually makes decisions concerning these matters. Women are considered to participate in decision making if they make decisions alone or jointly with their husband. Table 14.5 Participation in decision making Percent distribution of currently married women age 15-49 by person who usually makes decisions about various issues, Yemen 2013 Decision Mainly wife Wife and husband jointly Mainly husband Someone else Other, relatives Missing Total Number of women Own health care 9.4 45.2 42.2 1.9 1.2 0.2 100.0 15,566 Major household purchases 8.4 41.6 43.5 4.1 2.2 0.2 100.0 15,566 In Yemen, there is an even distribution between decisions made jointly by the husband and wife and decisions made mainly by the husband. Regarding the two decisions asked about in the survey, 42-45 percent of currently married women report that each of the decisions is made jointly by the husband and wife, and 42-44 percent report that the decisions are made mainly by the husband. Only 8-9 percent of women say they make these decisions mainly by themselves. Table 14.6 shows the percentage of currently married women who report that they usually make specific household decisions either by themselves or jointly with their husbands, according to background characteristics. A slight majority of Yemeni women make decisions pertaining to their own health care either by themselves or jointly with their husbands (55 percent), and half participate in decisions regarding major household purchases (50 percent). Almost as many married women participate in neither of the two decisions (38 percent) as participate in making both decisions (42 percent). 180 • Women’s Empowerment and Demographic and Health Outcomes Table 14.6 Women’s participation in decision making by background characteristics Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by background characteristics, Yemen 2013 Specific decisions Both decisions Neither of the two decisions Number of women Background characteristic Woman’s own health care Making major household purchases Age 15-19 48.0 39.2 31.2 44.0 1,084 20-24 50.9 44.8 37.1 41.3 2,968 25-29 54.5 49.0 41.3 37.8 3,574 30-34 54.8 53.8 45.0 36.3 2,675 35-39 57.3 53.7 46.7 35.7 2,409 40-44 56.4 52.2 45.1 36.5 1,579 45-49 60.5 56.1 48.5 31.9 1,277 Employment (last 12 months) Not employed 54.0 49.1 41.4 38.3 13,969 Employed for cash 74.7 74.1 64.3 15.5 820 Employed not for cash 44.5 40.9 34.2 48.9 758 Number of living children 0 49.7 44.6 35.9 41.6 1,864 1-2 54.4 47.9 40.5 38.2 4,538 3-4 56.9 52.6 45.3 35.8 3,941 5+ 54.6 51.7 43.7 37.3 5,223 Residence Urban 64.4 59.9 51.5 27.2 4,949 Rural 50.0 45.4 37.9 42.6 10,617 Governorate Ibb 54.0 60.2 44.6 30.4 1,678 Abyan 55.3 44.3 42.9 43.3 326 Sana’a City 64.8 61.0 55.3 29.5 1,510 Al-Baidha 47.5 35.8 28.0 44.7 702 Taiz 61.9 55.8 46.5 28.8 2,053 Al-Jawf 46.5 42.9 35.2 45.9 124 Hajjah 39.7 37.6 29.6 52.3 867 Al-Hodiedah 50.3 46.4 40.6 43.9 1,891 Hadramout 64.8 50.0 46.7 32.0 884 Dhamar 59.2 60.7 51.3 31.4 1,106 Shabwah 55.6 45.3 41.3 40.3 293 Sadah 64.0 45.5 41.2 31.8 504 Sana’a 35.5 34.6 27.3 57.2 831 Aden 81.4 63.7 56.5 11.5 487 Lahj 47.0 47.0 42.7 48.6 405 Mareb 41.6 49.7 29.9 38.6 111 Al-Mhweit 32.4 33.1 23.2 57.7 425 Al-Mhrah 48.3 55.2 35.2 31.7 61 Amran 48.8 40.5 35.4 46.1 595 Aldhalae 56.1 40.3 35.8 39.4 384 Reimah 48.6 48.8 44.8 47.4 330 Education No education 49.0 44.7 37.9 44.2 8,336 Fundamental 57.5 52.3 43.5 33.8 5,090 Secondary 66.4 58.8 50.5 25.4 1,511 Higher 76.2 80.0 69.4 13.2 629 Wealth quintile Lowest 40.6 37.4 30.6 52.7 2,840 Second 47.6 43.1 35.7 44.9 3,076 Middle 54.3 49.9 41.5 37.3 3,141 Fourth 59.8 54.5 46.1 31.9 3,147 Highest 68.1 62.8 55.1 24.2 3,362 Total1 54.6 50.0 42.2 37.7 15,566 1 Total includes 20 women with missing information on employment. Some women are more likely than others to be involved in making household decisions. Women who are older, who are employed for cash, who live in urban areas, who have more education, and who are in the higher wealth quintiles are more likely than other women to participate in decision making. Women in Sana’a City and Aden Governorate are most likely to report that they participate in making these two decisions. Women’s Empowerment and Demographic and Health Outcomes • 181 14.4 ATTITUDES TOWARD WIFE BEATING Violence is one of the most serious problems faced by women. The right to personal security is fundamental to all other rights. If violence against women is tolerated and accepted in a society, its eradication is made more difficult. To assess women’s attitudes toward wife beating, both ever-married and never-married women interviewed in the 2013 YNHDS were asked whether a husband is justified in hitting or beating his wife in each of the following five situations: if she burns the food, if she argues with him, if she goes out without telling him, if she neglects the children, and if she refuses to have sexual intercourse with him. The results of this series of questions are summarized in Table 14.7. Table 14.7 shows that 10 percent of women agree that a husband is justified in hitting or beating his wife if she burns the food, 20 percent if she argues with him, 36 percent if she goes out without telling him, 30 percent if she neglects the children, and 32 percent if she refuses to have sexual intercourse with him. Almost half (49 percent) of women believe that a husband is justified in hitting or beating his wife for at least one of the five specified reasons. It is notable that younger women are almost as accepting of wife beating as older women. There are also few differences by number of children and marital status. However, women who are employed for cash are less likely to agree with wife beating than women who are either not employed or employed but not for cash. Similarly, urban women are less likely than rural women to agree with at least one reason for wife beating (37 percent and 55 percent, respectively). The proportion of women who accept wife beating for at least one of the five reasons decreases with increasing education and wealth. Women in Al-Baidha, Mareb, Abyan, and Amran governorates are particularly likely to feel that wife beating is justified for at least one of the five reasons, while women in Al-Jawf and Al-Mhrah governorates are least likely to approve of wife beating. Table 14.7 Attitude toward wife beating Percentage of all women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Yemen 2013 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of women Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 9.9 19.2 36.0 30.3 27.9 48.5 6,342 20-24 8.1 17.8 33.2 27.6 29.7 46.1 5,197 25-29 10.1 19.7 34.8 29.2 33.2 48.1 4,634 30-34 10.1 20.1 35.2 30.3 34.7 48.7 3,225 35-39 10.5 21.8 36.4 31.7 37.1 51.1 2,761 40-44 9.1 22.1 39.0 31.8 37.4 52.5 1,807 45-49 10.8 23.4 39.1 32.8 38.7 52.4 1,468 Employment (last 12 months) Not employed 9.6 19.9 35.5 29.9 32.2 48.7 23,611 Employed for cash 5.9 13.8 25.9 22.0 25.9 39.4 972 Employed not for cash 15.2 25.1 47.8 42.4 47.3 61.6 829 Continued… 182 • Women’s Empowerment and Demographic and Health Outcomes Table 14.7—Continued Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of women Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Number of living children 0 9.8 20.7 35.6 30.8 34.3 49.6 2,075 1-2 8.3 17.3 32.9 27.7 31.0 46.2 4,890 3-4 9.5 20.7 36.3 30.7 34.8 48.7 4,145 5+ 10.1 20.4 36.2 30.4 31.9 49.5 14,324 Marital status Never married 9.2 17.7 33.4 27.7 26.2 45.9 8,870 Married 10.0 21.1 36.8 31.3 35.9 50.4 15,566 Divorced/widowed 8.9 19.5 34.4 29.3 33.2 47.6 998 Residence Urban 3.7 10.0 22.9 19.0 22.0 37.4 8,619 Rural 12.7 24.9 42.0 35.5 37.7 54.5 16,815 Governorate Ibb 6.8 19.9 35.1 28.4 35.3 52.0 2,739 Abyan 21.1 42.3 58.4 51.9 53.5 68.7 551 Sana’a City 1.7 4.9 16.2 14.3 17.8 30.8 2,487 Al-Baidha 15.3 31.4 59.8 53.3 53.3 78.1 1,101 Taiz 3.0 9.2 22.6 18.1 20.4 32.2 3,512 Al-Jawf 6.9 10.0 16.4 14.9 17.7 28.0 181 Hajjah 19.3 32.9 43.9 37.8 46.0 63.1 1,374 Al-Hodiedah 12.2 18.8 30.4 25.6 26.4 41.4 3,261 Hadramout 4.7 17.4 29.0 27.9 25.6 45.4 1,427 Dhamar 20.9 33.4 52.2 45.5 43.8 63.3 1,670 Shabwah 18.1 37.7 52.4 44.4 41.9 61.2 528 Sadah 4.0 18.4 44.6 27.8 35.1 53.9 823 Sana’a 7.3 13.9 32.6 26.2 28.0 44.1 1,265 Aden 4.4 13.3 25.6 22.2 21.2 38.9 921 Lahj 17.5 29.8 46.9 42.5 33.4 60.8 678 Mareb 24.6 46.0 59.4 57.3 54.3 74.1 183 Al-Mhweit 19.8 27.3 50.2 40.6 43.3 66.3 623 Al-Mhrah 2.3 7.4 21.5 11.2 14.2 30.4 95 Amran 6.2 17.5 50.2 41.9 52.3 67.8 852 Aldhalae 10.5 35.5 48.9 45.7 49.3 58.9 641 Reimah 13.8 19.6 37.6 24.8 34.4 44.8 520 Education No education 14.3 27.3 44.7 37.6 42.0 57.6 10,705 Fundamental 8.2 18.4 35.1 29.8 30.2 48.4 9,339 Secondary 3.5 8.9 20.9 17.4 19.4 35.4 3,767 Higher 1.3 4.8 11.0 9.6 12.3 22.9 1,623 Wealth quintile Lowest 19.7 32.4 48.9 42.5 43.2 60.7 4,435 Second 13.2 25.6 43.3 36.7 39.3 55.6 4,808 Middle 9.7 21.0 38.9 31.2 35.4 51.7 5,046 Fourth 6.0 15.4 31.6 26.3 29.0 46.4 5,320 Highest 2.4 8.6 19.6 17.0 18.9 33.5 5,825 Total1 9.7 19.9 35.5 29.9 32.4 48.7 25,434 1 Total includes 21 women with missing information on employment. 14.5 WOMEN’S EMPOWERMENT INDICATORS The two sets of empowerment indicators, namely women’s participation in making household decisions and women’s attitudes toward wife beating, can be summarized in two indices. The first index shows the number of decisions (see Table 14.6 for the list of decisions) in which women participate either alone or jointly with their husbands. This index, which ranges from 0 to 2, reflects the degree of decision-making control that women are able to exercise in areas that affect their own lives and is related to the level of women’s empowerment in a society. The second index, which ranges from 0 to 5, is the number of reasons (see Table 14.7 for the list of reasons) for which a woman thinks that a husband is justified in beating his wife. A low score on this indicator is interpreted as reflecting higher status of women in the household and society. Women’s Empowerment and Demographic and Health Outcomes • 183 Table 14.8 shows how the two indices relate to each other. The findings indicate that currently married women who participate in both household decisions asked about are slightly more likely to disagree with all five reasons justifying wife beating than women who participate in only one or no household decisions. Similarly, women who do not believe that wife beating is justified for any reason are somewhat more likely to participate in all household decision making than women who believe there are reasons for which wife beating is justified. Table 14.8 Indicators of women’s empowerment Percentage of currently married women age 15-49 who participate in all decision making and the percentage who disagree with all of the reasons justifying wife beating, by value on each of the indicators of women’s empowerment, Yemen 2013 Empowerment indicator Percentage who participate in all decision making Percentage who disagree with all reasons justifying wife beating Number of women Number of decisions in which women participate1 0 na 43.6 5,868 1 na 48.7 3,124 2 na 55.4 6,574 Number of reasons for which wife beating is justified2 0 47.2 na 7,718 1-2 39.9 na 3,896 3-4 36.8 na 2,859 5 30.0 na 1,093 na = Not applicable 1 See Table 14.6 for the list of decisions. 2 See Table 14.7 for the list of reasons. 14.6 CURRENT USE OF CONTRACEPTION BY WOMEN’S EMPOWERMENT A woman’s desire and ability to control her fertility and her choice of contraceptive method are in part affected by her status in the household and her own sense of empowerment. A woman who feels that she is unable to control her life may be less likely to feel she can make and carry out decisions about her fertility. Table 14.9 presents the distribution of currently married women by contraceptive method used, according to the two empowerment indicators. Table 14.9 Current use of contraception by women’s empowerment Percent distribution of currently married women age 15-49 by current contraceptive method, according to selected indicators of women’s status, Yemen 2013 Any method Any modern method Modern methods Any traditional method Not currently using Total Number of women Empowerment indicator Female sterili- zation Male sterili- zation Temporary modern female methods1 Male condom Number of decisions in which women participate2 0 28.9 25.6 2.0 0.0 23.2 0.4 3.4 71.1 100.0 5,868 1 33.2 29.2 2.0 0.1 26.8 0.4 3.9 66.8 100.0 3,124 2 37.7 32.3 2.6 0.1 28.8 0.7 5.4 62.3 100.0 6,574 Number of reasons for which wife beating is justified3 0 35.4 30.3 2.2 0.0 27.5 0.7 5.0 64.6 100.0 7,718 1-2 35.8 31.0 2.2 0.2 28.2 0.4 4.8 64.2 100.0 3,896 3-4 29.0 26.2 2.6 0.0 23.3 0.3 2.8 71.0 100.0 2,859 5 23.5 21.9 2.3 0.0 19.1 0.5 1.6 76.5 100.0 1,093 Total 33.5 29.2 2.3 0.1 26.3 0.5 4.3 66.5 100.0 15,566 Note: If more than one method is used, only the most effective method is considered in this tabulation. 1 Pill, IUD, injectables, implants, female condom, diaphragm, foam/jelly, and lactational amenorrhea method 2 See Table 14.6 for the list of decisions. 3 See Table 14.7 for the list of reasons. 184 • Women’s Empowerment and Demographic and Health Outcomes There is generally a positive relationship between women’s empowerment and use of contraception, although differences are not large. The proportion of married women who are using any method of contraception increases with the number of decisions in which they participate, from 29 percent among women who do not participate in any decision to 38 percent among those who participate in both decisions. Likewise, women who believe that wife beating is justified for two or fewer reasons are more likely than other women to use a method of contraception (35-36 percent and 24-29 percent, respectively). Conversely, the percentage of women not currently using any method is highest among those who justify all five reasons for wife beating (77 percent) and those who do not take part in any decision making (71 percent). 14.7 IDEAL FAMILY SIZE AND UNMET NEED BY WOMEN’S EMPOWERMENT An increase in women’s status and empowerment is expected to have an effect on women’s desired family size. Women who participate in decision making and who reject wife beating would be expected to have more control over their ability to space and limit their family size. Women who have a desire to space or limit their births but who are not using family planning are defined as having an unmet need for family planning. Table 14.10 shows how women’s ideal family size and their unmet need for family planning vary by the two empowerment indicators. Table 14.10 Ideal number of children and unmet need for family planning by women’s empowerment Mean ideal number of children for women age 15-49 and the percentage of currently married women age 15-49 with an unmet need for family planning, by indicators of women’s empowerment, Yemen 2013 Mean ideal number of children1 Number of women1 Percentage of currently married women with an unmet need for family planning2 Number of women Empowerment indicator For spacing For limiting Total Number of decisions in which women participate3 0 4.4 5,146 16.6 15.2 31.7 5,868 1 4.4 2,825 15.8 13.0 28.8 3,124 2 4.4 6,012 13.1 12.9 26.0 6,574 Number of reasons for which wife beating is justified4 0 4.2 7,500 15.6 11.9 27.5 7,718 1-2 4.4 3,695 14.3 14.0 28.2 3,896 3-4 4.5 2,649 14.2 16.4 30.6 2,859 5 4.5 991 14.7 19.6 34.2 1,093 Total 4.3 14,834 15.0 13.8 28.7 15,566 1 Mean and number of women exclude respondents who gave non-numeric responses. 2 See Table 7.12 for the definition of unmet need for family planning. 3 Restricted to currently married women. See Table 14.6 for the list of decisions. 4 See Table 14.7 for the list of reasons. Although there is no difference in mean ideal number of children by the number of decisions in which currently married women participate (4.4 for all categories), the results do show that unmet need for family planning decreases slightly as the number of decisions in which women participate increases. For example, unmet need is lower among women who participate in both decisions (26 percent) than among women who participate in no decisions (32 percent). Desired family size increases slightly with the number of reasons a woman thinks that wife beating is justified, from 4.2 children among women who do not agree with any of the reasons justifying wife beating to 4.5 children among women who agree with three or more reasons justifying wife beating. Unmet need for family planning increases steadily with the number of reasons for which a woman believes wife beating is justified, from 28 percent among women who do not agree with any of the reasons to 34 percent among women who agree with all five reasons. 14.8 WOMEN’S EMPOWERMENT AND REPRODUCTIVE HEALTH CARE Table 14.11 shows women’s use of prenatal, delivery, and postnatal care services from health care workers by level of empowerment, as measured by the two empowerment indicators. Theoretically, Women’s Empowerment and Demographic and Health Outcomes • 185 increased empowerment of women is likely to increase their ability to seek out and use health services, enabling them to better meet their reproductive health goals, including safe motherhood. Table 14.11 Reproductive health care by women’s empowerment Percentage of women age 15-49 with a live birth in the five years preceding the survey who received antenatal care, delivery assistance, and postnatal care from health personnel for the most recent birth, by indicators of women’s empowerment, Yemen 2013 Empowerment indicator Percentage receiving antenatal care from a skilled provider Percentage receiving delivery care from a skilled provider Received postnatal care from health personnel within the first two days since delivery1 Number of women with a child born in the last five years Number of decisions in which women participate2 0 52.5 41.8 16.4 4,019 1 66.0 50.7 22.6 2,047 2 63.9 54.1 24.1 4,120 Number of reasons for which wife beating is justified3 0 63.4 53.8 23.7 5,046 1-2 61.1 49.0 20.9 2,634 3-4 53.6 38.8 16.7 1,908 5 47.1 36.2 12.4 782 Total 59.8 48.5 20.8 10,369 Note: Skilled provider includes doctor, nurse, midwife, or auxiliary midwife. 1 Includes women who gave birth in a health facility and those who did not give birth in a health facility. 2 Restricted to currently married women. See Table 14.6 for the list of decisions. 3 See Table 14.7 for the list of reasons. The results in Table 14.11 show a robust correlation between women’s empowerment and reproductive health care. The proportions of women who receive antenatal, delivery, and postnatal care all increase with the number of decisions in which they participate. Similarly, the proportions of women who receive antenatal, delivery, and postnatal care decrease as the number of reasons justifying wife beating increases. 14.9 OPINIONS ABOUT DOMESTIC VIOLENCE In addition to the set of questions about situations in which women might think wife beating is justified, women interviewed in the 2013 YNHDS were asked several other questions regarding their opinions about domestic violence. Specifically, they were asked what their understanding of domestic violence is and whether it means: • Physical abuse • No participation in household decision making • No participation in decision making regarding children • Better treatment of males than females • Failure to meet basic living costs • Denial of education • Forced marriage • Rape • Sexual harassment They were also asked who are the people who commit the most violent acts against women and where the most violent acts take place. These questions were asked of both ever-married and never-married women. Table 14.12 shows that the vast majority of women believe that all of the acts described constitute domestic violence. Over 95 percent of women say that rape and forced marriage are considered domestic violence, and 94-95 percent say that sexual harassment, physical abuse, and denial of education constitute domestic violence. Slightly lower proportions (81-87 percent) define domestic violence as including better 186 • Women’s Empowerment and Demographic and Health Outcomes treatment of males than females and lack of participation in making decisions either in the household or about children. Only 68 percent of women feel that a failure to meet basic living costs constitutes domestic violence. Table 14.12 Opinions/acts that mean domestic violence Percentage of all women age 15-49 who understand domestic violence to mean various specified acts, by background characteristics, Yemen 2013 Acts that mean domestic violence Number of women Background characteristic Physical abuse No partici- pation in decision making in household matters No partici- pation in decision making for children Better treatment of males than females Failure to meet basic living costs Denial of education Forced marriage Rape Sexual harass- ment Other Age 15-19 94.4 79.3 78.6 86.9 69.0 94.1 96.1 96.9 94.1 1.2 6,342 20-24 94.3 82.0 81.7 88.4 69.1 94.7 96.3 97.8 95.4 1.3 5,197 25-29 93.7 82.0 81.8 88.1 68.0 94.1 96.0 97.0 95.0 1.2 4,634 30-34 94.7 81.8 82.3 87.3 68.3 93.4 96.7 97.6 95.8 1.3 3,225 35-39 94.7 82.1 81.8 88.0 68.4 95.0 96.4 98.1 95.8 1.4 2,761 40-44 93.2 81.1 81.0 85.1 68.3 92.8 95.6 96.8 93.6 1.4 1,807 45-49 93.3 78.1 78.7 85.4 64.6 92.2 95.2 97.0 93.8 1.0 1,468 Marital status Never married 94.6 80.5 79.5 87.7 67.8 95.0 96.5 97.4 94.7 1.5 8,870 Married 93.9 81.2 81.3 87.0 68.4 93.4 95.8 97.2 94.9 1.1 15,566 Divorced/widowed 95.6 84.0 84.8 90.1 74.6 95.9 97.0 98.0 96.6 1.4 998 Residence Urban 96.3 83.7 83.5 87.6 64.2 95.3 97.2 98.1 97.3 1.2 8,619 Rural 93.1 79.7 79.4 87.3 70.5 93.4 95.6 96.9 93.6 1.3 16,815 Education No education 91.9 76.9 76.6 85.3 67.8 92.2 94.8 96.5 92.9 1.5 10,705 Fundamental 95.1 82.0 81.9 87.8 68.1 94.1 96.5 97.3 95.2 0.9 9,339 Secondary 96.6 87.1 86.7 90.9 72.1 97.3 98.0 98.8 97.7 1.3 3,767 Higher 97.8 88.8 88.4 90.9 65.9 98.4 98.6 99.4 99.3 1.2 1,623 Wealth quintile Lowest 90.6 74.3 74.2 85.2 69.8 91.7 94.3 95.4 89.9 1.2 4,435 Second 92.2 79.1 78.2 87.5 70.1 92.4 94.7 96.6 92.9 1.6 4,808 Middle 94.8 82.8 82.3 88.5 72.1 94.8 96.5 97.8 95.6 1.3 5,046 Fourth 95.7 81.6 82.5 87.2 66.7 94.6 96.7 97.6 96.4 1.6 5,320 Highest 96.6 85.8 85.1 88.1 64.2 95.9 97.8 98.8 98.3 0.6 5,825 Total 94.2 81.0 80.8 87.4 68.4 94.0 96.1 97.3 94.9 1.3 25,434 Note: Women may report multiple meanings, so the sum may exceed 100 percent. There are only minor differences by background characteristics in which acts women think constitute domestic violence. Women with more education are generally more likely to report acts as constituting domestic violence than women with less education. Similarly, there is a tendency for women in the higher wealth quintiles to define domestic violence as including more specific acts than women in the lower quintiles, but the differences are slight. Table 14.13 shows results regarding women’s opinions about the people who commit the most violent acts against women. Women are most likely to report fathers and mothers as being the most common perpetrator of violence against women (37 percent), followed closely by sisters and brothers (35 percent). Nineteen percent of women report daughters and sons as committing the most violent acts against women. Interestingly, only 3 percent of women say that husbands commit the most violence against women. Women’s Empowerment and Demographic and Health Outcomes • 187 Table 14.13 Opinions regarding the most common perpetrator of violent acts against women Percent distribution of all women according to the person who, in their opinion, is the most common perpetrator of violent acts against women, by background characteristics, Yemen 2013 Individual who commits the most violent acts against women Total Number of women Background characteristic Father/ mother Husband Sister/ brother Daughter/ son Employer Someone/ colleague at work Other relatives Men Other Don’t know/ missing Age 15-19 41.2 3.4 26.5 22.7 0.5 0.5 0.9 0.5 1.6 2.3 100.0 6,342 20-24 37.5 2.4 33.1 20.9 0.7 0.5 1.1 0.5 1.1 2.3 100.0 5,197 25-29 35.2 2.5 38.9 17.8 0.7 0.6 0.8 0.4 0.9 2.3 100.0 4,634 30-34 34.7 3.2 40.2 16.9 0.3 0.6 0.5 0.4 1.1 2.0 100.0 3,225 35-39 35.7 2.6 41.7 14.3 0.8 0.4 0.9 0.6 1.2 1.8 100.0 2,761 40-44 37.5 1.7 41.2 13.9 0.7 0.2 0.6 0.4 1.1 2.6 100.0 1,807 45-49 36.2 2.6 40.4 13.1 2.1 0.6 0.6 0.3 1.5 2.5 100.0 1,468 Marital status Never married 39.6 3.2 26.3 25.4 0.5 0.7 0.8 0.5 1.4 1.7 100.0 8,870 Married 36.7 2.5 39.9 14.9 0.8 0.4 0.8 0.4 1.1 2.5 100.0 15,566 Divorced/widowed 28.1 3.3 45.5 15.8 0.9 0.2 1.3 0.4 1.5 2.9 100.0 998 Residence Urban 33.3 2.2 37.4 21.7 0.8 0.9 0.9 0.6 1.3 0.8 100.0 8,619 Rural 39.5 3.0 34.3 17.0 0.6 0.3 0.8 0.4 1.2 3.0 100.0 16,815 Education No education 40.0 2.9 36.3 14.9 0.8 0.2 0.7 0.2 1.1 2.9 100.0 10,705 Fundamental 37.2 3.0 34.3 19.2 0.6 0.5 1.1 0.6 1.4 2.2 100.0 9,339 Secondary 33.9 2.5 34.4 24.0 0.7 0.9 0.8 0.6 0.9 1.3 100.0 3,767 Higher 29.3 1.2 37.2 26.7 0.5 1.9 0.5 1.0 1.5 0.1 100.0 1,623 Wealth quintile Lowest 44.5 3.1 31.6 14.5 0.5 0.2 0.5 0.1 1.1 3.8 100.0 4,435 Second 40.2 3.5 32.5 17.2 0.7 0.3 0.8 0.4 1.3 3.2 100.0 4,808 Middle 36.4 2.9 35.2 19.4 0.6 0.4 1.1 0.5 1.1 2.4 100.0 5,046 Fourth 35.6 2.3 37.4 19.8 0.7 0.5 0.8 0.4 0.9 1.6 100.0 5,320 Highest 32.1 2.1 38.8 21.0 0.8 1.0 0.9 0.8 1.6 0.7 100.0 5,825 Total 37.4 2.7 35.3 18.6 0.7 0.5 0.8 0.5 1.2 2.2 100.0 25,434 Information about the place where women think the most violent acts occur is shown in Table 14.14. The overwhelming majority of women (92 percent) say that violence against women most commonly occurs at home. Four percent of women say that violence is most common on the street, while only 1 percent or less report violence as most commonly occurring in school, in the workplace, or somewhere else. Table 14.14 Opinions regarding the place of most violent acts against women Percent distribution of all women according to the place where, in their opinion, most of the violent acts against women occur, by background characteristics, Yemen 2013 Place where most violent acts against women occur Total Number of women Background characteristic At home Workplace Street School Other Don’t know/ missing Age 15-19 90.8 0.8 4.0 1.8 0.6 2.1 100.0 6,342 20-24 91.9 0.7 4.1 0.9 0.5 1.9 100.0 5,197 25-29 91.9 0.9 3.8 0.8 0.6 2.0 100.0 4,634 30-34 93.0 0.6 3.0 0.6 0.6 2.1 100.0 3,225 35-39 92.6 0.6 3.5 1.0 0.7 1.6 100.0 2,761 40-44 92.7 1.0 2.9 0.5 0.4 2.5 100.0 1,807 45-49 93.0 0.8 2.5 0.5 0.6 2.5 100.0 1,468 Marital status Never married 91.6 0.8 4.0 1.5 0.5 1.5 100.0 8,870 Married 92.1 0.8 3.5 0.7 0.6 2.3 100.0 15,566 Divorced/widowed 92.6 0.3 2.4 1.7 0.7 2.2 100.0 998 Residence Urban 93.7 1.1 3.6 0.7 0.2 0.7 100.0 8,619 Rural 91.1 0.6 3.7 1.2 0.8 2.7 100.0 16,815 Education No education 92.7 0.4 2.5 0.8 0.8 2.8 100.0 10,705 Fundamental 90.8 0.9 4.5 1.3 0.5 1.9 100.0 9,339 Secondary 92.3 0.8 4.2 1.5 0.2 1.0 100.0 3,767 Higher 92.7 1.9 4.6 0.4 0.2 0.1 100.0 1,623 Wealth quintile Lowest 92.1 0.3 2.3 0.9 0.9 3.6 100.0 4,435 Second 91.4 0.7 2.9 1.1 0.9 3.1 100.0 4,808 Middle 91.9 0.5 3.9 1.0 0.6 2.0 100.0 5,046 Fourth 91.5 1.0 4.4 1.3 0.3 1.5 100.0 5,320 Highest 92.8 1.2 4.4 0.9 0.2 0.5 100.0 5,825 Total 92.0 0.8 3.6 1.0 0.6 2.0 100.0 25,434 Harmful Health Practices • 189 HARMFUL HEALTH PRACTICES 15 he 2013 YNHDS Household Questionnaire included a series of questions on harmful health practices. Household Questionnaire respondents were asked whether each household member age 10 and older smokes cigarettes (or any other form of tobacco, including water pipes), chews al-Qat, and/or uses orange snuff. 15.1 SMOKING Smoking is a known risk factor for cardiovascular and respiratory disease and cancer. Tobacco kills up to half of its users and also has an impact on individuals who are exposed to smoke secondhand. Secondhand smoke causes serious cardiovascular and respiratory diseases in adults and can cause sudden death in infants (WHO, 2014). Because smoking is an acquired behavior, all morbidity and mortality caused by smoking is preventable. Table 15.1 shows the percent distribution of household members age 10 and older according to smoking status (use of cigarettes or any other form of tobacco). Thirteen percent of household members age 10 and older and 16 percent of household members age 15 and older are current smokers (i.e., they smoke regularly or sometimes). Of household members age 10 and older, 83 percent have never smoked; this proportion decreases to 79 percent among those age 15 and older. Men are more than three times as likely as women to be current smokers: 7 percent of female household members age 15 and older smoke, as compared with 26 percent of men. Among both male and female household members, current smoking prevalence is low in the younger age groups. Just 1 percent of male adolescents age 10-14 and 6 percent of young men age 15-19 are current smokers. Less than 1 percent of female adolescents age 10-14 and 1 percent of women age 15-19 are current smokers. Current smoking prevalence increases with age, peaking at age 40-44 among men (42 percent) and age 45-49 among women (15 percent) before decreasing to 14 percent among men age 80 and older and 6 percent among women age 80 and older (Figure 15.1). T Key Findings • Thirteen percent of household members age 10 and older currently smoke tobacco; men are more than three times as likely as women to be current smokers. • The proportion of current smokers has declined from 19 percent in 2003 to 13 percent in 2013. • Forty-three percent of household members age 10 and older chew al-Qat. More than twice as many male as female household members use al-Qat (59 percent and 28 percent, respectively). • Current al-Qat use has not changed since 2003. • Overall, 9 percent of household members age 10 and older are current orange snuff users. Current use is much higher among male (14 percent) than female (5 percent) household members. • The proportion of current orange snuff users has slightly declined from 11 percent in 2003 to 9 percent in 2013. 190 • Harmful Health Practices Table 15.1 Use of tobacco Percent distribution of household members age 10 and older by smoking status and percentage of current smokers, according to sex and age, Yemen 2013 Currently smokes Smoked before Never smoked Don’t know/ missing Total Percentage of current smokers Number of household members Age Smokes Smokes sometimes MALE 10-14 0.4 0.2 0.0 97.7 1.6 100.0 0.6 8,591 15-19 4.8 1.1 0.3 93.1 0.8 100.0 5.9 6,815 20-24 16.0 2.2 0.7 80.7 0.4 100.0 18.1 5,376 25-29 27.2 3.6 1.3 67.3 0.6 100.0 30.8 4,289 30-34 31.7 4.6 3.1 60.3 0.3 100.0 36.3 3,372 35-39 33.4 4.2 5.2 56.9 0.3 100.0 37.6 2,799 40-44 36.5 5.0 6.9 51.3 0.2 100.0 41.6 2,133 45-49 35.5 4.5 6.9 52.8 0.3 100.0 40.0 1,654 50-54 35.8 4.5 10.7 48.9 0.1 100.0 40.2 1,652 55-59 31.8 2.6 14.8 50.6 0.3 100.0 34.4 1,188 60-64 27.2 3.4 15.7 53.4 0.3 100.0 30.6 1,354 65-69 26.1 4.0 20.4 49.4 0.2 100.0 30.0 753 70-74 20.4 2.8 18.4 58.2 0.2 100.0 23.2 858 75-79 16.0 3.0 23.3 57.1 0.7 100.0 19.0 373 80+ 11.8 1.8 28.0 57.3 1.1 100.0 13.6 641 Total 10+1 18.2 2.5 4.3 74.4 0.7 100.0 20.7 41,858 Total 15+1 22.7 3.1 5.3 68.4 0.5 100.0 25.8 33,257 FEMALE 10-14 0.2 0.1 0.1 98.0 1.7 100.0 0.2 8,037 15-19 1.0 0.3 0.1 98.1 0.5 100.0 1.3 6,845 20-24 3.2 1.3 0.3 94.5 0.7 100.0 4.5 5,693 25-29 4.7 1.9 0.7 92.4 0.4 100.0 6.6 5,043 30-34 6.3 3.0 1.2 89.2 0.3 100.0 9.3 3,441 35-39 9.3 3.3 1.7 85.6 0.1 100.0 12.5 2,916 40-44 9.1 3.4 2.4 84.7 0.4 100.0 12.5 1,917 45-49 10.8 3.7 3.4 82.0 0.1 100.0 14.5 1,594 50-54 10.2 3.0 4.9 81.8 0.2 100.0 13.2 2,418 55-59 6.3 3.0 7.3 82.8 0.6 100.0 9.3 1,316 60-64 8.6 2.1 7.6 80.5 1.2 100.0 10.7 1,017 65-69 6.4 2.3 10.5 80.5 0.4 100.0 8.6 562 70-74 4.4 2.3 9.9 81.7 1.7 100.0 6.6 609 75-79 4.5 2.2 8.4 82.0 2.8 100.0 6.8 322 80+ 4.7 0.8 10.6 80.2 3.8 100.0 5.5 632 Total 10+1 4.4 1.6 1.8 91.4 0.8 100.0 6.0 42,368 Total 15+1 5.4 2.0 2.2 89.9 0.6 100.0 7.4 34,326 TOTAL 10-14 0.3 0.1 0.0 97.9 1.7 100.0 0.4 16,627 15-19 2.9 0.7 0.2 95.6 0.6 100.0 3.6 13,660 20-24 9.4 1.7 0.5 87.8 0.6 100.0 11.1 11,070 25-29 15.0 2.7 1.0 80.8 0.4 100.0 17.7 9,332 30-34 18.8 3.8 2.1 74.9 0.3 100.0 22.6 6,813 35-39 21.1 3.7 3.4 71.5 0.2 100.0 24.8 5,715 40-44 23.6 4.2 4.8 67.1 0.3 100.0 27.8 4,050 45-49 23.4 4.1 5.2 67.1 0.2 100.0 27.5 3,248 50-54 20.6 3.6 7.2 68.5 0.1 100.0 24.2 4,070 55-59 18.4 2.8 10.8 67.5 0.4 100.0 21.2 2,504 60-64 19.2 2.8 12.3 65.0 0.7 100.0 22.1 2,371 65-69 17.6 3.2 16.1 62.7 0.3 100.0 20.9 1,315 70-74 13.7 2.6 14.9 68.0 0.9 100.0 16.3 1,467 75-79 10.7 2.6 16.4 68.6 1.7 100.0 13.3 694 80+ 8.3 1.3 19.3 68.7 2.4 100.0 9.6 1,273 Total 10+1 11.2 2.1 3.0 83.0 0.7 100.0 13.3 84,226 Total 15+1 13.9 2.5 3.7 79.3 0.5 100.0 16.4 67,582 1 Total includes household members with missing information on age. Harmful Health Practices • 191 Figure 15.1 Percentage of current smokers by sex and age The results indicate a decline in the proportion of current smokers over the past 10 years, from 19 percent in 2003 (YFHS) to 13 percent in 2013 (YNHDS). The decline is important among both female (from 10 percent to 6 percent) and male (from 27 percent to 21 percent) household members, particularly those in the young age groups. For example, 12 percent of male household members age 10-19 were smokers in 2003, as compared with 3 percent in 2013. While smoking has decreased overall, the relationship with age remains similar: increasing dramatically in the 20s and peaking in the 40s before decreasing at older ages. By residence, smoking is slightly more common in urban areas than rural areas; 15 percent of household members age 10 and older are current smokers in urban areas, as compared with 12 percent in rural areas (Table 15.2). Al-Hodiedah and Al-Mhweit governorates have the highest prevalence of current smokers (20-21 percent), and Hadramout Governorate has the lowest (3 percent). Education and wealth quintile show no clear relationship with current smoking status. Table 15.2 Use of tobacco by background characteristics Percentage of household members age 10 and older who currently smoke cigarettes or any other kind of tobacco, by sex and background characteristics, Yemen 2013 Male Female Total Background characteristic Percentage of current smokers Number of household members Percentage of current smokers Number of household members Percentage of current smokers Number of household members Residence Urban 23.7 13,550 6.4 13,626 15.0 27,176 Rural 19.2 28,308 5.8 28,742 12.4 57,050 Governorate Ibb 18.7 4,532 3.9 4,736 11.2 9,268 Abyan 23.5 936 0.3 940 11.9 1,876 Sana’a City 26.2 3,829 7.7 3,848 16.9 7,677 Al-Baidha 20.1 1,657 0.1 1,725 9.9 3,382 Taiz 24.4 5,459 6.2 5,758 15.1 11,217 Al-Jawf 12.4 332 0.4 314 6.6 646 Hajjah 15.2 2,422 3.3 2,411 9.2 4,833 Al-Hodiedah 24.3 5,147 16.4 5,201 20.3 10,348 Hadramout 6.6 2,518 0.1 2,440 3.4 4,958 Dhamar 21.1 2,840 5.7 2,827 13.4 5,667 Shabwah 15.1 930 0.2 906 7.7 1,837 Sadah 24.3 1,287 7.7 1,300 16.0 2,587 Sana’a 22.5 2,181 4.4 2,149 13.5 4,330 Continued… 0 5 10 15 20 25 30 35 40 45 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80 + Age Male Female YNHDS 2013 Percentage 192 • Harmful Health Practices Table 15.2—Continued Male Female Total Background characteristic Percentage of current smokers Number of household members Percentage of current smokers Number of household members Percentage of current smokers Number of household members Governorate Aden 23.9 1,447 5.0 1,540 14.2 2,987 Lahj 18.5 1,212 0.6 1,216 9.5 2,428 Mareb 16.6 303 1.6 307 9.0 610 Al-Mhweit 26.3 1,042 15.2 1,058 20.7 2,100 Al-Mhrah 10.0 170 0.0 161 5.1 330 Amran 19.5 1,617 4.0 1,526 12.0 3,142 Aldhalae 12.5 1,081 1.8 1,103 7.1 2,184 Reimah 19.4 914 8.1 904 13.8 1,818 Education No education 29.2 8,232 9.6 18,949 15.6 27,181 Fundamental 16.5 21,366 3.0 17,217 10.5 38,583 Secondary 21.5 7,800 3.1 4,199 15.1 11,999 Higher 23.2 4,304 3.7 1,832 17.4 6,136 Don’t know/missing 25.5 155 5.6 172 15.0 327 Wealth quintile Lowest 19.6 7,789 7.8 7,972 13.6 15,760 Second 21.0 8,161 7.1 8,233 14.0 16,394 Middle 19.4 8,401 5.1 8,369 12.3 16,770 Fourth 20.8 8,677 5.3 8,678 13.1 17,356 Highest 22.3 8,829 4.8 9,117 13.4 17,946 Total 20.7 41,858 6.0 42,368 13.3 84,226 15.2 CHEWING AL-QAT Al-Qat (Catha edulis) is a plant containing cathinone, a natural amphetamine (Kalix, 1992). Qat leaf chewing is common in Yemen, and while WHO does not consider the drug to be seriously addictive, there are physiological effects such as increased heart rate and blood pressure, low birth weight, and insomnia (Al-Mugahed, 2008). Table 15.3 shows the percent distribution of household members age 10 and older by whether they currently use, previously used, or have never used al-Qat. Forty-three percent of household members age 10 and older currently use al-Qat, as compared with 52 percent of household members age 15 and older. Al-Qat use is much higher among males, with more than twice as many male household members age 10 and older as female household members using al-Qat (59 percent and 28 percent, respectively). The largest difference between male and female household members is in daily use, with 44 percent of males and only 14 percent of females using al-Qat daily; 12 percent of both male and female household members report using al-Qat sometimes. Current use of al-Qat is low among those age 10-14 (6 percent) but rises dramatically in the late teens and 20s; 29 percent of those age 15-19, 49 percent of those age 20-24, and 57 percent of those age 25-29 are current users (Figure 15.2). Al-Qat use levels off in the 30s, ranging from 63 percent to 68 percent among household members age 30-49, and decreases steadily after age 50, reaching 31 percent among those age 80 and older. More than eight of ten men age 30-54 currently use al-Qat. Harmful Health Practices • 193 Table 15.3 Use of al-Qat Percent distribution of household members age 10 and older by whether they currently chew al-Qat, have chewed in the past, or never chewed al-Qat, and percentage of current users, according to sex and age, Yemen 2013 Currently use al-Qat Used before Never used Don’t know/ missing Total Percentage of current users Number of household members Age Daily Weekly Sometimes MALE 10-14 4.6 0.3 4.5 3.4 85.6 1.6 100.0 9.5 8,591 15-19 31.1 1.9 13.3 2.5 50.6 0.6 100.0 46.3 6,815 20-24 55.6 2.4 14.7 1.7 25.1 0.3 100.0 72.8 5,376 25-29 63.0 2.9 15.0 1.8 16.9 0.4 100.0 80.8 4,289 30-34 66.4 3.3 14.0 2.2 13.9 0.3 100.0 83.7 3,372 35-39 68.3 2.4 13.7 2.5 12.9 0.3 100.0 84.4 2,799 40-44 68.0 2.5 13.1 3.4 12.6 0.3 100.0 83.7 2,133 45-49 64.1 3.5 15.5 2.7 14.0 0.2 100.0 83.1 1,654 50-54 60.1 4.2 17.1 5.5 12.9 0.3 100.0 81.4 1,652 55-59 62.4 3.1 13.2 6.7 14.4 0.2 100.0 78.7 1,188 60-64 55.2 2.2 13.8 10.7 17.7 0.3 100.0 71.3 1,354 65-69 53.5 3.1 15.0 11.1 17.0 0.2 100.0 71.6 753 70-74 48.9 1.8 14.5 15.3 19.5 0.1 100.0 65.1 858 75-79 36.8 2.7 13.6 21.9 24.4 0.6 100.0 53.1 373 80+ 29.8 3.6 10.6 27.2 28.4 0.5 100.0 43.9 641 Total 10+1 44.2 2.2 12.2 4.0 36.8 0.6 100.0 58.6 41,858 Total 15+1 54.5 2.6 14.2 4.2 24.2 0.4 100.0 71.3 33,257 FEMALE 10-14 1.4 0.1 1.4 3.6 91.7 1.8 100.0 2.9 8,037 15-19 4.3 0.5 7.2 3.3 84.2 0.5 100.0 12.0 6,845 20-24 11.1 1.5 13.9 3.0 69.9 0.6 100.0 26.5 5,693 25-29 16.4 2.0 17.6 3.0 60.7 0.3 100.0 36.0 5,043 30-34 20.1 2.5 20.0 2.4 54.6 0.3 100.0 42.7 3,441 35-39 25.0 2.2 20.3 2.4 49.9 0.2 100.0 47.6 2,916 40-44 27.5 1.6 19.7 3.0 47.8 0.4 100.0 48.8 1,917 45-49 30.4 2.2 19.4 5.0 42.9 0.1 100.0 51.9 1,594 50-54 29.1 1.3 16.8 7.2 45.3 0.2 100.0 47.3 2,418 55-59 27.0 1.7 16.8 9.5 44.5 0.6 100.0 45.5 1,316 60-64 26.1 3.2 11.8 10.0 47.7 1.2 100.0 41.1 1,017 65-69 24.6 0.9 11.9 10.9 51.2 0.4 100.0 37.4 562 70-74 14.7 1.5 14.6 13.2 54.3 1.7 100.0 30.8 609 75-79 11.7 2.3 11.1 11.5 60.6 2.8 100.0 25.0 322 80+ 11.0 1.7 5.9 20.6 57.1 3.7 100.0 18.6 632 Total 10+1 14.1 1.3 12.3 4.3 67.1 0.8 100.0 27.8 42,368 Total 15+1 17.1 1.6 14.9 4.5 61.4 0.5 100.0 33.6 34,326 TOTAL 10-14 3.1 0.2 3.0 3.5 88.5 1.7 100.0 6.3 16,627 15-19 17.7 1.2 10.3 2.9 67.5 0.5 100.0 29.1 13,660 20-24 32.7 2.0 14.3 2.4 48.2 0.4 100.0 49.0 11,070 25-29 37.8 2.4 16.4 2.4 40.6 0.4 100.0 56.6 9,332 30-34 43.0 2.9 17.0 2.3 34.4 0.3 100.0 63.0 6,813 35-39 46.2 2.3 17.1 2.4 31.7 0.2 100.0 65.6 5,715 40-44 48.8 2.1 16.2 3.3 29.3 0.3 100.0 67.2 4,050 45-49 47.6 2.9 17.4 3.8 28.2 0.1 100.0 67.8 3,248 50-54 41.7 2.5 16.9 6.5 32.1 0.2 100.0 61.1 4,070 55-59 43.8 2.4 15.1 8.1 30.2 0.4 100.0 61.3 2,504 60-64 42.8 2.6 13.0 10.4 30.6 0.7 100.0 58.4 2,371 65-69 41.2 2.2 13.7 11.1 31.7 0.3 100.0 57.0 1,315 70-74 34.7 1.6 14.5 14.4 33.9 0.8 100.0 50.9 1,467 75-79 25.1 2.5 12.5 17.1 41.2 1.7 100.0 40.1 694 80+ 20.4 2.7 8.2 23.9 42.6 2.1 100.0 31.3 1,273 Total 10+1 29.1 1.7 12.3 4.2 52.1 0.7 100.0 43.1 84,226 Total 15+1 35.5 2.1 14.6 4.3 43.1 0.4 100.0 52.1 67,582 1 Total includes household members with missing information on age. 194 • Harmful Health Practices Figure 15.2 Percentage of current users of al-Qat by sex and age Overall, al-Qat use has not changed since 2003 (YFHS), when 42 percent of household members age 10 and older were current users. The percentage of household members who have never used al-Qat, however, has decreased from 56 percent in 2003 to 52 percent in 2013. Table 15.4 displays the percentage of household members age 10 and older who chew al-Qat, according to background characteristics. Residents in rural areas are more likely to chew al-Qat than urban residents (44 percent versus 40 percent). Across governorates, there is wide variation in current use of al- Qat, ranging from just 5 percent of household members in Hadramout Governorate to 55 percent of those in Ibb Governorate. The results show an inverse relationship between wealth quintile and al-Qat use. Forty- seven percent of household members in the lowest wealth quintile chew al-Qat, as compared with 38 percent of those in the highest wealth quintile. 0 10 20 30 40 50 60 70 80 90 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80 + Age Male Female YNHDS 2013 Percentage Harmful Health Practices • 195 Table 15.4 Use of al-Qat by background characteristics Percentage of household members age 10 and older who currently chew al-Qat, by sex and background characteristics, Yemen 2013 Male Female Total Background characteristic Percentage of current users Number of household members Percentage of current users Number of household members Percentage of current users Number of household members Residence Urban 56.7 13,550 24.0 13,626 40.3 27,176 Rural 59.5 28,308 29.6 28,742 44.4 57,050 Governorate Ibb 68.8 4,532 41.6 4,736 54.9 9,268 Abyan 49.7 936 1.6 940 25.6 1,876 Sana’a City 62.4 3,829 29.7 3,848 46.0 7,677 Al-Baidha 52.8 1,657 3.7 1,725 27.7 3,382 Taiz 69.3 5,459 36.3 5,758 52.4 11,217 Al-Jawf 49.5 332 9.7 314 30.2 646 Hajjah 58.5 2,422 30.8 2,411 44.7 4,833 Al-Hodiedah 59.3 5,147 34.1 5,201 46.6 10,348 Hadramout 9.3 2,518 0.1 2,440 4.8 4,958 Dhamar 63.2 2,840 35.5 2,827 49.4 5,667 Shabwah 28.8 930 0.8 906 15.0 1,837 Sadah 65.1 1,287 31.3 1,300 48.1 2,587 Sana’a 69.4 2,181 31.4 2,149 50.5 4,330 Aden 54.1 1,447 13.3 1,540 33.0 2,987 Lahj 51.3 1,212 4.2 1,216 27.7 2,428 Mareb 47.7 303 9.4 307 28.4 610 Al-Mhweit 64.0 1,042 33.5 1,058 48.6 2,100 Al-Mhrah 11.8 170 0.7 161 6.4 330 Amran 68.4 1,617 28.5 1,526 49.1 3,142 Aldhalae 67.4 1,081 33.8 1,103 50.4 2,184 Reimah 59.1 914 43.2 904 51.2 1,818 Education No education 70.2 8,232 41.0 18,949 49.9 27,181 Fundamental 46.8 21,366 16.4 17,217 33.2 38,583 Secondary 69.1 7,800 19.2 4,199 51.6 11,999 Higher 75.9 4,304 17.0 1,832 58.3 6,136 Don’t know/missing 62.2 155 22.4 172 41.3 327 Wealth quintile Lowest 60.7 7,789 34.1 7,972 47.3 15,760 Second 61.6 8,161 32.3 8,233 46.9 16,394 Middle 62.2 8,401 29.0 8,369 45.6 16,770 Fourth 53.4 8,677 22.9 8,678 38.2 17,356 Highest 55.6 8,829 21.5 9,117 38.3 17,946 Total 58.6 41,858 27.8 42,368 43.1 84,226 15.3 ORANGE SNUFF Orange snuff (or shamma) is a smokeless tobacco used in Yemen. Snuff has been linked to immune dysfunction, reproductive impacts such as perinatal mortality and preterm birth, and cardiovascular effects, among other adverse health outcomes (Willis et al., 2012). Overall, 9 percent of household members age 10 and older and 11 percent of household members age 15 and older are current orange snuff users (Table 15.5). As with smoking and al-Qat chewing, current use is much higher among men than among women. Among the household population age 10 and older, almost three times as many males as females use orange snuff (14 percent and 5 percent, respectively). The relationship between age and current orange snuff use differs from the relationship between age and smoking or al-Qat use. With smoking and al-Qat, there is a sharp increase in the late teens or 20s and a drop-off in use at older ages. With orange snuff, however, there is a gradual increase with age and no drop-off at older ages (Figure 15.3). 196 • Harmful Health Practices Table 15.5 Use of orange snuff Percent distribution of household members age 10 and older by whether they currently use orange snuff, have used in the past, or never used orange snuff, and percentage of current users, according to sex and age, Yemen 2013 Currently uses orange snuff Used before Never used Don’t know/missing Total Percentage of current users Number of household members Age Uses Uses sometimes MALE 10-14 0.8 0.1 0.0 97.3 1.7 100.0 0.9 8,591 15-19 3.6 0.3 0.1 95.2 0.7 100.0 4.0 6,815 20-24 8.8 0.6 0.6 89.7 0.4 100.0 9.4 5,376 25-29 15.4 1.1 0.6 82.3 0.6 100.0 16.5 4,289 30-34 18.7 1.7 0.8 78.5 0.4 100.0 20.3 3,372 35-39 19.9 1.9 0.9 76.9 0.4 100.0 21.8 2,799 40-44 22.9 1.5 0.7 74.6 0.3 100.0 24.4 2,133 45-49 21.8 1.9 1.6 74.5 0.3 100.0 23.6 1,654 50-54 27.3 1.3 1.8 69.4 0.2 100.0 28.6 1,652 55-59 26.4 1.2 2.0 70.1 0.3 100.0 27.6 1,188 60-64 25.4 1.2 2.2 70.6 0.5 100.0 26.6 1,354 65-69 28.9 1.1 4.1 65.6 0.2 100.0 30.0 753 70-74 29.2 0.9 5.3 64.5 0.2 100.0 30.0 858 75-79 28.0 1.2 4.1 66.0 0.8 100.0 29.1 373 80+ 29.5 0.8 8.6 60.6 0.6 100.0 30.3 641 Total 10+1 12.8 0.9 0.9 84.7 0.7 100.0 13.7 41,858 Total 15+1 15.9 1.1 1.2 81.4 0.5 100.0 17.0 33,257 FEMALE 10-14 0.4 0.1 0.0 97.5 1.9 100.0 0.6 8,037 15-19 1.0 0.2 0.0 98.2 0.5 100.0 1.2 6,845 20-24 1.8 0.2 0.1 97.1 0.7 100.0 2.0 5,693 25-29 4.0 0.2 0.1 95.2 0.5 100.0 4.2 5,043 30-34 4.9 0.7 0.3 93.6 0.5 100.0 5.6 3,441 35-39 6.4 1.0 0.4 92.0 0.3 100.0 7.4 2,916 40-44 8.3 0.8 0.6 89.9 0.4 100.0 9.1 1,917 45-49 10.3 1.2 0.8 87.3 0.4 100.0 11.4 1,594 50-54 9.6 1.1 0.9 88.1 0.4 100.0 10.6 2,418 55-59 12.9 0.9 1.7 83.7 0.8 100.0 13.8 1,316 60-64 12.1 1.5 2.8 82.1 1.5 100.0 13.6 1,017 65-69 11.0 0.7 3.1 84.7 0.5 100.0 11.7 562 70-74 12.6 0.3 3.2 82.1 1.9 100.0 12.9 609 75-79 12.6 0.7 1.4 82.4 2.8 100.0 13.3 322 80+ 11.6 0.0 4.0 80.1 4.2 100.0 11.6 632 Total 10+1 4.4 0.4 0.5 93.8 0.9 100.0 4.8 42,368 Total 15+1 5.3 0.5 0.6 92.9 0.7 100.0 5.9 34,326 TOTAL 10-14 0.6 0.1 0.0 97.4 1.8 100.0 0.8 16,627 15-19 2.3 0.3 0.1 96.7 0.6 100.0 2.6 13,660 20-24 5.2 0.4 0.3 93.5 0.6 100.0 5.6 11,070 25-29 9.3 0.6 0.3 89.3 0.5 100.0 9.9 9,332 30-34 11.7 1.2 0.6 86.1 0.5 100.0 12.9 6,813 35-39 13.0 1.4 0.7 84.6 0.3 100.0 14.4 5,715 40-44 16.0 1.1 0.6 81.9 0.4 100.0 17.1 4,050 45-49 16.1 1.5 1.2 80.8 0.4 100.0 17.7 3,248 50-54 16.8 1.2 1.3 80.5 0.3 100.0 17.9 4,070 55-59 19.3 1.1 1.8 77.3 0.6 100.0 20.3 2,504 60-64 19.7 1.3 2.5 75.6 0.9 100.0 21.0 2,371 65-69 21.2 0.9 3.7 73.8 0.3 100.0 22.2 1,315 70-74 22.3 0.6 4.4 71.8 0.9 100.0 22.9 1,467 75-79 20.9 0.9 2.8 73.6 1.7 100.0 21.8 694 80+ 20.6 0.4 6.3 70.3 2.4 100.0 21.0 1,273 Total 10+1 8.6 0.7 0.7 89.3 0.8 100.0 9.2 84,226 Total 15+1 10.5 0.8 0.9 87.3 0.6 100.0 11.3 67,582 1 Total includes household members with missing information on age. Harmful Health Practices • 197 Figure 15.3 Percentage of current users of orange snuff by sex and age Use of orange snuff has declined slightly over the past 10 years. In 2003, 11 percent of household members age 10 and older were currently using orange snuff, as compared with 9 percent of household members in 2013. Table 15.6 displays the percentage of household members age 10 and older who currently use orange snuff, according to background characteristics. Orange snuff use is almost twice as prevalent in rural areas as urban areas (11 percent and 6 percent, respectively). By governorate, orange snuff use ranges from 1 percent among household members in Al-Baidha Governorate to 21 percent among those in Hajjah and Al- Hodiedah governorates. Orange snuff use has an inverse relationship with education and wealth quintile. Sixteen percent of household members with no education use orange snuff, as compared with 4 percent of those with a higher education. Similarly, 19 percent of household members in the lowest wealth quintile use orange snuff, compared with 3 percent of those in the highest wealth quintile. 0 5 10 15 20 25 30 35 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80 + Age Male Female YNHDS 2013 Percentage 198 • Harmful Health Practices Table 15.6 Use of orange snuff by background characteristics Percentage of household members age 10 and older who currently use orange snuff, by sex and background characteristics, Yemen 2013 Male Female Total Background characteristic Percentage of current users Number of household members Percentage of current users Number of household members Percentage of current users Number of household members Residence Urban 9.3 13,550 2.6 13,626 5.9 27,176 Rural 15.8 28,308 5.9 28,742 10.8 57,050 Governorate Ibb 10.5 4,532 1.1 4,736 5.7 9,268 Abyan 5.4 936 0.3 940 2.8 1,876 Sana’a City 4.1 3,829 0.6 3,848 2.3 7,677 Al-Baidha 2.2 1,657 0.0 1,725 1.1 3,382 Taiz 9.1 5,459 2.4 5,758 5.7 11,217 Al-Jawf 19.7 332 1.0 314 10.6 646 Hajjah 26.4 2,422 16.1 2,411 21.2 4,833 Al-Hodiedah 26.3 5,147 16.1 5,201 21.2 10,348 Hadramout 6.5 2,518 0.2 2,440 3.4 4,958 Dhamar 10.0 2,840 4.2 2,827 7.1 5,667 Shabwah 6.9 930 0.1 906 3.5 1,837 Sadah 27.0 1,287 8.2 1,300 17.6 2,587 Sana’a 18.1 2,181 0.8 2,149 9.5 4,330 Aden 15.3 1,447 3.2 1,540 9.1 2,987 Lahj 8.2 1,212 0.4 1,216 4.3 2,428 Mareb 11.8 303 1.0 307 6.4 610 Al-Mhweit 25.0 1,042 4.5 1,058 14.7 2,100 Al-Mhrah 11.5 170 1.8 161 6.8 330 Amran 20.7 1,617 8.3 1,526 14.7 3,142 Aldhalae 6.5 1,081 0.4 1,103 3.4 2,184 Reimah 17.0 914 13.0 904 15.0 1,818 Education No education 31.1 8,232 9.4 18,949 16.0 27,181 Fundamental 10.5 21,366 1.3 17,217 6.4 38,583 Secondary 8.0 7,800 0.6 4,199 5.4 11,999 Higher 5.6 4,304 0.5 1,832 4.1 6,136 Don’t know/missing 27.7 155 13.4 172 20.2 327 Wealth quintile Lowest 24.5 7,789 13.8 7,972 19.1 15,760 Second 17.0 8,161 5.3 8,233 11.1 16,394 Middle 12.8 8,401 2.7 8,369 7.7 16,770 Fourth 10.1 8,677 2.2 8,678 6.1 17,356 Highest 5.4 8,829 1.1 9,117 3.2 17,946 Total 13.7 41,858 4.8 42,368 9.2 84,226 Chronic Disease, Disability, and Injury • 199 CHRONIC DISEASE, DISABILITY, AND INJURY 16 nformation about the health status of the population is of great importance for proper health care planning. Chronic illnesses can place demands on the health care system and can lead to long-term disability. Accidental injury can also strain health care services. Data on these issues can help in formulating policies to prevent illness and injury. In the 2013 YNHDS, respondents to the Household Questionnaire were asked whether each household member suffered from one or more chronic diseases and whether the disease was diagnosed by a physician. They were also asked if household members suffered from any physical, mental, or other state that limited them from engaging in normal activities. Finally, respondents were asked if any household member had been injured in the two years preceding the survey. If the answer to any of these questions was affirmative, follow-up questions were asked about the type of disease, disability, and/or injury. 16.1 PREVALENCE OF CHRONIC DISEASES Table 16.1 shows that, according to the reports of Household Questionnaire respondents, 12 percent of household members suffer from one or more diseases diagnosed by a physician. Nine percent have only one chronic disease, meaning that 3 percent of household members suffer with more than one chronic illness. Urban residents have a slightly higher reported prevalence of chronic disease than rural residents (13 percent versus 12 percent). Females are more likely than males to have at least one chronic disease (13 percent and 11 percent, respectively). As expected, the prevalence of chronic illness increases dramatically with age. Whereas only 3 percent of children under age 10 have a chronic disease, the proportion rises to just under half among household members age 70 and older (48 percent). Older household members are also much more likely than younger ones to have more than one chronic disease. For example, the proportions of those under age 10 who have only one and at least one chronic disease are almost the same, while 30 percent of those age 70 and over have only one chronic disease and 48 percent have at least one. This means that about 18 percent of household members age 70 and over have more than one chronic illness. These patterns are similar for both males and females. I Key Findings • As reported by respondents to the Household Questionnaire, 12 percent of the population in Yemen has at least one chronic disease. This proportion rises dramatically with age; almost half of those age 70 and older have a chronic disease. • The most common chronic diseases are high blood pressure, inflammation or ulcers, and arthritis. • Three percent of household members were reported to have a disability, with mobility impairments and visual disorders being the most common disabilities. • Nine percent of households were reported to have had a household member injured in the two years before the survey. The main causes of injuries are traffic accidents and falls. 200 • Chronic Disease, Disability, and Injury Table 16.1 Prevalence of chronic or other diseases Percentage of de jure household members who have only one chronic or other disease diagnosed by a physician, and percentage who have at least one chronic disease diagnosed by a physician, according to the household respondent’s report, by sex, age, and residence, Yemen 2013 Background characteristic Percentage of household members who have only one chronic or other disease diagnosed by a physician Percentage of household members who have at least one chronic or other disease diagnosed by a physician Number of de jure household members MALE Age 0-9 3.0 3.4 16,394 10-19 3.9 4.3 15,353 20-29 7.6 8.7 9,605 30-39 13.1 15.9 6,115 40-49 17.4 23.4 3,761 50-59 22.0 34.0 2,828 60-69 23.8 38.8 2,096 70+ 29.8 48.5 1,858 Residence Urban 8.8 11.8 17,842 Rural 8.4 11.1 40,178 Total1 8.5 11.3 58,021 FEMALE Age 0-9 2.3 2.5 15,913 10-19 4.1 4.7 14,758 20-29 8.4 10.6 10,507 30-39 14.9 19.8 6,284 40-49 21.8 31.1 3,493 50-59 25.7 40.3 3,696 60-69 29.1 48.5 1,543 70+ 29.1 47.6 1,524 Residence Urban 9.6 13.6 17,681 Rural 9.3 12.8 40,042 Total1 9.4 13.0 57,723 TOTAL Age 0-9 2.6 2.9 32,307 10-19 4.0 4.5 30,111 20-29 8.0 9.7 20,112 30-39 14.0 17.9 12,399 40-49 19.5 27.1 7,254 50-59 24.1 37.6 6,523 60-69 26.0 42.9 3,638 70+ 29.5 48.1 3,382 Residence Urban 9.2 12.7 35,523 Rural 8.8 11.9 80,220 Total1 8.9 12.2 115,743 1 Total includes household members with missing information on age. Table 16.2 shows the prevalence of specific types of chronic and other diseases according to residence and sex. The most commonly reported chronic disease is high blood pressure or hypertension, which affects 2 percent of Yemen’s population (Figure 16.1). Inflammation or ulcers and arthritis also affect almost 2 percent of the population. Diseases that affect about 1 percent of the household population include diabetes, kidney disease, heart disease, asthma, chronic back pain, and mental illness. Differences in the prevalence of specific diseases by residence and sex are small. Chronic Disease, Disability, and Injury • 201 Table 16.2 Prevalence of specific chronic or other diseases Percentage of de jure household members who have specific chronic or other diseases diagnosed by a physician, by place of residence and sex, Yemen 2013 Residence Sex Total Type of disease Urban Rural Male Female Blood pressure 2.7 1.7 1.8 2.2 2.0 Diabetes 2.3 1.0 1.6 1.1 1.4 Inflammation or ulcers 1.3 1.9 1.3 2.1 1.7 Anemia 0.1 0.2 0.1 0.2 0.2 Sickle cell anemia 0.0 0.1 0.1 0.1 0.1 Thalassemia 0.1 0.1 0.1 0.1 0.1 Heart disease 1.0 0.7 0.9 0.7 0.8 Kidney disease 1.0 1.6 1.4 1.5 1.4 Liver disease 0.4 0.3 0.4 0.3 0.3 Arthritis 1.3 1.6 0.9 2.1 1.5 Chronic headache 0.2 0.3 0.1 0.4 0.3 Stroke 0.1 0.1 0.2 0.1 0.1 Epilepsy 0.2 0.2 0.2 0.1 0.2 Asthma 0.8 0.6 0.6 0.6 0.6 Lung disease 0.2 0.2 0.2 0.2 0.2 Hyperactive thyroid 0.2 0.1 0.1 0.2 0.1 Hypoactive thyroid 0.1 0.0 0.0 0.0 0.0 Prostatitis 0.1 0.1 0.1 0.0 0.1 Cataract 0.1 0.1 0.1 0.1 0.1 Opacity of eye lens 0.1 0.1 0.1 0.1 0.1 Chronic back pain or problems in the spinal cord 0.7 0.6 0.5 0.7 0.6 Mental illness 0.4 0.5 0.7 0.3 0.5 Skin disease 0.3 0.3 0.3 0.4 0.3 Cancerous tumors 0.1 0.0 0.0 0.1 0.1 Gum or mouth disease 0.1 0.1 0.1 0.1 0.1 Other, not listed above 1.8 2.1 1.8 2.2 2.0 Any disease (at least one disease) 12.7 11.9 11.3 13.0 12.2 Number of household members 35,523 80,220 58,021 57,723 115,743 Note: The reported prevalence of tuberculosis was 0.0 for all groups. A person may have two reported diseases; consequently, the percentages by specific diseases sum to more than the percentage for any disease. Figure 16.1 Prevalence of most common chronic diseases Table 16.3 shows the prevalence of the most common specific chronic diseases according to age group, by residence and sex. As noted, disease prevalence increases rapidly with age. Also, chronic illness is slightly more common among urban than rural residents and among females than males. The table shows that these patterns largely hold for specific diseases. For example, almost all of the most common chronic 2 2 1 1 1 1 1 1 1 4 2 1 2 1 2 2 1 1 0 5Percentage Male Female YNHDS 2013 202 • Chronic Disease, Disability, and Injury diseases show an increase in prevalence by age group. Among those age 60 and over, 14-15 percent have high blood pressure, 7-11 percent have arthritis, and 8-10 percent have diabetes. Table 16.3 Prevalence of most common specific chronic or other diseases Percentage of de jure household members who have a specific chronic or other disease diagnosed by a physician, by age and sex, Yemen 2013 Disease Any disease Number of household members Background characteristic Blood pressure Diabetes Inflam- mation or ulcers Heart disease Kidney disease Arthritis Asthma Chronic back pain or problems in the spinal cord Mental illness Other MALE Age 0-9 0.0 0.0 0.1 0.2 0.1 0.1 0.5 0.0 0.1 2.5 3.4 16,394 10-19 0.0 0.1 0.2 0.2 0.3 0.4 0.4 0.1 0.2 2.6 4.3 15,353 20-29 0.2 0.3 1.4 0.4 1.7 0.4 0.6 0.4 1.0 3.1 8.7 9,605 30-39 1.5 1.6 2.7 0.6 2.9 0.8 0.5 0.7 1.9 4.9 15.9 6,115 40-49 4.2 4.9 3.5 1.4 3.4 0.9 0.8 1.4 1.9 6.2 23.3 3,761 50-59 8.5 8.1 5.0 3.5 3.9 2.5 1.6 1.9 1.9 7.7 34.0 2,828 60-69 12.1 9.7 4.0 4.9 4.0 4.1 0.9 2.1 1.2 8.3 38.8 2,096 70+ 14.1 8.9 3.2 5.4 3.7 8.8 1.6 2.6 0.5 15.9 48.5 1,858 Residence Urban 2.3 2.6 1.1 1.1 0.9 0.7 0.7 0.5 0.7 3.8 11.8 17,842 Rural 1.6 1.2 1.4 0.7 1.6 1.0 0.6 0.5 0.7 4.1 11.1 40,178 Total1 1.8 1.6 1.3 0.9 1.4 0.9 0.6 0.5 0.7 4.0 11.3 58,021 FEMALE Age 0-9 0.0 0.0 0.0 0.1 0.1 0.1 0.2 0.0 0.0 2.0 2.5 15,913 10-19 0.0 0.0 0.5 0.2 0.6 0.6 0.3 0.2 0.1 2.5 4.7 14,758 20-29 0.3 0.2 2.2 0.4 2.1 1.1 0.5 0.5 0.3 4.6 10.6 10,507 30-39 1.5 0.8 4.9 0.9 3.2 2.3 1.1 1.4 1.0 6.9 19.8 6,284 40-49 5.7 2.4 5.6 1.5 3.7 4.9 1.7 1.8 0.7 10.8 31.1 3,493 50-59 12.0 6.8 6.4 2.5 3.3 8.6 1.1 2.8 0.5 9.0 40.3 3,696 60-69 16.0 9.1 5.2 3.4 2.7 11.9 1.2 3.3 0.9 12.1 48.5 1,543 70+ 15.4 6.6 5.1 3.3 2.1 12.6 2.6 1.8 0.4 12.8 47.6 1,524 Residence Urban 3.1 2.0 1.6 0.9 1.1 2.0 0.8 0.9 0.2 4.2 13.5 17,681 Rural 1.8 0.7 2.3 0.6 1.7 2.2 0.5 0.6 0.4 4.9 12.8 40,042 Total1 2.2 1.1 2.1 0.7 1.5 2.1 0.6 0.7 0.3 4.7 13.0 57,723 TOTAL Age 0-9 0.0 0.0 0.1 0.2 0.1 0.1 0.4 0.0 0.0 2.3 2.9 32,307 10-19 0.0 0.1 0.4 0.2 0.4 0.5 0.4 0.1 0.1 2.6 4.5 30,111 20-29 0.3 0.2 1.8 0.4 1.9 0.8 0.6 0.4 0.6 3.9 9.7 20,112 30-39 1.5 1.2 3.8 0.8 3.1 1.5 0.8 1.1 1.4 5.9 17.9 12,399 40-49 4.9 3.7 4.5 1.4 3.6 2.8 1.3 1.6 1.3 8.5 27.1 7,254 50-59 10.5 7.3 5.8 2.9 3.5 5.9 1.3 2.4 1.1 8.5 37.6 6,523 60-69 13.8 9.5 4.5 4.3 3.5 7.4 1.1 2.6 1.1 9.9 42.9 3,638 70+ 14.7 7.9 4.0 4.5 3.0 10.5 2.1 2.3 0.4 14.5 48.1 3,382 Residence Urban 2.7 2.3 1.3 1.0 1.0 1.3 0.8 0.7 0.4 4.0 12.7 35,523 Rural 1.7 1.0 1.9 0.7 1.6 1.6 0.6 0.6 0.5 4.5 11.9 80,220 Total1 2.0 1.4 1.7 0.8 1.4 1.5 0.6 0.6 0.5 4.4 12.2 115,743 1 Total includes household members with missing information on age. A person may have two reported diseases; consequently, the percentages by specific diseases sum to more than the percentage for any disease. 16.2 PREVALENCE OF DISABILITY The 2013 YNHDS included a series of questions on disability. Respondents were asked whether each household member had, for six months or more, any physical or mental disability that limited (relative to other people of the same age) his or her ability to perform daily activities. If the answer was yes, the interviewer asked if the household member’s disability was severely or moderately limiting. Then the respondent was asked the type and origin of the disability and whether the disabled person had received any care or support in the past 12 months. It should be noted that respondents’ reports of disability were not verified by a clinical diagnosis; therefore, the percentages presented here should be interpreted with caution. Table 16.4 shows the percent distribution of household members by disability status according to sex, age, and urban-rural residence. Chronic Disease, Disability, and Injury • 203 Table 16.4 Prevalence of disability Percent distribution of the de jure household population by disability status, and percentage of household members who have any disability according to the household respondent’s report, by sex, age, and residence, Yemen 2013 Background characteristic Household members who have severe disability Household members who have moderate disability Household members who do not have any disability Don’t know/missing Total Percentage of household members who have any disability Number of household members MALE Age 0-9 0.8 0.7 98.0 0.5 100.0 1.5 16,394 10-19 1.1 1.2 97.2 0.5 100.0 2.3 15,353 20-29 1.3 1.9 96.5 0.4 100.0 3.1 9,605 30-39 1.9 2.2 95.3 0.6 100.0 4.2 6,115 40-49 2.0 2.7 94.8 0.5 100.0 4.6 3,761 50-59 2.5 3.9 93.3 0.3 100.0 6.4 2,828 60-69 3.8 6.5 89.4 0.3 100.0 10.3 2,096 70+ 9.4 9.9 80.2 0.5 100.0 19.3 1,858 Residence Urban 1.7 1.9 95.9 0.5 100.0 3.6 17,842 Rural 1.6 2.0 96.0 0.4 100.0 3.6 40,178 Total1 1.6 2.0 95.9 0.5 100.0 3.6 58,021 FEMALE Age 0-9 0.7 0.3 98.5 0.5 100.0 0.9 15,913 10-19 0.9 1.0 97.7 0.4 100.0 1.9 14,758 20-29 0.8 1.0 97.7 0.5 100.0 1.8 10,507 30-39 1.1 1.6 96.7 0.6 100.0 2.7 6,284 40-49 1.5 2.4 95.7 0.3 100.0 4.0 3,493 50-59 1.7 3.1 94.8 0.4 100.0 4.8 3,696 60-69 3.7 6.1 89.4 0.7 100.0 9.9 1,543 70+ 11.0 10.6 78.0 0.3 100.0 21.7 1,524 Residence Urban 1.3 1.3 96.8 0.6 100.0 2.7 17,681 Rural 1.3 1.5 96.8 0.4 100.0 2.8 40,042 Total1 1.3 1.5 96.8 0.5 100.0 2.7 57,723 TOTAL Age 0-9 0.7 0.5 98.3 0.5 100.0 1.2 32,307 10-19 1.0 1.1 97.5 0.4 100.0 2.1 30,111 20-29 1.0 1.4 97.1 0.4 100.0 2.4 20,112 30-39 1.5 1.9 96.0 0.6 100.0 3.4 12,399 40-49 1.8 2.6 95.3 0.4 100.0 4.3 7,254 50-59 2.0 3.4 94.2 0.4 100.0 5.5 6,523 60-69 3.8 6.3 89.4 0.5 100.0 10.1 3,638 70+ 10.1 10.2 79.2 0.4 100.0 20.4 3,382 Residence Urban 1.5 1.6 96.3 0.6 100.0 3.1 35,523 Rural 1.4 1.8 96.4 0.4 100.0 3.2 80,220 Total1 1.4 1.7 96.4 0.5 100.0 3.2 115,743 1 Total includes household members with missing information on age. The table shows that 3 percent of the Yemeni population has some type of disability, with the prevalence of moderate disabilities slightly higher than that of severe disabilities (2 percent and 1 percent, respectively). There is no difference between urban and rural areas; however, males are slightly more likely to have any disability than females (4 percent versus 3 percent). As expected, the reported prevalence of disability increases with age and reaches a maximum of 20 percent among people age 70 and older (Figure 16.2). 204 • Chronic Disease, Disability, and Injury Figure 16.2 Prevalence of any disability by age Table 16.5 shows the percentage of household members with disabilities who suffer from specific types of disabilities, as reported by Household Questionnaire respondents. Among people who have a disability, mobility impairment is the most frequent (38 percent), and it affects people of all ages. Male household members are more likely than female household members to have a mobility impairment (40 percent versus 35 percent). Visual impairment is the second most common type of disability: it affects one third of disabled people (33 percent) and occurs more frequently among females than males (37 percent versus 30 percent). Visual impairment increases with age, from 18 percent among children under age 10 to 51 percent among people age 70 and above. Hearing impairment is the third most common type of disability, affecting 22 percent of disabled people; it is more frequent among females than males (28 percent versus 18 percent). Seventeen percent of disabled people have problems with comprehension or communication skills, while 13 percent have problems dealing with people and 9 percent have problems caring for themselves. Problems with comprehension/communication tend to decrease with age. Table 16.5 Common types of disability Among de jure household members who have any disability, the percentage who are reported to have specific types of disabilities, by sex, age, and residence, Yemen 2013 Among household members with disabilities, percentage who suffer from specific types of disabilities1 Number of household members with disabilities Background characteristic Visual disorder/ impairment Hearing impairment Compre- hension/ communication Mobility impairment Self-care Dealing with people Sex Male 30.3 17.6 18.3 40.3 9.0 14.9 2,089 Female 37.0 27.6 16.3 35.3 9.0 11.5 1,584 Age 0-9 17.8 24.5 35.1 45.4 16.5 17.1 392 10-19 26.1 22.5 26.1 35.2 10.3 14.5 636 20-29 27.1 16.3 21.0 34.9 7.1 18.6 488 30-39 22.7 19.8 19.3 37.3 11.7 20.1 427 40-49 29.2 18.8 16.3 35.5 3.1 17.0 314 50-59 40.2 15.4 7.1 38.3 6.7 9.8 358 60-69 44.8 20.9 9.3 40.9 6.2 8.4 367 70+ 51.1 30.3 5.8 39.2 8.5 5.6 689 Residence Urban 37.9 14.9 17.2 35.8 8.0 11.8 1,108 Rural 31.1 24.9 17.5 39.1 9.5 14.2 2,565 Total2 33.2 21.9 17.4 38.1 9.0 13.4 3,673 1 A person may have several disabilities, so the sum of percentages may exceed 100 percent. 2 Total includes 2 cases with missing information on age. 1 2 2 3 4 6 10 20 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+ Age Percentage YNHDS 2013 Chronic Disease, Disability, and Injury • 205 16.3 ORIGIN AND AGE AT ONSET OF DISABILITY For any household member with a disability, Household Questionnaire respondents were asked about the main reason for or cause of the disability. The results, shown in Table 16.6, indicate that congenital (birth-related) problems and aging each account for about one-fifth of disabilities, whereas non-contagious diseases and injuries each account for an additional 15-16 percent of disabilities. Table 16.6 Origin of disabilities Percent distribution of disabled people according to the origin of disability, by sex, age, and residence, Yemen 2013 Origin of disability Total Number of household members with disabilities Background characteristic Con- genital Conditions related to childbirth Conta- gious disease Other diseases Physical and psycho- logical abuse Aging Injury, accident Supernatural means/magic Other Don’t know/ missing Sex Male 20.0 3.4 4.0 14.2 3.7 14.7 20.9 4.8 6.1 8.2 100.0 2,089 Female 21.0 4.5 3.5 17.5 2.4 25.3 7.4 4.8 5.2 8.3 100.0 1,584 Age 0-9 53.0 11.3 1.9 14.3 1.1 0.3 6.2 1.3 3.1 7.4 100.0 392 10-19 38.6 7.5 3.2 18.7 1.7 0.0 11.3 3.0 6.9 9.3 100.0 636 20-29 30.2 3.4 3.6 14.4 3.4 0.0 19.8 10.0 6.7 8.6 100.0 488 30-39 19.1 4.0 3.4 16.9 6.3 0.1 22.0 8.6 8.7 11.0 100.0 427 40-49 13.6 3.7 2.3 20.5 4.7 4.6 20.1 9.9 9.5 11.1 100.0 314 50-59 4.1 0.1 4.2 20.5 6.6 21.9 24.2 4.5 6.1 7.8 100.0 358 60-69 1.9 0.6 3.8 13.6 2.2 41.7 17.2 3.0 4.5 11.6 100.0 367 70+ 0.6 0.4 6.3 9.9 1.6 66.6 8.0 1.2 2.3 3.1 100.0 689 Residence Urban 24.1 5.2 2.7 17.4 3.5 14.8 13.3 4.8 6.7 7.6 100.0 1,108 Rural 18.8 3.3 4.3 14.8 3.0 21.2 15.9 4.8 5.3 8.6 100.0 2,565 Total1 20.4 3.9 3.8 15.6 3.1 19.3 15.1 4.8 5.7 8.3 100.0 3,673 1 Total includes 2 cases with missing information on age. Aging accounts for a larger proportion of disabilities among women (25 percent) than men (15 percent), while injuries account for a larger proportion of disabilities among men (21 percent) than women (7 percent). Congenital causes of disability decline with increasing age, whereas aging is associated with an increased proportion of disabilities. Injuries and accidents account for a larger proportion of disabilities among those age 30-59 than among those in the younger and older age groups. Table 16.7 provides information about age at disability onset. Differences by sex and residence are minimal. Differences by age group are substantial. As expected, by definition, younger disabled people are younger at onset of disability. In the case of almost one in five disabled household members, respondents were not able to provide an age at onset of disability. Table 16.7 Age at onset of disability Percent distribution of disabled people according to the age at onset of disability, by sex, age, and residence, Yemen 2013 Background characteristic Age at onset of disability Total Number of household members with disabilities At birth 0-4 5-9 10-19 20-29 30-39 40-49 50-59 60-69 70+ Don’t know/ missing Sex Male 23.2 8.8 5.5 8.5 8.2 6.1 4.9 6.5 5.4 4.8 18.1 100.0 2,089 Female 23.6 8.6 5.6 7.9 4.1 5.8 6.3 7.3 5.5 5.3 19.8 100.0 1,584 Age 0-9 61.7 20.7 7.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 10.0 100.0 392 10-19 45.1 17.0 12.2 17.3 0.0 0.0 0.0 0.0 0.0 0.0 8.4 100.0 636 20-29 33.5 10.4 7.9 17.4 18.8 0.0 0.0 0.0 0.0 0.0 12.0 100.0 488 30-39 20.7 9.0 4.5 10.8 23.4 17.7 0.0 0.0 0.0 0.0 13.9 100.0 427 40-49 15.6 2.8 3.8 7.8 8.3 27.0 14.9 0.0 0.0 0.0 19.9 100.0 314 50-59 4.6 2.5 1.4 2.8 2.4 13.6 31.6 20.6 0.0 0.0 20.7 100.0 358 60-69 1.7 3.9 2.0 2.6 0.3 1.0 9.0 31.8 17.7 0.0 30.0 100.0 367 70+ 1.0 1.4 2.1 2.6 1.4 0.9 1.4 8.9 19.8 26.5 34.0 100.0 689 Residence Urban 28.0 7.9 5.0 8.9 6.2 5.7 5.8 6.2 4.3 4.2 17.8 100.0 1,108 Rural 21.4 9.1 5.8 8.0 6.6 6.1 5.4 7.1 6.0 5.4 19.3 100.0 2,565 Total1 23.4 8.7 5.5 8.3 6.4 6.0 5.5 6.8 5.5 5.0 18.8 100.0 3,673 1 Total includes 2 cases with missing information on age. 206 • Chronic Disease, Disability, and Injury 16.4 CARE AND SUPPORT FOR DISABILITIES As shown in Table 16.8, two-thirds of disabled people in Yemen were reported to have not received any care or support for their disability in the 12 months preceding the survey. Just over one-quarter of disabled household members received medical care, while 6 percent received welfare, 3 percent received financial support, and 1 percent received nutritional support. Differences by sex, age, and residence are not large. Table 16.8 Care and support received Percentage of disabled people who received any kind of care and support for their disability in the past 12 months, by sex, age, and residence, Yemen 2013 Care and support received No care/no support Number of household members with disabilities Background characteristic Medical care Welfare Financial support Nutritional support Sex Male 26.8 6.1 3.0 1.3 65.9 2,089 Female 25.3 5.7 2.2 0.8 67.3 1,584 Age 0-9 25.0 4.3 1.6 1.0 71.8 392 10-19 25.8 6.5 2.6 2.3 66.9 636 20-29 23.2 6.2 4.1 0.7 69.3 488 30-39 29.8 6.3 2.9 0.6 64.6 427 40-49 28.9 3.8 2.5 0.6 65.0 314 50-59 25.9 4.9 1.3 0.5 66.3 358 60-69 24.9 2.9 2.8 0.5 66.5 367 70+ 26.6 9.0 2.8 1.4 62.9 689 Residence Urban 26.5 5.4 3.5 0.9 62.9 1,108 Rural 26.0 6.2 2.3 1.1 68.0 2,565 Total1 26.1 5.9 2.6 1.1 66.5 3,673 1 Total includes 2 cases with missing information on age. 16.5 INJURIES AND ACCIDENTS In the 2013 YNHDS, Household Questionnaire respondents were asked if they or any member of the household had been injured or had an accident in the two years before the survey. Responses allowed for reporting of injuries among anyone who had been a member of the household over the two prior years, including those who might have moved away or died. Consequently, the data do not necessarily correspond to current household members and do not allow for computation of the prevalence or incidence of injuries among the population. Nine percent of household respondents reported that at least one member of the household had been injured or had an accident in the two years before the survey (Table 16.9). The proportion of households with injuries is slightly higher in urban than rural areas (11 percent and 9 percent, respectively). It ranges from only 4 percent of households in Al-Mhrah Governorate to 22 percent of households in Mareb Governorate. Table 16.10 shows the percentage of household members who were injured by the type of injury or accident. Traffic accidents cause the largest proportion of injuries (44 percent), with falls accounting for 29 percent of injured household members. Gunshots were the cause of 8 percent Table 16.9 Injuries and accidents Percentage of households with at least one member who was injured or had an accident in the past 2 years, by background characteristics, Yemen 2013 Background characteristic Percentage of households with members who were injured or had an accident Number of households Residence Urban 11.2 5,413 Rural 8.5 11,938 Governorate Ibb 10.9 1,827 Abyan 12.0 374 Sana’a City 11.6 1,640 Al-Baidha 20.2 533 Taiz 7.5 2,306 Al-Jawf 15.2 142 Hajjah 8.7 1,094 Al-Hodiedah 5.3 2,487 Hadramout 6.6 822 Dhamar 10.2 1,246 Shabwah 6.1 271 Sadah 8.3 493 Sana’a 9.8 779 Aden 12.8 620 Lahj 6.5 601 Mareb 22.0 103 Al-Mhweit 10.7 488 Al-Mhrah 3.8 85 Amran 16.1 622 Aldhalae 8.1 397 Reimah 5.4 423 Total 9.4 17,351 Chronic Disease, Disability, and Injury • 207 of injuries to household members, whereas 6 percent of injured people were hit by someone or by an object of some kind. Five percent of injured household members were burned, and 3 percent were poisoned and/or stabbed. For 1 percent of injured people, the cause of injury was electric shock, and for less than 1 percent the cause was drowning. Traffic accidents cause a larger proportion of injuries in urban areas than in rural areas, whereas falls cause a larger proportion of injuries in rural areas. Due to the relatively small numbers of injured household members, results by governorate should be viewed with caution. Table 16.10 Types of injuries or accidents Among household members who were injured or had an accident, percentage who had different types of accidents, by background characteristics, Yemen 2013 Type of injury or accident1 Number of household members who were injured or had an accident Background characteristic Traffic accident Fall Hit by someone or by an object Stabbed Gunshot Burn Drowning Poisoning Electric shock Other Residence Urban 48.6 20.6 6.9 4.3 7.0 5.6 0.7 4.5 0.9 1.8 727 Rural 41.9 34.0 6.0 1.4 8.7 4.0 0.8 1.6 1.4 0.9 1,192 Governorate Ibb 53.3 27.8 1.9 3.8 7.1 5.5 0.0 0.0 1.4 0.0 234 Abyan 35.7 24.0 11.8 0.5 22.1 3.6 0.0 0.0 1.0 3.0 52 Sana’a City 48.4 21.1 7.5 6.1 5.3 7.7 0.7 2.4 0.8 0.0 213 Al-Baidha 33.9 43.6 4.0 5.1 5.3 3.0 0.0 4.8 0.0 0.8 134 Taiz 21.8 41.6 14.5 0.9 8.3 7.8 1.1 2.9 1.1 0.9 211 Al-Jawf 50.9 16.9 3.5 3.4 14.8 8.9 1.3 2.4 0.0 0.0 23 Hajjah 60.6 25.9 0.7 1.1 5.3 2.1 0.8 0.9 2.8 0.0 119 Al-Hodiedah 55.6 19.8 8.6 0.0 0.0 1.6 0.0 6.4 0.0 8.2 157 Hadramout 52.1 38.8 5.8 1.3 0.0 1.0 1.4 1.0 0.0 0.0 64 Dhamar 33.5 29.6 5.7 2.5 15.7 3.0 0.0 4.8 2.1 3.0 155 Shabwah 69.1 19.2 3.4 2.2 3.7 0.0 0.7 0.7 0.7 0.0 20 Sadah 57.4 14.1 5.3 1.2 8.7 2.3 1.3 12.6 1.1 0.0 52 Sana’a 47.4 29.3 4.0 2.0 8.0 7.1 0.9 1.2 1.1 0.0 84 Aden 44.4 30.6 7.0 0.0 7.6 4.7 1.6 1.6 2.4 0.0 91 Lahj 35.3 46.4 5.3 0.0 3.9 3.0 0.0 0.0 1.8 4.2 40 Mareb 57.5 18.7 4.4 2.1 14.2 3.7 0.5 1.3 0.0 1.0 28 Al-Mhweit 47.1 31.0 3.0 0.8 5.7 4.8 3.8 3.8 0.0 0.0 56 Al-Mhrah * * * * * * * * * * 3 Amran 40.0 23.0 8.9 4.2 16.2 3.7 1.4 2.2 2.5 0.0 115 Aldhalae 47.2 27.7 3.8 2.1 14.7 1.2 0.0 2.2 0.0 1.0 40 Reimah 39.5 25.9 5.7 0.0 12.1 11.3 5.5 0.0 3.5 0.0 27 Total 44.4 29.0 6.3 2.5 8.0 4.6 0.8 2.7 1.2 1.3 1,919 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 A person may have multiple injuries/accidents, so the sum may exceed 100 percent. 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Appendix A • 211 SAMPLE DESIGN IMPLEMENTATION Appendix A A.1 INTRODUCTION The 2013 Yemen National Health and Demographic Survey (2013 YNHDS) is the fourth survey of its kind and follows surveys completed in 1991-1992, 1997, and 2003. The survey is nationwide and calls for a nationally representative sample of about 20,000 households. All women (ever-married and never- married) age 15-49 living in the selected households or staying in the households the night before the survey were eligible for individual interview. All women age 15-49 and children between age 6-59 months in one- third of the selected households were eligible for an anemia test. The survey was designed to yield approximately 26,505 completed interviews (18,457 ever-married women and 8,048 never-married women), 7,500 anemia tests of women age 15-49, and about 4,000 anemia tests of children age 659 months. It is designed to provide estimates on the levels of fertility, infant and child mortality, use of contraception and family planning, and family welfare and health indicators. Yemen is divided into 20 governorates and Sana’a, the capital city. In turn, each governorate is subdivided into districts, each district into sections, and each section into sectors. In addition to these administrative units, during the last census in 2004, each sector was subdivided into convenient areas called census enumeration areas (EAs). In total, Yemen has about 35,000 EAs. The list of EAs has census information on households and population counts, and also the census cartographic materials. This list of EAs was used as the sampling frame for the 2013 YNHDS. The survey estimates of the 2013 YNHDS will be reported for the country as a whole, for urban and rural areas, and for Sana’a, the capital city, and each of the 20 governorates, namely, Al-Mahrah, Mareb, Raimali, Abyan, Al-Jawf, Shabwah, Al-Dhaleh, Al-Mahwit, Al-Baida, Aden, Saadah, Lahj, Amran, Sana’a, Hadramout, Dhamar, Hajjah, Alamana, Ibb, Al-Hodeidah, and Taiz. A.2 SAMPLING FRAME The sampling frame used for the 2013 YNHDS is based on the General Population, Housing and Establishment Census conducted in 2004 by the Central Statistical Organization. The frame consists of 35,000 EAs. An EA is a convenient geographical area with an average size of 144 households. The frame contains information about each EA location, the type of residences, the number of households, and the population. Each EA has a cartographical map that delimits the boundaries and shows the main landmarks of the EA. Table A.1 shows the 2004 census population distribution of Yemen by governorates. Table A.1 Population distribution by governorates (2004 General Population, Housing and Establishment Census, Yemen) Governorate Population Population % Ibb 2,131,861 10.83 Abyan 433,819 2.20 Sana’a City 1,747,834 8.88 Al-Baidha 577,369 2.93 Taiz 2,393,425 12.16 Al-Jawf 443,797 2.25 Hajjah 1,479,568 7.52 Al-Hodiedah 2,157,552 10.96 Hadramout 1,028,556 5.23 Dhamar 1,330,108 6.76 Shabwah 470,440 2.39 Sadah 695,033 3.53 Sana’a 919,215 4.67 Aden 589,419 2.99 Lahj 722,694 3.67 Mareb 238,522 1.21 Al-Mhweit 494,557 2.51 Al-Mhrah 88,594 0.45 Amran 877,786 4.46 Aldhalae 470,564 2.39 Reimah 394,448 2.00 Yemen 19,685,161 100.00 212 • Appendix A A.3 SAMPLE DESIGN AND SAMPLING PROCEDURE The sample for the 2013 YNHDS is a stratified sample selected in two stages from the 2004 census frame. Stratification was achieved by separating every governorate into urban and rural areas. Because there are no rural areas in Sana’a City or Aden, the governorates were stratified into 40 sampling strata. Samples were selected independently in every stratum, by a two-stage selection process. Implicit stratifications and proportional allocation were achieved at each of the lower geographical/administrative levels by sorting the sampling frame according to geographical/administrative order and by using a probability proportional to size selection at the first stage of sampling. In the first stage, 800 EAs were selected with probability proportional to EA size. The EA size is the number of households residing in the EA. A household listing operation was carried out in all selected EAs, and the resulting lists of households served as a sampling frame for the selection of households in the second stage. Each selected EA was an YNHDS sampling cluster. In the second stage of selection, a fixed number of 25 households per cluster was selected from the newly created household listing. In each rural cluster, one household was randomly selected. This household and the subsequent 24 households in the list together constituted the household sample for each of the 587 rural clusters; in urban clusters, the 25 households were randomly selected with an equal probability systematic selection. In addition, in each cluster, 8 of the 25 households were selected with equal probability systematic selection for anemia testing. The survey interviewer had to interview only the pre-selected households. No replacements and no changes of the pre-selected households were allowed in the implementing stages in order to prevent bias. All women age 15-49 who are usual members of the selected households or who spent the night before the survey in the selected households were eligible for the female survey. Table A.2 shows the allocation of households according to governorate and urban-rural areas, and Table A.3 shows the expected number of completed ever-married and never-married interviews of women, according to governorate and urban-rural areas. To ensure that survey precision was comparable across governorates, the sample allocation figured a power allocation between governorates. The proportional allocation between the urban and rural areas was enough to ensure comparable precision across the urban and rural areas. Based on a fixed sample take of 25 households per cluster, the survey selected 800 EAs, or 213 EAs in urban areas and 587 EAs in rural areas. The survey was conducted in 20,000 residential households, 5,325 urban households, and 14,675 rural households. The sample was expected to result in about 26,505 completed interviews (18,457 ever-married women age 15-49 and 8,048 never-married women age 15-49), 7,916 interviews in urban areas, and 18,589 interviews in rural areas. Appendix A • 213 Table A.2 Sample allocation of clusters and households, according to governorate and by type of residence, YNHDS 2013 Governorate Allocation of clusters Allocation of households Urban Rural Total Urban Rural Total Ibb 8 36 44 200 900 1,100 Abyan 10 26 36 250 650 900 Sanaa City 44 0 44 1,100 0 1,100 Al-Baidha 7 29 36 175 725 900 Taiz 9 35 44 225 875 1,100 Al-Jawf 5 31 36 125 775 900 Hajjah 4 40 44 100 1000 1,100 Al-Hodiedah 14 30 44 350 750 1,100 Hadramout 20 20 40 500 500 1,000 Dhamar 5 35 40 125 875 1,000 Shabwah 7 29 36 175 725 900 Sadah 6 34 40 150 850 1,000 Sanaa 2 38 40 50 950 1,000 Aden 36 0 36 900 0 900 Lahj 3 37 40 75 925 1,000 Mareb 3 25 28 75 625 700 Al-Mhweit 3 33 36 75 825 900 Al-Mhrah 12 12 24 300 300 600 Amran 8 32 40 200 800 1,000 Aldhalae 5 31 36 125 775 900 Reimah 2 34 36 50 850 900 Yemen 213 587 800 5,325 14,675 20,000 Table A.3 Sample allocation for expected number of completed women interviews, according to governorate and by type of residence, YNHDS 2013 Governorate Completed ever-married women interviews Completed never-married women interviews Urban Rural Total Urban Rural Total Ibb 195 814 1009 103 326 429 Abyan 243 588 831 128 235 363 Sanaa City 1071 0 1071 564 0 564 Al-Baidha 170 656 826 90 263 353 Taiz 219 791 1010 115 317 432 Al-Jawf 122 701 823 64 281 345 Hajjah 97 904 1001 51 362 413 Al-Hodiedah 341 678 1019 180 272 452 Hadramout 487 452 939 256 181 437 Dhamar 122 791 913 64 317 381 Shabwah 170 656 826 90 263 353 Sadah 146 769 915 77 308 385 Sanaa 49 859 908 26 344 370 Aden 876 0 876 462 0 462 Lahj 73 837 910 38 335 373 Mareb 73 565 638 38 226 264 Al-Mhweit 73 746 819 38 299 337 Al-Mhrah 292 271 563 154 109 263 Amran 195 724 919 103 290 393 Aldhalae 122 701 823 64 281 345 Reimah 49 769 818 26 308 334 Yemen 5185 13272 18457 2731 5317 8048 The preceding calculations are based on facts obtained from the 2003 Yemen Family Health Survey (YFHS). In urban and rural areas, there are 1.137 and 1.084 ever-married women age 15-49 per household. There also are about 0.56 and 0.434 never-married women age 15-49 per household in urban and rural areas. The household response rates are 91.8 percent for urban and 91.6 percent for rural areas. The ever-married women age 15-54 response rates are 93.3% and 91.1% in urban and rural areas, respectively. We assumed that the latter response rates applied for both ever-married women and never-married women age 15-49. A.4 SAMPLING PROBABILITIES Because of the nonproportional allocation of the sample to different governorates and the possible differences in response rates, sampling weight is required for any analysis that uses the 2013 YNHDS data; this ensures the actual representativeness of the survey results at the national level and the domain level. Because the 2013 YNHDS sample is a two-stage stratified cluster sample, sampling weight is calculated based on separate sampling probabilities for each sampling stage and for each cluster. We use the following notations: 214 • Appendix A P1hi: first-stage sampling probability of the ith cluster in stratum h P2hi: second -stage sampling probability within the ith cluster (households) Let ah be the number of EAs selected in stratum h, Mhi the number of households according to the sampling frame in the ith EA, and M hi the total number of households in the stratum. The probability of selecting the ith EA in the 2013 YNHDS sample is calculated as follows: hih 1hi hi a M = P M Let hiL be the number of households listed in the household listing operation in cluster i in stratum h, let hig be the number of households selected in the cluster. In the second stage the selection probability for each household in the cluster is calculated as follows: hi hi hi L gP =2 The overall selection probability of each household in cluster i of stratum h is therefore the product of the two stages of selection probabilities: hihihi PPP 21 ×= The sampling weight for each household in cluster i of stratum h is the inverse of its overall selection probability: hihi PW /1= Design weight is adjusted for household and individual nonresponse to get the sampling weights for household and women surveys, respectively. The differences between the household sampling weight and the individual sampling weights are introduced by individual nonresponse. The final sampling weights are normalized to give the total number of unweighted cases equal to the total number of weighted cases at national level, for both household and individual weights. The normalized weights are relative weights valid for estimating means, proportions, and ratios but not valid for estimating population totals and for pooling data. A.5 SAMPLE IMPLEMENTATION Table A.4 presents the sample implementation results by the number of households selected and interviewed and the number of ever-married women found and interviewed. Ta bl e A .4 S am pl e im pl em en ta tio n P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le w om en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le w om en a nd o ve ra ll w om en re sp on se ra te s, a cc or di ng to u rb an -r ur al re si de nc e an d re gi on (u nw ei gh te d) , Y em en 2 01 3 R es id en ce G ov er no ra te s To ta l R es ul t U rb an R ur al Ib b A by an S an a’ a C ity A l- B ai dh a Ta iz A l- Ja w f H aj ja h A l- H od ie da h H ad ra - m ou t D ha m ar S ha bw ah S ad ah S an a’ a A de n La hj M ar eb A l- M hw ei t A l- M hr ah A m ra n A ld ha la e R ei m ah Se le ct ed ho us eh ol ds C om pl et ed (C ) 88 .5 89 .0 92 .2 86 .6 93 .6 88 .3 92 .9 71 .7 90 .3 93 .5 84 .9 95 .5 81 .4 82 .0 92 .9 88 .1 84 .8 85 .8 92 .9 85 .7 88 .8 89 .8 94 .8 88 .9 H ou se ho ld pr es en t b ut n o co m pe te nt re sp on de nt a t ho m e (H P ) 0. 8 0. 5 0. 4 0. 0 0. 5 0. 9 0. 6 1. 6 0. 2 0. 5 1. 5 0. 1 0. 8 1. 1 0. 4 1. 4 0. 3 0. 1 0. 7 0. 0 0. 1 1. 4 0. 3 0. 6 P os tp on ed (P ) 0. 0 0. 0 0. 0 0. 0 0. 1 0. 1 0. 1 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 R ef us ed (R ) 3. 5 1. 7 1. 2 1. 7 1. 9 6. 1 0. 7 2. 0 0. 3 0. 7 3. 3 0. 9 8. 0 2. 0 0. 9 3. 8 5. 4 0. 7 0. 8 1. 3 1. 9 2. 1 1. 2 2. 2 D w el lin g no t f ou nd (D N F) 0. 7 0. 6 0. 2 0. 0 0. 0 0. 8 0. 0 3. 3 0. 1 0. 0 0. 4 0. 3 0. 3 6. 7 0. 2 0. 2 0. 1 0. 7 0. 0 1. 5 0. 3 0. 0 0. 0 0. 6 H ou se ho ld a bs en t (H A ) 4. 5 5. 8 3. 5 11 .3 1. 5 3. 6 4. 2 15 .0 8. 8 4. 1 7. 1 2. 1 5. 9 2. 5 1. 4 4. 7 6. 9 9. 5 3. 7 10 .8 6. 8 3. 8 2. 6 5. 4 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V ) 1. 2 1. 4 1. 8 0. 0 1. 8 0. 2 1. 3 1. 7 0. 2 0. 6 2. 4 1. 0 2. 4 3. 8 3. 7 1. 0 0. 4 1. 9 1. 7 0. 5 1. 2 0. 3 1. 0 1. 4 D w el lin g de st ro ye d (D D ) 0. 4 0. 1 0. 3 0. 2 0. 2 0. 0 0. 1 0. 0 0. 1 0. 1 0. 0 0. 0 0. 1 1. 5 0. 1 0. 3 0. 0 0. 1 0. 0 0. 2 0. 0 0. 1 0. 0 0. 2 O th er (O ) 0. 3 0. 8 0. 5 0. 2 0. 4 0. 0 0. 1 4. 6 0. 1 0. 4 0. 4 0. 1 0. 9 0. 5 0. 3 0. 4 2. 1 1. 1 0. 3 0. 0 0. 8 2. 4 0. 1 0. 7 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f s am pl ed ho us eh ol ds 5, 30 0 14 ,2 17 1, 10 0 90 0 1, 10 0 89 5 1, 10 0 69 9 1, 10 0 1, 10 0 97 5 1, 00 0 87 5 85 0 97 5 90 0 1, 00 0 69 8 90 0 60 0 95 0 90 0 90 0 19 ,5 17 H ou se ho ld re sp on se ra te (H R R )1 94 .7 96 .8 98 .2 98 .1 97 .4 91 .8 98 .5 91 .1 99 .4 98 .7 94 .2 98 .7 89 .8 89 .4 98 .4 94 .2 93 .6 98 .2 98 .5 96 .8 97 .5 96 .2 98 .4 96 .3 Ev er -m ar rie d w om en El ig ib le w om en C om pl et ed (E W C ) 96 .3 96 .1 96 .0 98 .5 98 .1 94 .4 98 .5 97 .8 98 .8 98 .6 90 .7 96 .6 92 .4 99 .2 90 .7 94 .9 96 .2 93 .2 96 .7 98 .4 96 .9 98 .3 98 .9 96 .2 N ot a t h om e (E W N H ) 1. 3 1. 9 1. 5 0. 5 0. 7 2. 1 0. 9 0. 4 0. 7 0. 5 4. 6 2. 3 2. 7 0. 1 5. 7 2. 0 0. 7 3. 5 1. 1 0. 3 2. 0 0. 7 0. 8 1. 7 P os tp on ed (E W P ) 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 R ef us ed (E W R ) 1. 5 1. 4 1. 8 0. 7 1. 1 3. 0 0. 3 0. 6 0. 1 0. 6 4. 0 0. 7 4. 0 0. 1 2. 5 1. 4 1. 6 2. 4 1. 1 0. 3 1. 0 0. 2 0. 0 1. 4 P ar tly c om pl et ed (E W P C ) 0. 5 0. 3 0. 3 0. 1 0. 0 0. 1 0. 3 0. 2 0. 1 0. 0 0. 4 0. 0 0. 8 0. 5 0. 8 1. 2 1. 5 0. 4 0. 3 0. 5 0. 0 0. 6 0. 1 0. 4 In ca pa ci ta te d (E W I) 0. 3 0. 3 0. 4 0. 1 0. 1 0. 3 0. 0 0. 8 0. 2 0. 4 0. 1 0. 4 0. 1 0. 0 0. 4 0. 1 0. 0 0. 6 0. 8 0. 5 0. 1 0. 1 0. 1 0. 3 O th er (E W O ) 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f w om en 4, 72 3 12 ,5 95 1, 01 8 75 2 1, 00 8 1, 16 4 99 8 50 3 82 4 85 7 95 2 91 8 88 3 77 0 1, 04 0 69 0 61 0 72 1 79 6 37 8 86 5 83 8 73 3 17 ,3 18 E lig ib le w om en re sp on se ra te (E W R R )2 96 .3 96 .1 96 .0 98 .5 98 .1 94 .4 98 .5 97 .8 98 .8 98 .6 90 .7 96 .6 92 .4 99 .2 90 .7 94 .9 96 .2 93 .2 96 .7 98 .4 96 .9 98 .3 98 .9 96 .2 C on tin ue d… Appendix A • 215 T ab le A .4 — C on tin ue d R es id en ce G ov er no ra te s To ta l R es ul t U rb an R ur al Ib b A by an S an a’ a C ity A l- B ai dh a Ta iz A l- Ja w f H aj ja h A l- H od ie da h H ad ra - m ou t D ha m ar S ha bw ah S ad ah S an a’ a A de n La hj M ar eb A l- M hw ei t A l- M hr ah A m ra n A ld ha la e R ei m ah O ve ra ll w om en re sp on se ra te (O R R )3 3. 0 1. 4 14 .4 17 .6 13 .6 14 .2 13 .6 34 .4 17 .9 15 .2 13 .8 19 .3 12 .4 16 .8 15 .2 14 .4 18 .3 20 .1 22 .4 29 .8 21 .3 15 .1 20 .3 1. 0 N ev er m ar rie d w om en El ig ib le w om en C om pl et ed (E W C ) 90 .8 90 .7 79 .3 78 .0 83 .6 79 .6 81 .1 62 .5 77 .1 81 .6 67 .7 72 .8 82 .1 80 .6 72 .7 78 .9 73 .4 73 .3 72 .7 62 .0 73 .7 80 .7 77 .6 91 .6 N ot a t h om e (E W N H ) 2. 1 2. 8 1. 4 0. 9 0. 4 2. 9 2. 4 0. 4 2. 6 0. 9 5. 2 4. 0 1. 3 0. 0 7. 2 2. 1 1. 6 3. 7 0. 7 3. 1 2. 7 1. 3 1. 3 2. 6 P os tp on ed (E W P ) 0. 1 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 6 0. 0 0. 0 0. 0 0. 0 R ef us ed (E W R ) 2. 1 2. 4 2. 1 1. 1 1. 0 1. 5 0. 7 0. 4 0. 2 1. 1 11 .3 0. 4 1. 2 0. 2 3. 6 2. 4 4. 3 1. 3 2. 4 2. 8 1. 4 0. 5 0. 0 2. 3 P ar tly c om pl et ed (E W P C ) 0. 6 0. 9 0. 2 0. 2 0. 4 0. 5 0. 1 0. 8 0. 7 0. 5 0. 3 1. 0 1. 3 2. 5 0. 0 0. 5 0. 8 0. 7 0. 7 0. 9 0. 2 1. 4 0. 4 0. 8 In ca pa ci ta te d (E W I) 1. 2 1. 8 2. 6 2. 2 0. 9 1. 1 2. 1 1. 5 1. 5 0. 5 1. 6 2. 4 1. 6 0. 0 1. 4 1. 6 1. 6 0. 9 1. 2 0. 6 0. 7 1. 0 0. 4 1. 6 O th er (E W O ) 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 2 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f w om en 2, 99 4 6, 67 8 65 2 54 9 70 5 61 1 71 3 25 9 54 7 63 8 62 0 49 4 66 9 52 9 58 6 62 1 49 2 45 6 42 5 31 9 44 2 62 5 47 9 9, 58 1 E lig ib le w om en re sp on se ra te (E W R R )2 3. 0 1. 4 14 .4 17 .6 13 .6 14 .2 13 .6 34 .4 17 .9 15 .2 13 .8 19 .3 12 .4 16 .8 15 .2 14 .4 18 .3 20 .1 22 .4 29 .8 21 .3 15 .1 20 .3 1. 0 O ve ra ll w om en re sp on se ra te (O R R )3 0. 0 0. 0 0. 9 1. 4 0. 8 0. 8 0. 8 4. 4 1. 4 1. 1 0. 9 1. 4 0. 8 1. 2 1. 0 1. 1 1. 7 1. 8 1. 9 4. 6 1. 7 1. 1 1. 8 0. 0 El ig ib le w om en C om pl et ed (E W C ) 95 .3 94 .7 94 .0 95 .7 96 .8 93 .2 95 .9 92 .9 95 .8 96 .7 85 .5 93 .3 92 .2 97 .1 88 .2 92 .7 92 .1 91 .1 94 .0 90 .3 94 .3 96 .1 96 .7 94 .9 N ot a t h om e (E W N H ) 1. 7 2. 2 1. 5 0. 7 0. 6 2. 5 1. 6 0. 4 1. 5 0. 7 5. 1 3. 1 2. 2 0. 1 6. 5 2. 2 1. 2 3. 8 1. 0 1. 7 2. 4 1. 0 1. 1 2. 1 P os tp on ed (E W P ) 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 R ef us ed (E W R ) 1. 8 1. 7 2. 0 0. 9 1. 1 2. 6 0. 5 0. 6 0. 2 0. 8 7. 2 0. 6 2. 9 0. 2 3. 0 2. 0 3. 0 2. 1 1. 7 1. 6 1. 2 0. 4 0. 0 1. 7 P ar tly c om pl et ed (E W P C ) 0. 6 0. 5 0. 3 0. 2 0. 2 0. 2 0. 2 0. 4 0. 4 0. 2 0. 4 0. 4 1. 1 1. 4 0. 5 0. 9 1. 3 0. 5 0. 4 0. 8 0. 1 1. 0 0. 3 0. 5 In ca pa ci ta te d (E W I) 0. 6 0. 8 1. 3 1. 1 0. 4 0. 6 0. 9 1. 1 0. 8 0. 4 0. 7 1. 2 0. 8 0. 0 0. 8 0. 9 0. 8 0. 7 1. 0 0. 6 0. 3 0. 5 0. 3 0. 7 O th er (E W O ) 0. 0 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 1 0. 0 0. 1 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f w om en 7, 62 9 19 ,1 81 1, 59 0 1, 22 1 1, 63 0 1, 70 1 1, 62 7 70 4 1, 29 1 1, 41 3 1, 50 0 1, 33 6 1, 48 0 1, 22 5 1, 55 2 1, 23 6 1, 02 9 1, 10 5 1, 14 8 63 1 1, 23 4 1, 38 3 1, 13 5 26 ,8 07 E lig ib le w om en re sp on se ra te (E W R R )2 0. 0 0. 0 0. 9 1. 4 0. 8 0. 8 0. 8 4. 4 1. 4 1. 1 0. 9 1. 4 0. 8 1. 2 1. 0 1. 1 1. 7 1. 8 1. 9 4. 6 1. 7 1. 1 1. 8 0. 0 O ve ra ll w om en re sp on se ra te (O R R )3 0. 0 0. 0 0. 9 1. 4 0. 8 0. 7 0. 8 4. 1 1. 4 1. 0 0. 8 1. 4 0. 7 1. 1 0. 9 1. 0 1. 6 1. 8 1. 9 4. 4 1. 6 1. 0 1. 7 0. 0 1 U si ng th e nu m be r o f h ou se ho ld s fa llin g in to s pe ci fic re sp on se c at eg or ie s, th e ho us eh ol d re sp on se ra te (H R R ) i s ca lc ul at ed a s: 10 0 * C __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C + H P + P + R + D N F 2 T he e lig ib le w om en re sp on se ra te (E W R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed (E W C ). 3 T he o ve ra ll w om en re sp on se ra te (O W R R ) i s ca lc ul at ed a s: O W R R = H R R * E W R R /1 00 2216 • Appendix A Appendix B • 217 ESTIMATES OF SAMPLING ERRORS Appendix B he estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2013 Yemen HDS (YNHDS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2013 YNHDS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2013 YNHDS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed in either ISSA or SAS, using programs developed by ICF International. These programs use the Taylor linearization method of variance estimation for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r= y x , where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula that follows, with the standard error being the square root of the variance: ( ) ( ) 2 2 2 2 1 1 1var 1 hmH h h hi h ih h f m zSE r = r z x m m = =   − = −   −     in which hi hi hiz = y rx− , and h h hz = y rx− T 218 • Appendix B where h represents the stratum that varies from 1 to H hm is the total number of clusters selected in the hth stratum hiy is the sum of the weighted values of variable y in the ith cluster in the hth stratum hix is the sum of the weighted number of cases in the ith cluster in the hth stratum f is the overall sampling fraction, which is so small that it is ignored The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulas. Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent replications are thus created. In the 2013 YNHDS, there were 800 non-empty clusters. Hence, 758 replications were created. The variance of a rate r is calculated as follows: ( ) ( ) ( ) ( ) 22 1 1var 1 k i i SE r = r r r k k = = − −  in which ( ) ( )1i ir = kr k r− − where r is the estimate computed from the full sample of 800 clusters ( )ir is the estimate computed from the reduced sample of 799 clusters (ith cluster excluded) k is the total number of clusters In addition to the standard error, the design effect (DEFT) for each estimate is also calculated. The design effect is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. Relative standard errors and confidence limits for the estimates are also calculated. Sampling errors for the 2013 YNHDS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for each of the 21 governorates. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 through B.25 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE) for each selected variable. The DEFT is considered undefined when the standard error of a simple random sample is zero (when the estimate is close to 0 or 1). The confidence interval (e.g., as calculated for the number of children ever born) can be interpreted as follows: the overall average from the national sample is 2.511 and its standard error is 0.028. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 2.511 ± 2×0.028. There is a high probability (95 percent) that the true average number of children ever born is between 2.455 and 2.566. For the total sample, the value of the DEFT, averaged over all variables, is 1.702. This means that, due to multi-stage clustering of the sample, the average standard error is increased by a factor of 1.702 over that in an equivalent simple random sample. Appendix B • 219 Table B.1 List of selected variables for sampling errors, Yemen 2013 Variable Estimate Base population WOMEN Urban residence Proportion All women 15-49 Literacy Proportion All women 15-49 No education Proportion All women 15-49 Secondary education or higher Proportion All women 15-49 Never married/in union Proportion All women 15-49 Currently married/in union Proportion All women 15-49 Married before age 20 Proportion All women 20-49 Currently pregnant Proportion All women 15-49 Children ever born Mean All women 15-49 Children surviving Mean All women 15-49 Children ever born to women age 40-49 Mean All women 40-49 Know any contraceptive method Proportion Currently married women 15-49 Know a modern method Proportion Currently married women 15-49 Currently using any method Proportion Currently married women 15-49 Currently using a modern method Proportion Currently married women 15-49 Currently using a traditional method Proportion Currently married women 15-49 Currently using pill Proportion Currently married women 15-49 Currently using condoms Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using female sterilization Proportion Currently married women 15-49 Currently using withdrawal Proportion Currently married women 15-49 Currently using rhythm Proportion Currently married women 15-49 Used public sector source Proportion Current users of modern method Want no more children Proportion Currently married women 15-49 Want to delay next birth at least two years Proportion Currently married women 15-49 Ideal number of children Mean All women 15-49 Mothers protected against tetanus for last birth Proportion Women with a live birth in last five years Births with skilled attendant at delivery Proportion Births occurring 1-59 months before survey Had diarrhea in the past two weeks Proportion Children under 5 Treated with ORS Proportion Children under 5 with diarrhea in past 2 weeks Sought medical treatment Proportion Children under 5 with diarrhea in past 2 weeks Vaccination card seen Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received penta vaccination (three doses) Proportion Children 12-23 months Received polio vaccination (three doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Received all vaccinations Proportion Children 12-23 months Received pnuemococcal vaccination (3 doses) Proportion Children 12-23 months Height-for-age (-2SD) Proportion Children under 5 who are measured Weight-for-height (-2SD) Proportion Children under 5 who are measured Weight-for-age (-2SD) Proportion Children under 5 who are measured Body mass index (BMI) <18.5 Proportion All women 15-49 who were measured Prevalence of anemia (children 6-59 months) Proportion All children 6-59 months who were tested Prevalence of anemia (women 15-49) Proportion All women 15-49 who were tested Total fertility rate (three years) Rate Women-years of exposure to childbearing Neonatal mortality rate¹ Rate Children exposed to the risk of mortality Postneonatal mortality rate¹ Rate Children exposed to the risk of mortality Infant mortality rate¹ Rate Children exposed to the risk of mortality Child mortality rate¹ Rate Children exposed to the risk of mortality Under-5 mortality rate¹ Rate Children exposed to the risk of mortality 1 The mortality rates are calculated for 5 years and 10 years before the survey for the national sample and regional samples, respectively. 220 • Appendix B Table B.2 Sampling errors: Total sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.339 0.010 25434 25434 3.401 0.030 0.319 0.359 Literacy 0.529 0.009 25434 25434 2.839 0.017 0.512 0.547 No education 0.421 0.009 25434 25434 2.772 0.020 0.404 0.438 Secondary or higher education 0.212 0.007 25434 25434 2.862 0.035 0.197 0.227 Never married (never in union) 0.349 0.005 25434 25434 1.747 0.015 0.338 0.359 Currently married (in union) 0.612 0.005 25434 25434 1.702 0.008 0.602 0.622 Married before age 20 0.590 0.006 19019 19092 1.798 0.011 0.577 0.602 Currently pregnant 0.084 0.002 25434 25434 1.421 0.029 0.079 0.089 Children ever born 2.511 0.028 25434 25434 1.459 0.011 2.455 2.566 Children surviving 2.303 0.024 25434 25434 1.409 0.011 2.254 2.351 Children ever born to women age 40-49 6.680 0.083 3387 3275 1.438 0.012 6.515 6.845 Knows any contraceptive method 0.983 0.003 15649 15566 2.527 0.003 0.978 0.988 Knows any modern contraceptive method 0.983 0.003 15649 15566 2.507 0.003 0.977 0.988 Currently using any method 0.335 0.007 15649 15566 1.789 0.020 0.321 0.348 Currently using a modern method 0.292 0.006 15649 15566 1.724 0.021 0.279 0.304 Currently using a traditional method 0.043 0.002 15649 15566 1.346 0.051 0.039 0.048 Currently using pill 0.116 0.004 15649 15566 1.684 0.037 0.108 0.125 Currently using condoms 0.005 0.001 15649 15566 1.143 0.125 0.004 0.007 Currently using injectables 0.042 0.003 15649 15566 1.605 0.061 0.037 0.047 Currently using female sterilization 0.023 0.002 15649 15566 1.350 0.071 0.019 0.026 Currently using rhythm 0.016 0.001 15649 15566 1.299 0.082 0.013 0.018 Currently using withdrawal 0.026 0.002 15649 15566 1.299 0.063 0.023 0.030 Used public sector source 0.530 0.013 3794 3920 1.568 0.024 0.505 0.555 Want no more children 0.413 0.007 15649 15566 1.707 0.016 0.400 0.426 Want to delay birth at least two years 0.242 0.005 15649 15566 1.358 0.019 0.233 0.252 Ideal number of children 4.341 0.038 14758 14834 1.814 0.009 4.264 4.418 Mothers protected against tetanus for last birth 0.279 0.008 10549 10369 1.851 0.029 0.263 0.295 Births with skilled attendant at delivery 0.447 0.011 16093 15880 2.313 0.025 0.424 0.469 Had diarrhea in the last two weeks 0.312 0.007 15383 15170 1.652 0.021 0.299 0.325 Treated with ORS 0.253 0.009 4770 4733 1.284 0.035 0.235 0.270 Sought medical treatment for diarrhea 0.328 0.012 4770 4733 1.575 0.036 0.305 0.352 Vaccination card seen 0.471 0.014 3053 3028 1.537 0.030 0.443 0.499 Received BCG vaccination 0.676 0.014 3053 3028 1.621 0.021 0.648 0.703 Received Penta vaccination (three doses) 0.596 0.014 3053 3028 1.595 0.024 0.568 0.625 Received polio vaccination (three doses) 0.587 0.014 3053 3028 1.545 0.024 0.559 0.615 Received measles vaccination 0.633 0.013 3053 3028 1.478 0.021 0.607 0.659 Received all vaccinations 0.426 0.014 3053 3028 1.584 0.034 0.397 0.455 Received pnuemococcal vaccination (three doses) 0.384 0.014 3053 3028 1.577 0.037 0.356 0.413 Height-for-age (-2SD) 0.465 0.007 14014 13823 1.568 0.016 0.451 0.480 Weight-for-height (-2SD) 0.163 0.005 14014 13823 1.452 0.029 0.153 0.173 Weight-for-age (-2SD) 0.390 0.007 14014 13823 1.548 0.018 0.376 0.405 Body mass index (BMI) < 18.5 0.249 0.006 22067 22207 1.959 0.023 0.238 0.260 Prevalence of anemia (children) 0.863 0.007 3859 3785 1.277 0.009 0.849 0.878 Prevalence of anemia (women) 0.706 0.009 7380 7412 1.612 0.012 0.689 0.723 Total fertility rate (three years) 4.429 0.092 70024 70157 1.812 0.021 4.245 4.614 Neonatal mortality rate (last 0-4 years) 25.881 1.739 16200 15983 1.277 0.067 22.402 29.360 Postneonatal mortality rate (last 0-4 years) 17.350 1.468 16196 15966 1.323 0.085 14.414 20.286 Infant mortality rate (last 0-4 years) 43.231 2.396 16226 16010 1.358 0.055 38.439 48.024 Child mortality rate (last 0-4 years) 9.955 1.022 15327 15113 1.337 0.103 7.912 11.999 Under5 mortality rate (last 0-4 years) 52.756 2.727 16277 16065 1.420 0.052 47.302 58.210 Appendix B • 221 Table B.3 Sampling errors: Urban sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 1.000 0.000 7268 8619 NA 0.000 1.000 1.000 Literacy 0.761 0.011 7268 8619 2.175 0.014 0.739 0.783 No education 0.205 0.009 7268 8619 1.939 0.045 0.186 0.223 Secondary or higher education 0.400 0.016 7268 8619 2.801 0.040 0.368 0.432 Never married (never in union) 0.383 0.010 7268 8619 1.668 0.025 0.363 0.402 Currently married (in union) 0.574 0.009 7268 8619 1.607 0.016 0.556 0.593 Married before age 20 0.523 0.013 5611 6642 1.898 0.024 0.498 0.549 Currently pregnant 0.062 0.004 7268 8619 1.482 0.068 0.054 0.070 Children ever born 2.160 0.050 7268 8619 1.572 0.023 2.060 2.261 Children surviving 2.024 0.045 7268 8619 1.537 0.022 1.933 2.114 Children ever born to women age 40-49 5.840 0.170 958 1098 1.596 0.029 5.499 6.180 Knows any contraceptive method 0.998 0.001 4236 4949 0.917 0.001 0.997 0.999 Knows any modern contraceptive method 0.998 0.001 4236 4949 0.914 0.001 0.997 0.999 Currently using any method 0.475 0.012 4236 4949 1.508 0.024 0.451 0.498 Currently using a modern method 0.402 0.011 4236 4949 1.434 0.027 0.380 0.423 Currently using a traditional method 0.073 0.005 4236 4949 1.167 0.064 0.063 0.082 Currently using pill 0.172 0.008 4236 4949 1.340 0.045 0.156 0.187 Currently using condoms 0.012 0.002 4236 4949 1.127 0.159 0.008 0.016 Currently using injectables 0.033 0.003 4236 4949 1.136 0.094 0.027 0.040 Currently using female sterilization 0.031 0.003 4236 4949 1.303 0.112 0.024 0.038 Currently using rhythm 0.029 0.003 4236 4949 1.133 0.100 0.023 0.035 Currently using withdrawal 0.043 0.004 4236 4949 1.152 0.084 0.035 0.050 Used public sector source 0.535 0.019 1519 1828 1.511 0.036 0.496 0.574 Want no more children 0.392 0.013 4236 4949 1.740 0.033 0.366 0.418 Want to delay birth at least two years 0.263 0.008 4236 4949 1.249 0.032 0.246 0.280 Ideal number of children 4.029 0.051 4147 4871 1.379 0.013 3.927 4.131 Mothers protected against tetanus for last birth 0.375 0.013 2655 3077 1.369 0.035 0.349 0.401 Births with skilled attendant at delivery 0.730 0.015 3703 4301 1.750 0.021 0.700 0.761 Had diarrhea in the last two weeks 0.281 0.015 3559 4137 1.906 0.054 0.250 0.311 Treated with ORS 0.240 0.019 977 1161 1.307 0.078 0.202 0.278 Sought medical treatment for diarrhea 0.390 0.029 977 1161 1.734 0.074 0.332 0.448 Vaccination card seen 0.582 0.025 694 801 1.291 0.043 0.533 0.632 Received BCG vaccination 0.858 0.019 694 801 1.383 0.022 0.821 0.896 Received Penta vaccination (three doses) 0.765 0.022 694 801 1.358 0.029 0.720 0.809 Received polio vaccination (three doses) 0.696 0.025 694 801 1.412 0.036 0.646 0.747 Received measles vaccination 0.744 0.022 694 801 1.302 0.030 0.700 0.788 Received all vaccinations 0.588 0.025 694 801 1.310 0.043 0.538 0.639 Received pnuemococcal vaccination (3 doses) 0.524 0.027 694 801 1.398 0.052 0.469 0.578 Height-for-age (-2SD) 0.337 0.013 3221 3813 1.449 0.038 0.311 0.362 Weight-for-height (-2SD) 0.144 0.009 3221 3813 1.365 0.061 0.127 0.162 Weight-for-age (-2SD) 0.289 0.013 3221 3813 1.510 0.045 0.264 0.315 Body mass index (BMI) < 18.5 0.171 0.007 6406 7672 1.579 0.043 0.156 0.186 Prevalence of anemia (children) 0.812 0.018 894 1063 1.317 0.022 0.777 0.848 Prevalence of anemia (women) 0.655 0.015 2081 2490 1.492 0.024 0.624 0.686 Total fertility rate (three years) 3.201 0.087 20358 24092 1.259 0.027 3.027 3.374 Neonatal mortality rate (last 0-4 years) 21.397 1.985 7470 8585 1.164 0.093 17.427 25.367 Postneonatal mortality rate (last 0-4 years) 14.734 1.985 7480 8583 1.351 0.135 10.764 18.704 Infant mortality rate (last 0-4 years) 36.131 2.789 7477 8596 1.199 0.077 30.553 41.708 Child mortality rate (last 0-4 years) 8.312 1.332 7460 8598 1.104 0.160 5.647 10.977 Under-5 mortality rate (last 0-4 years) 44.142 3.301 7490 8610 1.269 0.075 37.541 50.744 222 • Appendix B Table B.4 Sampling errors: Rural sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.000 0.000 18166 16815 NA NA 0.000 0.000 Literacy 0.411 0.012 18166 16815 3.302 0.029 0.387 0.435 No education 0.532 0.011 18166 16815 3.093 0.022 0.509 0.555 Secondary or higher education 0.116 0.008 18166 16815 3.508 0.072 0.099 0.132 Never married (never in union) 0.331 0.006 18166 16815 1.808 0.019 0.319 0.344 Currently married (in union) 0.631 0.006 18166 16815 1.757 0.010 0.619 0.644 Married before age 20 0.625 0.008 13408 12449 1.817 0.012 0.610 0.640 Currently pregnant 0.095 0.003 18166 16815 1.413 0.032 0.089 0.101 Children ever born 2.690 0.036 18166 16815 1.514 0.013 2.619 2.762 Children surviving 2.445 0.031 18166 16815 1.441 0.013 2.384 2.507 Children ever born to women age 40-49 7.104 0.095 2429 2177 1.422 0.013 6.915 7.293 Knows any contraceptive method 0.976 0.004 11413 10617 2.658 0.004 0.968 0.983 Knows any modern contraceptive method 0.975 0.004 11413 10617 2.637 0.004 0.968 0.983 Currently using any method 0.270 0.008 11413 10617 2.005 0.031 0.253 0.286 Currently using a modern method 0.240 0.008 11413 10617 1.960 0.033 0.225 0.256 Currently using a traditional method 0.029 0.002 11413 10617 1.419 0.076 0.025 0.034 Currently using pill 0.090 0.005 11413 10617 1.875 0.056 0.080 0.100 Currently using condoms 0.002 0.000 11413 10617 1.081 0.213 0.001 0.003 Currently using injectables 0.046 0.003 11413 10617 1.771 0.075 0.039 0.053 Currently using female sterilization 0.019 0.002 11413 10617 1.361 0.092 0.015 0.022 Currently using rhythm 0.010 0.001 11413 10617 1.482 0.141 0.007 0.012 Currently using withdrawal 0.019 0.002 11413 10617 1.308 0.089 0.015 0.022 Used public sector source 0.525 0.017 2275 2092 1.602 0.032 0.492 0.559 Want no more children 0.423 0.008 11413 10617 1.702 0.019 0.407 0.438 Want to delay birth at least two years 0.233 0.006 11413 10617 1.410 0.024 0.222 0.244 Ideal number of children 4.493 0.051 10611 9963 1.963 0.011 4.392 4.594 Mothers protected against tetanus for last birth 0.238 0.010 7894 7292 2.159 0.043 0.217 0.259 Births with skilled attendant at delivery 0.341 0.014 12390 11579 2.624 0.040 0.314 0.368 Had diarrhea in the last two weeks 0.324 0.007 11824 11033 1.601 0.023 0.309 0.339 Treated with ORS 0.257 0.010 3793 3572 1.295 0.039 0.237 0.277 Sought medical treatment for diarrhea 0.309 0.012 3793 3572 1.431 0.039 0.285 0.332 Vaccination card seen 0.431 0.017 2359 2227 1.635 0.038 0.398 0.465 Received BCG vaccination 0.610 0.018 2359 2227 1.753 0.029 0.575 0.645 Received Penta vaccination (three doses) 0.536 0.018 2359 2227 1.720 0.033 0.501 0.571 Received polio vaccination (three doses) 0.548 0.017 2359 2227 1.623 0.030 0.515 0.581 Received measles vaccination 0.594 0.016 2359 2227 1.593 0.027 0.562 0.626 Received all vaccinations 0.367 0.017 2359 2227 1.719 0.046 0.333 0.401 Received pnuemococcal vaccination (3 doses) 0.334 0.016 2359 2227 1.658 0.048 0.302 0.366 Height-for-age (-2SD) 0.514 0.008 10793 10010 1.556 0.016 0.498 0.531 Weight-for-height (-2SD) 0.170 0.006 10793 10010 1.473 0.033 0.159 0.181 Weight-for-age (-2SD) 0.429 0.008 10793 10010 1.519 0.019 0.412 0.445 Body Mass Index (BMI) < 18.5 0.290 0.007 15661 14535 2.023 0.025 0.276 0.305 Prevalence of anemia (children) 0.883 0.008 2965 2722 1.220 0.009 0.868 0.898 Prevalence of anemia (women) 0.732 0.010 5299 4922 1.588 0.013 0.712 0.751 Total fertility rate (3 years) 5.091 0.119 49667 46064 2.053 0.023 4.852 5.329 Neonatal mortality rate (last 0-4 years) 28.422 1.475 24967 23323 1.271 0.052 25.472 31.372 Post-neonatal mortality rate (last 0-4 years) 22.487 1.559 24985 23333 1.552 0.069 19.369 25.605 Infant mortality rate (last 0-4 years) 50.909 2.266 24993 23351 1.472 0.045 46.376 55.441 Child mortality rate (last 0-4 years) 12.222 0.948 24816 23097 1.285 0.078 10.327 14.118 Under-five mortality rate (last 0-4 years) 62.509 2.556 25050 23404 1.504 0.041 57.397 67.620 Appendix B • 223 Table B.5 Sampling errors: Ibb sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.213 0.016 1494 2739 1.507 0.075 0.181 0.245 Literacy 0.539 0.028 1494 2739 2.132 0.051 0.484 0.594 No education 0.411 0.025 1494 2739 1.951 0.061 0.361 0.461 Secondary or higher education 0.155 0.021 1494 2739 2.222 0.135 0.113 0.196 Never married (never in union) 0.346 0.020 1494 2739 1.588 0.057 0.307 0.385 Currently married (in union) 0.613 0.019 1494 2739 1.489 0.031 0.575 0.650 Married before age 20 0.658 0.023 1081 1978 1.576 0.035 0.612 0.703 Currently pregnant 0.088 0.009 1494 2739 1.257 0.105 0.069 0.106 Children ever born 2.550 0.101 1494 2739 1.254 0.040 2.347 2.752 Children surviving 2.319 0.083 1494 2739 1.150 0.036 2.153 2.486 Children ever born to women age 40-49 7.679 0.278 169 306 1.171 0.036 7.123 8.234 Knows any contraceptive method 0.988 0.004 915 1678 1.204 0.004 0.980 0.997 Knows any modern contraceptive method 0.988 0.004 915 1678 1.204 0.004 0.980 0.997 Currently using any method 0.327 0.022 915 1678 1.407 0.067 0.283 0.371 Currently using a modern method 0.307 0.021 915 1678 1.405 0.070 0.264 0.350 Currently using a traditional method 0.020 0.005 915 1678 1.098 0.254 0.010 0.030 Currently using pill 0.120 0.016 915 1678 1.444 0.130 0.089 0.151 Currently using condoms 0.003 0.002 915 1678 0.972 0.546 0.000 0.007 Currently using injectables 0.069 0.013 915 1678 1.572 0.191 0.043 0.095 Currently using female sterilization 0.028 0.006 915 1678 1.127 0.221 0.016 0.040 Currently using rhythm 0.009 0.003 915 1678 1.133 0.404 0.002 0.015 Currently using withdrawal 0.010 0.003 915 1678 1.088 0.367 0.003 0.017 Used public sector source 0.518 0.044 265 492 1.428 0.085 0.430 0.606 Want no more children 0.401 0.018 915 1678 1.116 0.045 0.364 0.437 Want to delay birth at least 2 years 0.199 0.015 915 1678 1.167 0.077 0.169 0.230 Ideal number of children 4.073 0.141 721 1333 1.510 0.035 3.791 4.356 Mothers protected against tetanus for last birth 0.279 0.030 627 1147 1.696 0.109 0.218 0.339 Births with skilled attendant at delivery 0.424 0.035 953 1738 1.780 0.082 0.355 0.494 Had diarrhea in the last two weeks 0.377 0.024 902 1644 1.404 0.064 0.329 0.425 Treated with ORS 0.226 0.025 338 619 1.001 0.111 0.176 0.276 Sought medical treatment for diarrhea 0.320 0.031 338 619 1.079 0.097 0.258 0.382 Vaccination card seen 0.441 0.055 189 344 1.502 0.125 0.331 0.551 Received BCG vaccination 0.641 0.051 189 344 1.441 0.080 0.539 0.744 Received penta vaccination (three doses) 0.509 0.056 189 344 1.522 0.110 0.397 0.622 Received polio vaccination (three doses) 0.600 0.045 189 344 1.257 0.075 0.509 0.690 Received measles vaccination 0.591 0.049 189 344 1.356 0.083 0.492 0.689 Received all vaccinations 0.414 0.055 189 344 1.511 0.132 0.305 0.524 Received pnuemococcal vaccination (3 doses) 0.346 0.058 189 344 1.659 0.168 0.230 0.463 Height-for-age (-2SD) 0.473 0.027 867 1555 1.468 0.057 0.419 0.527 Weight-for-height (-2SD) 0.109 0.013 867 1555 1.160 0.117 0.083 0.134 Weight-for-age (-2SD) 0.307 0.021 867 1555 1.202 0.069 0.265 0.349 Body mass index (BMI) < 18.5 0.202 0.018 1316 2410 1.605 0.088 0.166 0.237 Prevalence of anemia (children) 0.743 0.025 200 358 0.791 0.034 0.692 0.793 Prevalence of anemia (women) 0.463 0.031 421 778 1.294 0.068 0.400 0.526 Total fertility rate (three years) 4.820 0.296 4137 7589 1.363 0.061 4.228 5.411 Neonatal mortality rate (last 0-4 years) 28.454 5.355 1921 3500 1.230 0.188 17.744 39.165 Post-neonatal mortality rate (last 0-4 years) 22.599 5.432 1914 3485 1.463 0.240 11.736 33.463 Infant mortality rate (last 0-4 years) 51.053 9.240 1921 3500 1.554 0.181 32.574 69.533 Child mortality rate (last 0-4 years) 11.200 2.614 1896 3455 0.961 0.233 5.971 16.429 Under-5 mortality rate (last 0-4 years) 61.682 9.874 1923 3504 1.525 0.160 41.935 81.429 224 • Appendix B Table B.6 Sampling errors: Abyan sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.269 0.034 1169 551 2.630 0.127 0.200 0.337 Literacy 0.627 0.035 1169 551 2.489 0.056 0.557 0.698 No education 0.288 0.035 1169 551 2.636 0.121 0.218 0.359 Secondary or higher education 0.221 0.038 1169 551 3.121 0.172 0.145 0.297 Never married (never in union) 0.374 0.019 1169 551 1.364 0.052 0.335 0.412 Currently married (in union) 0.591 0.017 1169 551 1.182 0.029 0.557 0.625 Married before age 20 0.417 0.042 898 436 2.567 0.102 0.332 0.502 Currently pregnant 0.061 0.008 1169 551 1.149 0.132 0.045 0.077 Children ever born 1.994 0.103 1169 551 1.361 0.052 1.787 2.201 Children surviving 1.878 0.098 1169 551 1.370 0.052 1.682 2.075 Children ever born to women age 40-49 4.845 0.335 188 90 1.411 0.069 4.176 5.515 Knows any contraceptive method 0.990 0.004 700 326 1.047 0.004 0.983 0.998 Knows any modern contraceptive method 0.990 0.004 700 326 1.047 0.004 0.983 0.998 Currently using any method 0.324 0.028 700 326 1.593 0.087 0.267 0.380 Currently using a modern method 0.295 0.025 700 326 1.432 0.084 0.246 0.345 Currently using a traditional method 0.029 0.008 700 326 1.232 0.271 0.013 0.044 Currently using pill 0.155 0.024 700 326 1.774 0.157 0.106 0.203 Currently using condoms 0.003 0.002 700 326 1.006 0.724 0.000 0.007 Currently using injectables 0.028 0.007 700 326 1.053 0.235 0.015 0.041 Currently using female sterilization 0.007 0.004 700 326 1.149 0.525 0.000 0.014 Currently using rhythm 0.012 0.004 700 326 1.102 0.383 0.003 0.021 Currently using withdrawal 0.017 0.005 700 326 1.038 0.298 0.007 0.027 Used public sector source 0.760 0.054 147 77 1.530 0.072 0.651 0.868 Want no more children 0.316 0.035 700 326 1.998 0.111 0.246 0.387 Want to delay birth at least two years 0.246 0.024 700 326 1.481 0.098 0.198 0.294 Ideal number of children 4.580 0.119 675 312 1.366 0.026 4.341 4.818 Mothers protected against tetanus for last birth 0.193 0.028 442 207 1.501 0.146 0.137 0.250 Births with skilled attendant at delivery 0.740 0.039 649 309 1.828 0.052 0.663 0.817 Had diarrhea in the last two weeks 0.261 0.019 628 300 0.969 0.073 0.223 0.299 Treated with ORS 0.263 0.060 167 78 1.471 0.230 0.142 0.384 Sought medical treatment for diarrhea 0.531 0.048 167 78 1.063 0.091 0.434 0.627 Vaccination card seen 0.402 0.052 134 63 1.208 0.128 0.299 0.506 Received BCG vaccination 0.628 0.061 134 63 1.428 0.097 0.507 0.749 Received penta vaccination (three doses) 0.506 0.069 134 63 1.582 0.137 0.367 0.644 Received polio vaccination (three doses) 0.559 0.059 134 63 1.348 0.105 0.442 0.677 Received measles vaccination 0.496 0.061 134 63 1.388 0.122 0.375 0.618 Received all vaccinations 0.440 0.060 134 63 1.382 0.136 0.320 0.560 Received pnuemococcal vaccination (three doses) 0.317 0.055 134 63 1.369 0.175 0.206 0.428 Height-for-age (-2SD) 0.234 0.022 587 284 1.301 0.096 0.189 0.279 Weight-for-height (-2SD) 0.216 0.022 587 284 1.293 0.100 0.173 0.259 Weight-for-age (-2SD) 0.264 0.024 587 284 1.234 0.091 0.216 0.312 Body mass index (BMI) < 18.5 0.213 0.024 1033 493 1.920 0.114 0.164 0.261 Prevalence of anemia (children) 0.978 0.011 163 82 0.964 0.011 0.957 0.999 Prevalence of anemia (women) 0.924 0.015 336 155 1.038 0.016 0.893 0.954 Total fertility rate (three years) 4.044 0.231 3271 1554 0.939 0.057 3.582 4.507 Neonatal mortality rate (last 0-4 years) 26.595 8.005 1257 575 1.464 0.301 10.586 42.604 Post-neonatal mortality rate (last 0-4 years) 14.573 3.713 1262 578 1.056 0.255 7.148 21.998 Infant mortality rate (last 0-4 years) 41.168 7.741 1258 576 1.226 0.188 25.686 56.651 Child mortality rate (last 0-4 years) 8.181 3.302 1232 555 1.086 0.404 1.577 14.784 Under-5e mortality rate (last 0-4 years) 49.012 8.344 1261 577 1.215 0.170 32.324 65.700 Appendix B • 225 Table B.7 Sampling errors: Sana'a City sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 1.000 0.000 1578 2487 NA 0.000 1.000 1.000 Literacy 0.806 0.018 1578 2487 1.835 0.023 0.770 0.843 No education 0.186 0.018 1578 2487 1.820 0.096 0.150 0.221 Secondary or higher education 0.482 0.027 1578 2487 2.172 0.057 0.427 0.537 Never married (never in union) 0.362 0.016 1578 2487 1.310 0.044 0.330 0.394 Currently married (in union) 0.607 0.016 1578 2487 1.298 0.026 0.575 0.639 Married before age 20 0.533 0.019 1259 1975 1.366 0.036 0.495 0.572 Currently pregnant 0.066 0.008 1578 2487 1.255 0.119 0.050 0.082 Children ever born 2.113 0.090 1578 2487 1.389 0.043 1.933 2.294 Children surviving 1.982 0.081 1578 2487 1.353 0.041 1.820 2.144 Children ever born to women age 40-49 6.190 0.352 150 232 1.384 0.057 5.487 6.894 Knows any contraceptive method 1.000 0.000 936 1510 NA 0.000 1.000 1.000 Knows any modern contraceptive method 1.000 0.000 936 1510 NA 0.000 1.000 1.000 Currently using any method 0.562 0.025 936 1510 1.518 0.044 0.513 0.611 Currently using a modern method 0.481 0.021 936 1510 1.278 0.043 0.439 0.522 Currently using a traditional method 0.081 0.010 936 1510 1.105 0.122 0.061 0.101 Currently using pill 0.196 0.017 936 1510 1.324 0.088 0.162 0.231 Currently using condoms 0.016 0.004 936 1510 1.072 0.275 0.007 0.025 Currently using injectables 0.019 0.004 936 1510 0.804 0.188 0.012 0.026 Currently using female sterilization 0.034 0.007 936 1510 1.122 0.195 0.021 0.048 Currently using rhythm 0.022 0.005 936 1510 0.987 0.213 0.013 0.032 Currently using withdrawal 0.059 0.008 936 1510 0.977 0.128 0.044 0.074 Used public sector source 0.527 0.033 422 669 1.340 0.062 0.462 0.592 Want no more children 0.388 0.013 936 1510 0.833 0.034 0.361 0.414 Want to delay birth at least two years 0.284 0.015 936 1510 1.000 0.052 0.254 0.313 Ideal number of children 3.650 0.063 972 1562 1.110 0.017 3.525 3.775 Mothers protected against tetanus for last birth 0.338 0.021 574 933 1.082 0.062 0.296 0.380 Births with skilled attendant at delivery 0.748 0.022 777 1280 1.241 0.030 0.704 0.792 Had diarrhea in the last two weeks 0.240 0.023 753 1242 1.458 0.098 0.193 0.287 Treated with ORS 0.194 0.037 178 298 1.231 0.192 0.119 0.269 Sought medical treatment for diarrhea 0.310 0.048 178 298 1.409 0.156 0.213 0.407 Vaccination card seen 0.560 0.042 151 244 1.046 0.075 0.476 0.644 Received BCG vaccination 0.920 0.031 151 244 1.424 0.034 0.858 0.982 Received penta vaccination (three doses) 0.881 0.031 151 244 1.205 0.036 0.819 0.944 Received polio vaccination (three doses) 0.737 0.040 151 244 1.126 0.054 0.657 0.817 Received measles vaccination 0.761 0.031 151 244 0.906 0.041 0.699 0.823 Received all vaccinations 0.595 0.035 151 244 0.893 0.059 0.524 0.666 Received pnuemococcal vaccination (three doses) 0.542 0.041 151 244 1.022 0.076 0.459 0.624 Height-for-age (-2SD) 0.307 0.021 707 1180 1.195 0.070 0.264 0.349 Weight-for-height (-2SD) 0.112 0.014 707 1180 1.122 0.122 0.085 0.139 Weight-for-age (-2SD) 0.228 0.023 707 1180 1.386 0.100 0.182 0.274 Body mass index (BMI) < 18.5 0.157 0.013 1426 2235 1.329 0.082 0.131 0.183 Prevalence of anemia (children) 0.761 0.039 185 318 1.205 0.051 0.683 0.838 Prevalence of anemia (women) 0.585 0.023 439 695 0.966 0.039 0.540 0.630 Total fertility rate (three years) 3.060 0.195 4495 7075 1.182 0.064 2.670 3.450 Neonatal mortality rate (last 0-4 years) 21.766 3.359 1581 2605 0.949 0.154 15.048 28.484 Postneonatal mortality rate (last 0-4 years) 9.959 2.993 1579 2602 1.218 0.301 3.974 15.945 Infant mortality rate (last 0-4 years) 31.726 4.526 1583 2609 0.997 0.143 22.673 40.778 Child mortality rate (last 0-4 years) 5.389 2.004 1569 2592 1.069 0.372 1.380 9.397 Under-5 mortality rate (last 0-4 years) 36.943 4.872 1586 2613 1.010 0.132 27.199 46.687 226 • Appendix B Table B.8 Sampling errors: Al-Baidha sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.384 0.153 1585 1101 11.915 0.397 0.079 0.689 Literacy 0.588 0.038 1585 1101 3.072 0.065 0.512 0.664 No education 0.340 0.051 1585 1101 4.240 0.149 0.239 0.442 Secondary or higher education 0.105 0.018 1585 1101 2.304 0.169 0.070 0.141 Never married (never in union) 0.303 0.011 1585 1101 0.994 0.038 0.280 0.326 Currently married (in union) 0.637 0.015 1585 1101 1.252 0.024 0.607 0.668 Married before age 20 0.708 0.015 1147 802 1.137 0.022 0.677 0.738 Currently pregnant 0.084 0.011 1585 1101 1.527 0.126 0.063 0.106 Children ever born 2.642 0.120 1585 1101 1.614 0.046 2.401 2.882 Children surviving 2.430 0.109 1585 1101 1.610 0.045 2.213 2.647 Children ever born to women age 40-49 6.768 0.148 211 175 0.729 0.022 6.471 7.065 Knows any contraceptive method 0.983 0.010 1024 702 2.447 0.010 0.963 1.003 Knows any modern contraceptive method 0.983 0.010 1024 702 2.447 0.010 0.963 1.003 Currently using any method 0.339 0.026 1024 702 1.723 0.075 0.288 0.390 Currently using a modern method 0.302 0.022 1024 702 1.532 0.073 0.258 0.346 Currently using a traditional method 0.037 0.009 1024 702 1.484 0.237 0.019 0.054 Currently using pill 0.122 0.029 1024 702 2.794 0.235 0.065 0.180 Currently using condoms 0.004 0.002 1024 702 1.115 0.585 0.000 0.008 Currently using injectables 0.059 0.011 1024 702 1.467 0.184 0.037 0.080 Currently using female sterilization 0.012 0.005 1024 702 1.546 0.445 0.001 0.022 Currently using rhythm 0.002 0.001 1024 702 0.947 0.739 0.000 0.004 Currently using withdrawal 0.035 0.009 1024 702 1.564 0.259 0.017 0.052 Used public sector source 0.451 0.041 269 187 1.348 0.091 0.369 0.533 Want no more children 0.420 0.051 1024 702 3.295 0.122 0.318 0.523 Want to delay birth at least two years 0.287 0.022 1024 702 1.533 0.076 0.244 0.330 Ideal number of children 4.090 0.092 780 567 1.195 0.023 3.905 4.274 Mothers protected against tetanus for last birth 0.156 0.020 655 446 1.414 0.131 0.115 0.196 Births with skilled attendant at delivery 0.612 0.057 948 643 3.054 0.093 0.498 0.725 Had diarrhea in the last two weeks 0.401 0.038 898 604 2.199 0.096 0.324 0.477 Treated with ORS 0.219 0.029 319 242 1.217 0.133 0.161 0.277 Sought medical treatment for diarrhea 0.400 0.083 319 242 2.827 0.208 0.233 0.567 Vaccination card seen 0.312 0.049 189 120 1.367 0.157 0.214 0.409 Received BCG vaccination 0.508 0.066 189 120 1.719 0.130 0.376 0.640 Received penta vaccination (three doses) 0.345 0.053 189 120 1.436 0.153 0.240 0.450 Received polio vaccination (three doses) 0.381 0.047 189 120 1.261 0.124 0.287 0.475 Received measles vaccination 0.415 0.050 189 120 1.328 0.122 0.314 0.516 Received all vaccinations 0.261 0.059 189 120 1.757 0.228 0.142 0.380 Received Pnuemococcal vaccination (three doses) 0.197 0.031 189 120 1.025 0.160 0.134 0.260 Height-for-age (-2SD) 0.356 0.033 813 543 1.860 0.094 0.289 0.423 Weight-for-height (-2SD) 0.136 0.022 813 543 1.724 0.162 0.092 0.180 Weight-for-age (-2SD) 0.295 0.031 813 543 1.767 0.104 0.234 0.357 Body mass index (BMI) < 18.5 0.109 0.016 1370 958 1.874 0.144 0.078 0.141 Prevalence of anemia (children) 0.837 0.018 241 184 0.946 0.022 0.800 0.873 Prevalence of anemia (women) 0.545 0.052 460 318 2.242 0.096 0.440 0.649 Total fertility rate (three years) 3.949 0.262 4343 3012 1.421 0.066 3.424 4.474 Neonatal mortality rate (last 0-4 years) 29.861 4.317 1938 1260 0.964 0.145 21.226 38.495 Postneonatal mortality rate (last 0-4 years) 31.897 4.034 1952 1262 0.920 0.126 23.829 39.965 Infant mortality rate (last 0-4 years) 61.758 4.368 1940 1261 0.720 0.071 53.022 70.494 Child mortality rate (last 0-4 years) 9.080 3.145 1965 1274 1.218 0.346 2.789 15.370 Under-5 mortality rate (last 0-4 years) 70.277 5.429 1944 1263 0.804 0.077 59.420 81.135 Appendix B • 227 Table B.9 Sampling errors: Taiz sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.260 0.030 1561 3512 2.664 0.114 0.201 0.320 Literacy 0.591 0.037 1561 3512 2.927 0.062 0.518 0.664 No education 0.340 0.030 1561 3512 2.488 0.088 0.280 0.399 Secondary or higher education 0.321 0.031 1561 3512 2.644 0.098 0.259 0.384 Never married (never in union) 0.375 0.017 1561 3512 1.394 0.046 0.341 0.409 Currently married (in union) 0.585 0.018 1561 3512 1.438 0.031 0.549 0.620 Married before age 20 0.564 0.020 1161 2612 1.349 0.035 0.525 0.603 Currently pregnant 0.078 0.009 1561 3512 1.302 0.114 0.060 0.095 Children ever born 2.304 0.093 1561 3512 1.249 0.040 2.118 2.490 Children surviving 2.113 0.081 1561 3512 1.187 0.038 1.952 2.275 Children ever born to women age 40-49 6.534 0.313 194 443 1.304 0.048 5.908 7.159 Knows any contraceptive method 0.984 0.015 920 2053 3.565 0.015 0.955 1.014 Knows any modern contraceptive method 0.984 0.015 920 2053 3.565 0.015 0.955 1.014 Currently using any method 0.314 0.023 920 2053 1.528 0.075 0.267 0.361 Currently using a modern method 0.277 0.021 920 2053 1.410 0.075 0.235 0.318 Currently using a traditional method 0.037 0.007 920 2053 1.199 0.201 0.022 0.052 Currently using pill 0.089 0.013 920 2053 1.397 0.147 0.063 0.115 Currently using condoms 0.003 0.002 920 2053 0.974 0.578 0.000 0.007 Currently using injectables 0.044 0.010 920 2053 1.536 0.237 0.023 0.064 Currently using female sterilization 0.013 0.004 920 2053 1.019 0.292 0.005 0.021 Currently using rhythm 0.020 0.005 920 2053 1.106 0.256 0.010 0.030 Currently using withdrawal 0.017 0.005 920 2053 1.084 0.276 0.007 0.026 Used public sector source 0.512 0.045 193 415 1.254 0.089 0.421 0.602 Want no more children 0.408 0.027 920 2053 1.650 0.066 0.354 0.461 Want to delay birth at least two years 0.282 0.017 920 2053 1.135 0.060 0.248 0.316 Ideal number of children 4.570 0.158 963 2148 1.739 0.034 4.255 4.885 Mothers protected against tetanus for last birth 0.319 0.032 572 1274 1.629 0.100 0.255 0.383 Births with skilled attendant at delivery 0.415 0.034 899 1994 1.658 0.082 0.346 0.483 Had diarrhea in the last two weeks 0.347 0.018 858 1910 1.007 0.051 0.311 0.382 Treated with ORS 0.182 0.024 299 663 1.015 0.132 0.134 0.230 Sought medical treatment for diarrhea 0.224 0.030 299 663 1.087 0.135 0.163 0.284 Vaccination card seen 0.459 0.048 180 402 1.272 0.105 0.363 0.555 Received BCG vaccination 0.716 0.048 180 402 1.393 0.067 0.620 0.811 Received Penta vaccination (three doses) 0.757 0.041 180 402 1.285 0.055 0.675 0.840 Received polio vaccination (three doses) 0.714 0.041 180 402 1.220 0.058 0.631 0.797 Received measles vaccination 0.740 0.033 180 402 0.984 0.044 0.674 0.806 Received all vaccinations 0.512 0.051 180 402 1.336 0.099 0.411 0.613 Received pnuemococcal vaccination (three doses) 0.428 0.045 180 402 1.193 0.105 0.339 0.518 Height-for-age (-2SD) 0.468 0.020 837 1873 1.025 0.042 0.428 0.507 Weight-for-height (-2SD) 0.146 0.012 837 1873 0.965 0.085 0.121 0.171 Weight-for-age (-2SD) 0.401 0.024 837 1873 1.260 0.060 0.353 0.450 Body mass index (BMI) < 18.5 0.286 0.018 1405 3153 1.525 0.064 0.249 0.323 Prevalence of anemia (children) 0.790 0.030 226 513 1.134 0.038 0.729 0.850 Prevalence of anemia (women) 0.633 0.029 445 1017 1.263 0.045 0.575 0.690 Total fertility rate (three years) 4.006 0.296 4298 9657 1.644 0.074 3.414 4.599 Neonatal mortality rate (last 0-4 years) 29.308 4.484 1780 3944 0.980 0.153 20.341 38.276 Postneonatal mortality rate (last 0-4 years) 21.739 4.282 1781 3948 1.101 0.197 13.175 30.303 Infant mortality rate (last 0-4 years) 51.047 6.211 1784 3953 1.060 0.122 38.626 63.469 Child mortality rate (last 0-4 years) 9.592 2.578 1757 3911 1.059 0.269 4.435 14.749 Under-5 mortality rate (last 0-4 years) 60.149 7.027 1785 3956 1.104 0.117 46.095 74.203 228 • Appendix B Table B.10 Sampling errors: Al-Jawf sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.320 0.084 654 181 4.515 0.262 0.152 0.487 Literacy 0.511 0.030 654 181 1.512 0.058 0.452 0.570 No education 0.440 0.031 654 181 1.608 0.071 0.378 0.503 Secondary or higher education 0.221 0.045 654 181 2.747 0.203 0.131 0.311 Never married (never in union) 0.221 0.025 654 181 1.515 0.111 0.172 0.271 Currently married (in union) 0.686 0.030 654 181 1.649 0.044 0.626 0.746 Married before age 20 0.721 0.030 504 141 1.510 0.042 0.660 0.781 Currently pregnant 0.082 0.010 654 181 0.889 0.116 0.063 0.101 Children ever born 2.916 0.171 654 181 1.461 0.058 2.575 3.257 Children surviving 2.783 0.167 654 181 1.498 0.060 2.449 3.118 Children ever born to women age 40-49 7.301 0.191 94 25 0.793 0.026 6.919 7.684 Knows any contraceptive method 0.982 0.007 427 124 1.162 0.008 0.967 0.997 Knows any modern contraceptive method 0.982 0.007 427 124 1.162 0.008 0.967 0.997 Currently using any method 0.263 0.052 427 124 2.406 0.196 0.160 0.367 Currently using a modern method 0.260 0.052 427 124 2.414 0.199 0.156 0.363 Currently using a traditional method 0.004 0.003 427 124 0.931 0.730 0.000 0.009 Currently using pill 0.107 0.039 427 124 2.585 0.364 0.029 0.185 Currently using condoms 0.001 0.001 427 124 0.535 1.035 0.000 0.002 Currently using injectables 0.079 0.012 427 124 0.912 0.151 0.055 0.103 Currently using female sterilization 0.001 0.001 427 124 0.810 1.025 0.000 0.004 Currently using rhythm 0.002 0.002 427 124 1.001 1.002 0.000 0.007 Currently using withdrawal 0.001 0.002 427 124 0.816 1.034 0.000 0.004 Used public sector source 0.098 0.048 84 29 1.459 0.489 0.002 0.194 Want no more children 0.340 0.016 427 124 0.718 0.048 0.307 0.373 Want to delay birth at least two years 0.262 0.035 427 124 1.636 0.133 0.192 0.332 Ideal number of children 5.161 0.204 447 132 1.371 0.040 4.753 5.569 Mothers protected against tetanus for last birth 0.105 0.028 326 95 1.673 0.264 0.050 0.160 Births with skilled attendant at delivery 0.538 0.083 497 144 3.312 0.155 0.371 0.704 Had diarrhea in the last two weeks 0.357 0.038 476 140 1.731 0.106 0.281 0.433 Treated with ORS 0.516 0.078 157 50 2.023 0.151 0.360 0.672 Sought medical treatment for diarrhea 0.585 0.052 157 50 1.369 0.090 0.480 0.690 Vaccination card seen 0.140 0.052 85 24 1.399 0.368 0.037 0.244 Received BCG vaccination 0.408 0.070 85 24 1.341 0.172 0.268 0.548 Received penta vaccination (three doses) 0.208 0.058 85 24 1.349 0.280 0.092 0.324 Received polio vaccination (three doses) 0.202 0.051 85 24 1.200 0.254 0.100 0.304 Received measles vaccination 0.293 0.063 85 24 1.307 0.216 0.166 0.419 Received all vaccinations 0.158 0.054 85 24 1.389 0.341 0.051 0.266 Received pnuemococcal vaccination (three doses) 0.089 0.033 85 24 1.102 0.376 0.022 0.155 Height-for-age (-2SD) 0.571 0.048 447 130 2.024 0.085 0.474 0.668 Weight-for-height (-2SD) 0.121 0.014 447 130 0.917 0.115 0.093 0.149 Weight-for-age (-2SD) 0.370 0.038 447 130 1.423 0.102 0.295 0.446 Body mass index (BMI) < 18.5 0.203 0.036 566 158 2.129 0.177 0.131 0.275 Prevalence of anemia (children) 0.987 0.009 121 35 0.864 0.009 0.970 1.005 Prevalence of anemia (women) 0.882 0.024 199 59 1.067 0.027 0.834 0.929 Total fertility rate (three years) 5.772 0.693 1796 497 1.966 0.120 4.385 7.159 Neonatal mortality rate (last 0-4 years) 14.954 5.071 984 278 1.042 0.339 4.811 25.096 Postneonatal mortality rate (last 0-4 years) 11.168 5.199 989 279 1.421 0.466 0.770 21.566 Infant mortality rate (last 0-4 years) 26.122 9.434 984 278 1.446 0.361 7.253 44.990 Child mortality rate (last 0-4 years) 6.112 3.005 976 275 1.077 0.492 0.102 12.122 Under-5 mortality rate (last 0-4 years) 32.074 10.557 985 279 1.511 0.329 10.960 53.188 Appendix B • 229 Table B.11 Sampling errors: Hajjah sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.129 0.013 1236 1374 1.327 0.098 0.104 0.154 Literacy 0.289 0.031 1236 1374 2.422 0.108 0.226 0.352 No education 0.671 0.032 1236 1374 2.419 0.048 0.607 0.736 Secondary or higher education 0.121 0.017 1236 1374 1.853 0.142 0.086 0.155 Never married (never in union) 0.349 0.020 1236 1374 1.440 0.056 0.310 0.388 Currently married (in union) 0.631 0.020 1236 1374 1.467 0.032 0.591 0.672 Married before age 20 0.573 0.024 949 1052 1.520 0.043 0.524 0.622 Currently pregnant 0.093 0.012 1236 1374 1.418 0.126 0.070 0.117 Children ever born 2.931 0.111 1236 1374 1.184 0.038 2.709 3.153 Children surviving 2.734 0.098 1236 1374 1.138 0.036 2.538 2.931 Children ever born to women age 40-49 7.323 0.281 161 175 1.064 0.038 6.762 7.885 Knows any contraceptive method 0.960 0.011 790 867 1.521 0.011 0.939 0.981 Knows any modern contraceptive method 0.959 0.011 790 867 1.495 0.011 0.938 0.980 Currently using any method 0.171 0.024 790 867 1.760 0.138 0.124 0.218 Currently using a modern method 0.164 0.022 790 867 1.655 0.133 0.121 0.208 Currently using a traditional method 0.006 0.004 790 867 1.465 0.651 0.000 0.015 Currently using pill 0.063 0.012 790 867 1.409 0.193 0.039 0.088 Currently using condoms 0.002 0.002 790 867 1.098 1.000 0.000 0.005 Currently using injectables 0.057 0.011 790 867 1.338 0.194 0.035 0.079 Currently using female sterilization 0.016 0.005 790 867 1.153 0.318 0.006 0.027 Currently using rhythm 0.005 0.003 790 867 1.208 0.601 0.000 0.011 Currently using withdrawal 0.001 0.001 790 867 0.996 0.994 0.000 0.004 Used public sector source 0.666 0.056 117 133 1.269 0.084 0.555 0.778 Want no more children 0.558 0.022 790 867 1.234 0.039 0.514 0.601 Want to delay birth at least two years 0.158 0.017 790 867 1.290 0.106 0.124 0.192 Ideal number of children 4.126 0.128 790 870 1.261 0.031 3.870 4.382 Mothers protected against tetanus for last birth 0.316 0.034 563 620 1.732 0.108 0.248 0.385 Births with skilled attendant at delivery 0.201 0.026 922 1019 1.685 0.128 0.150 0.253 Had diarrhea in the last two weeks 0.294 0.016 891 983 1.049 0.056 0.261 0.327 Treated with ORS 0.205 0.027 265 289 1.053 0.132 0.151 0.259 Sought medical treatment for diarrhea 0.205 0.024 265 289 0.913 0.118 0.156 0.253 Vaccination card seen 0.456 0.055 171 186 1.429 0.121 0.346 0.567 Received BCG vaccination 0.593 0.063 171 186 1.649 0.106 0.468 0.719 Received penta vaccination (three doses) 0.491 0.064 171 186 1.641 0.130 0.364 0.618 Received polio vaccination (three doses) 0.476 0.056 171 186 1.447 0.118 0.364 0.588 Received measles vaccination 0.562 0.063 171 186 1.646 0.113 0.435 0.689 Received all vaccinations 0.341 0.063 171 186 1.714 0.185 0.215 0.466 Received pnuemococcal vaccination (3 doses) 0.356 0.060 171 186 1.630 0.170 0.235 0.476 Height-for-age (-2SD) 0.588 0.028 833 926 1.558 0.048 0.531 0.644 Weight-for-height (-2SD) 0.211 0.020 833 926 1.343 0.094 0.172 0.251 Weight-for-age (-2SD) 0.550 0.024 833 926 1.312 0.044 0.502 0.599 Body mass index (BMI) < 18.5 0.400 0.021 1080 1202 1.418 0.053 0.357 0.442 Prevalence of anemia (children) 0.922 0.016 261 287 1.022 0.018 0.890 0.955 Prevalence of anemia (women) 0.815 0.023 408 462 1.220 0.029 0.768 0.861 Total fertility rate (three years) 5.530 0.451 3434 3809 1.853 0.082 4.627 6.432 Neonatal mortality rate (last 0-4 years) 20.323 3.914 1963 2163 1.025 0.193 12.494 28.152 Post-neonatal mortality rate (last 0-4 years) 12.282 3.036 1960 2159 1.112 0.247 6.209 18.354 Infant mortality rate (last 0-4 years) 32.605 5.361 1964 2164 1.105 0.164 21.882 43.328 Child mortality rate (last 0-4 years) 11.231 2.353 1974 2173 0.952 0.209 6.525 15.936 Under-5 mortality rate (last 0-4 years) 43.469 6.309 1972 2172 1.124 0.145 30.851 56.087 230 • Appendix B Table B.12 Sampling errors: Al-Hodiedah sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.374 0.024 1366 3261 1.793 0.063 0.327 0.421 Literacy 0.418 0.031 1366 3261 2.285 0.073 0.357 0.479 No education 0.501 0.031 1366 3261 2.270 0.061 0.439 0.562 Secondary or higher education 0.177 0.027 1366 3261 2.619 0.153 0.122 0.231 Never married (never in union) 0.380 0.018 1366 3261 1.392 0.048 0.343 0.416 Currently married (in union) 0.580 0.018 1366 3261 1.357 0.031 0.543 0.616 Married before age 20 0.569 0.020 1035 2466 1.306 0.035 0.528 0.609 Currently pregnant 0.082 0.007 1366 3261 0.916 0.083 0.069 0.096 Children ever born 2.523 0.089 1366 3261 0.998 0.035 2.346 2.701 Children surviving 2.289 0.081 1366 3261 1.013 0.035 2.127 2.450 Children ever born to women age 40-49 6.802 0.303 170 399 1.058 0.045 6.196 7.409 Knows any contraceptive method 0.985 0.004 791 1891 1.039 0.005 0.976 0.994 Knows any modern contraceptive method 0.985 0.004 791 1891 1.039 0.005 0.976 0.994 Currently using any method 0.165 0.021 791 1891 1.622 0.130 0.122 0.208 Currently using a modern method 0.137 0.020 791 1891 1.661 0.148 0.097 0.178 Currently using a traditional method 0.028 0.006 791 1891 1.058 0.222 0.015 0.040 Currently using pill 0.074 0.011 791 1891 1.228 0.154 0.051 0.097 Currently using condoms 0.000 0.000 791 1891 NA NA 0.000 0.000 Currently using injectables 0.018 0.005 791 1891 1.104 0.294 0.007 0.028 Currently using female sterilization 0.017 0.004 791 1891 0.923 0.250 0.008 0.025 Currently using rhythm 0.019 0.004 791 1891 0.811 0.209 0.011 0.026 Currently using withdrawal 0.005 0.003 791 1891 1.231 0.591 0.000 0.012 Used public sector source 0.442 0.053 101 257 1.074 0.121 0.336 0.549 Want no more children 0.442 0.024 791 1891 1.365 0.055 0.393 0.490 Want to delay birth at least two years 0.233 0.014 791 1891 0.953 0.062 0.204 0.261 Ideal number of children 4.573 0.105 769 1852 1.157 0.023 4.363 4.784 Mothers protected against tetanus for last birth 0.256 0.024 519 1257 1.280 0.095 0.207 0.304 Births with skilled attendant at delivery 0.489 0.046 842 2037 2.104 0.093 0.397 0.580 Had diarrhea in the last two weeks 0.288 0.026 799 1932 1.512 0.090 0.236 0.340 Treated with ORS 0.283 0.036 241 557 1.119 0.127 0.211 0.354 Sought medical treatment for diarrhea 0.445 0.048 241 557 1.347 0.109 0.348 0.542 Vaccination card seen 0.540 0.044 150 368 1.090 0.082 0.452 0.628 Received BCG vaccination 0.666 0.049 150 368 1.281 0.074 0.568 0.764 Received penta vaccination (three doses) 0.563 0.051 150 368 1.275 0.091 0.460 0.666 Received polio vaccination (three doses) 0.589 0.057 150 368 1.427 0.097 0.475 0.703 Received measles vaccination 0.652 0.050 150 368 1.290 0.076 0.552 0.751 Received all vaccinations 0.395 0.048 150 368 1.204 0.122 0.299 0.491 Received pnuemococcal vaccination (three doses) 0.381 0.048 150 368 1.220 0.127 0.285 0.478 Height-for-age (-2SD) 0.486 0.024 739 1798 1.195 0.050 0.438 0.535 Weight-for-height (-2SD) 0.262 0.020 739 1798 1.191 0.076 0.223 0.302 Weight-for-age (-2SD) 0.544 0.025 739 1798 1.227 0.046 0.494 0.594 Body mass index (BMI) < 18.5 0.403 0.021 1206 2880 1.466 0.051 0.362 0.445 Prevalence of anemia (children) 0.940 0.019 201 478 0.996 0.020 0.902 0.979 Prevalence of anemia (women) 0.849 0.021 425 1014 1.206 0.025 0.807 0.891 Total fertility rate (three years) 4.441 0.305 3746 8936 1.495 0.069 3.832 5.050 Neonatal mortality rate (last 0-4 years) 28.774 4.539 1687 4055 0.990 0.158 19.695 37.852 Postneonatal mortality rate (last 0-4 years) 20.527 4.472 1691 4062 1.264 0.218 11.582 29.471 Infant mortality rate (last 0-4 years) 49.300 5.687 1690 4062 1.009 0.115 37.927 60.673 Child mortality rate (last 0-4 years) 17.670 3.284 1683 4024 0.968 0.186 11.103 24.238 Under-5 mortality rate (last 0-4 years) 66.099 7.478 1696 4074 1.167 0.113 51.144 81.054 Appendix B • 231 Table B.13 Sampling errors: Hadramout sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.458 0.034 1283 1427 2.428 0.074 0.390 0.526 Literacy 0.654 0.040 1283 1427 2.970 0.061 0.575 0.733 No education 0.308 0.039 1283 1427 3.015 0.127 0.230 0.386 Secondary or higher education 0.179 0.023 1283 1427 2.174 0.130 0.133 0.226 Never married (never in union) 0.328 0.019 1283 1427 1.423 0.057 0.291 0.366 Currently married (in union) 0.620 0.018 1283 1427 1.337 0.029 0.583 0.656 Married before age 20 0.580 0.030 990 1092 1.922 0.052 0.520 0.641 Currently pregnant 0.069 0.007 1283 1427 1.023 0.105 0.054 0.083 Children ever born 2.420 0.062 1283 1427 0.798 0.025 2.297 2.543 Children surviving 2.298 0.062 1283 1427 0.858 0.027 2.173 2.422 Children ever born to women age 40-49 5.542 0.170 223 242 0.882 0.031 5.201 5.882 Knows any contraceptive method 0.972 0.011 796 884 1.948 0.012 0.949 0.995 Knows any modern contraceptive method 0.972 0.011 796 884 1.948 0.012 0.949 0.995 Currently using any method 0.373 0.024 796 884 1.417 0.065 0.325 0.422 Currently using a modern method 0.275 0.022 796 884 1.370 0.079 0.232 0.319 Currently using a traditional method 0.098 0.010 796 884 0.974 0.105 0.078 0.119 Currently using pill 0.154 0.021 796 884 1.626 0.135 0.113 0.196 Currently using condoms 0.005 0.003 796 884 1.084 0.567 0.000 0.010 Currently using injectables 0.016 0.008 796 884 1.803 0.504 0.000 0.032 Currently using female sterilization 0.013 0.003 796 884 0.762 0.237 0.007 0.019 Currently using rhythm 0.055 0.008 796 884 1.047 0.154 0.038 0.072 Currently using withdrawal 0.043 0.009 796 884 1.203 0.201 0.026 0.060 Used public sector source 0.651 0.050 191 211 1.449 0.077 0.551 0.752 Want no more children 0.198 0.019 796 884 1.332 0.095 0.160 0.235 Want to delay birth at least two years 0.316 0.018 796 884 1.079 0.056 0.280 0.351 Ideal number of children 5.189 0.132 715 794 1.671 0.025 4.926 5.452 Mothers protected against tetanus for last birth 0.365 0.049 487 543 2.265 0.135 0.266 0.464 Births with skilled attendant at delivery 0.653 0.063 664 738 2.871 0.096 0.528 0.778 Had diarrhea in the last two weeks 0.137 0.015 644 716 1.098 0.113 0.106 0.168 Treated with ORS 0.106 0.026 87 98 0.784 0.242 0.054 0.157 Sought medical treatment for diarrhea 0.365 0.062 87 98 1.159 0.170 0.241 0.489 Vaccination card seen 0.517 0.059 114 125 1.236 0.113 0.400 0.635 Received BCG vaccination 0.765 0.055 114 125 1.381 0.072 0.655 0.876 Received penta vaccination (three doses) 0.775 0.061 114 125 1.554 0.079 0.652 0.897 Received polio vaccination (three doses) 0.683 0.057 114 125 1.301 0.084 0.569 0.798 Received measles vaccination 0.628 0.054 114 125 1.188 0.087 0.519 0.737 Received all vaccinations 0.517 0.058 114 125 1.228 0.113 0.401 0.634 Received pnuemococcal vaccination (three doses) 0.427 0.059 114 125 1.250 0.138 0.309 0.545 Height-for-age (-2SD) 0.301 0.023 523 519 1.075 0.075 0.255 0.346 Weight-for-height (-2SD) 0.180 0.024 523 519 1.393 0.133 0.132 0.228 Weight-for-age (-2SD) 0.265 0.026 523 519 1.252 0.098 0.213 0.317 Body mass index (BMI) < 18.5 0.201 0.023 1066 1187 1.906 0.116 0.154 0.248 Prevalence of anemia (children) 0.901 0.029 125 124 1.034 0.033 0.842 0.960 Prevalence of anemia (women) 0.752 0.028 309 345 1.140 0.037 0.696 0.808 Total fertility rate (three years) 3.441 0.199 3553 3948 1.189 0.058 3.044 3.838 Neonatal mortality rate (last 0-4 years) 16.797 3.267 1408 1571 0.820 0.195 10.262 23.331 Postneonatal mortality rate (last 0-4 years) 9.714 3.382 1419 1582 1.141 0.348 2.949 16.479 Infant mortality rate (last 0-4 years) 26.511 4.618 1410 1574 0.943 0.174 17.274 35.748 Child mortality rate (last 0-4 years) 6.089 1.934 1431 1597 0.922 0.318 2.222 9.957 Under-5 mortality rate (last 0-4 years) 32.439 5.351 1414 1578 1.007 0.165 21.737 43.140 232 • Appendix B Table B.14 Sampling errors: Dhamar sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.167 0.024 1247 1670 2.231 0.141 0.120 0.214 Literacy 0.350 0.032 1247 1670 2.376 0.092 0.286 0.415 No education 0.601 0.035 1247 1670 2.533 0.059 0.530 0.671 Secondary or higher education 0.076 0.017 1247 1670 2.193 0.216 0.043 0.109 Never married (never in union) 0.289 0.023 1247 1670 1.822 0.081 0.242 0.336 Currently married (in union) 0.662 0.022 1247 1670 1.672 0.034 0.618 0.707 Married before age 20 0.667 0.026 911 1222 1.678 0.039 0.614 0.719 Currently pregnant 0.101 0.011 1247 1670 1.279 0.108 0.080 0.123 Children ever born 3.051 0.135 1247 1670 1.393 0.044 2.781 3.321 Children surviving 2.704 0.110 1247 1670 1.298 0.041 2.484 2.923 Children ever born to women age 40-49 7.975 0.287 159 211 1.116 0.036 7.400 8.549 Knows any contraceptive method 0.970 0.015 826 1106 2.456 0.015 0.940 0.999 Knows any modern contraceptive method 0.969 0.015 826 1106 2.410 0.015 0.939 0.998 Currently using any method 0.352 0.036 826 1106 2.181 0.103 0.279 0.425 Currently using a modern method 0.332 0.037 826 1106 2.236 0.111 0.259 0.406 Currently using a traditional method 0.020 0.007 826 1106 1.347 0.331 0.007 0.033 Currently using pill 0.082 0.015 826 1106 1.617 0.189 0.051 0.113 Currently using condoms 0.009 0.003 826 1106 0.888 0.332 0.003 0.014 Currently using injectables 0.063 0.011 826 1106 1.266 0.169 0.042 0.085 Currently using female sterilization 0.042 0.009 826 1106 1.342 0.223 0.023 0.061 Currently using rhythm 0.006 0.004 826 1106 1.492 0.656 0.000 0.014 Currently using withdrawal 0.013 0.005 826 1106 1.168 0.348 0.004 0.023 Used public sector source 0.483 0.038 218 310 1.112 0.078 0.407 0.558 Want no more children 0.404 0.024 826 1106 1.415 0.060 0.356 0.452 Want to delay birth at least two years 0.207 0.019 826 1106 1.367 0.093 0.168 0.245 Ideal number of children 4.052 0.107 738 991 1.318 0.026 3.837 4.266 Mothers protected against tetanus for last birth 0.319 0.026 599 802 1.359 0.081 0.267 0.371 Births with skilled attendant at delivery 0.221 0.029 992 1322 1.829 0.130 0.163 0.279 Had diarrhea in the last two weeks 0.310 0.027 939 1251 1.583 0.086 0.257 0.363 Treated with ORS 0.297 0.035 296 388 1.145 0.117 0.228 0.366 Sought medical treatment for diarrhea 0.240 0.032 296 388 1.184 0.134 0.176 0.304 Vaccination card seen 0.405 0.048 207 274 1.395 0.120 0.308 0.502 Received BCG vaccination 0.750 0.040 207 274 1.318 0.054 0.669 0.831 Received penta vaccination (three doses) 0.573 0.047 207 274 1.337 0.081 0.480 0.666 Received polio vaccination (three doses) 0.554 0.046 207 274 1.302 0.082 0.463 0.645 Received measles vaccination 0.657 0.046 207 274 1.382 0.070 0.565 0.749 Received all vaccinations 0.422 0.046 207 274 1.320 0.109 0.330 0.514 Received pnuemococcal vaccination (three doses) 0.346 0.044 207 274 1.308 0.128 0.258 0.434 Height-for-age (-2SD) 0.592 0.022 844 1101 1.262 0.038 0.547 0.637 Weight-for-height (-2SD) 0.151 0.016 844 1101 1.189 0.104 0.119 0.182 Weight-for-age (-2SD) 0.450 0.027 844 1101 1.401 0.060 0.395 0.504 Body mass index (BMI) < 18.5 0.232 0.020 1059 1418 1.552 0.087 0.191 0.272 Prevalence of anemia (children) 0.870 0.020 243 312 0.843 0.023 0.830 0.909 Prevalence of anemia (women) 0.655 0.024 384 509 1.001 0.037 0.606 0.704 Total fertility rate (three years) 6.236 0.470 3358 4500 1.924 0.075 5.295 7.177 Neonatal mortality rate (last 0-4 years) 26.920 3.157 2000 2656 0.822 0.117 20.607 33.233 Postneonatal mortality rate (last 0-4 years) 34.904 5.268 2012 2672 1.310 0.151 24.369 45.439 Infant mortality rate (last 0-4 years) 61.824 6.466 2007 2665 1.147 0.105 48.892 74.755 Child mortality rate (last 0-4 years) 15.424 3.505 1971 2612 1.146 0.227 8.414 22.433 Under-5 mortality rate (last 0-4 years) 76.294 7.157 2013 2673 1.125 0.094 61.979 90.609 Appendix B • 233 Table B.15 Sampling errors: Shabwah sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.195 0.017 1365 528 1.611 0.089 0.161 0.230 Literacy 0.628 0.026 1365 528 1.959 0.041 0.576 0.679 No education 0.371 0.027 1365 528 2.046 0.072 0.318 0.425 Secondary or higher education 0.086 0.019 1365 528 2.478 0.220 0.048 0.123 Never married (never in union) 0.404 0.023 1365 528 1.722 0.057 0.358 0.450 Currently married (in union) 0.555 0.023 1365 528 1.690 0.041 0.509 0.600 Married before age 20 0.604 0.032 949 368 1.993 0.053 0.540 0.667 Currently pregnant 0.078 0.008 1365 528 1.136 0.106 0.062 0.095 Children ever born 2.301 0.107 1365 528 1.318 0.047 2.087 2.515 Children surviving 2.187 0.102 1365 528 1.316 0.046 1.984 2.390 Children ever born to women age 40-49 6.787 0.251 190 75 1.177 0.037 6.284 7.290 Knows any contraceptive method 0.992 0.003 759 293 0.995 0.003 0.986 0.999 Knows any modern contraceptive method 0.992 0.003 759 293 0.995 0.003 0.986 0.999 Currently using any method 0.213 0.018 759 293 1.241 0.087 0.176 0.250 Currently using a modern method 0.194 0.017 759 293 1.199 0.089 0.159 0.228 Currently using a traditional method 0.019 0.005 759 293 0.985 0.254 0.010 0.029 Currently using pill 0.099 0.014 759 293 1.327 0.146 0.070 0.128 Currently using condoms 0.004 0.003 759 293 1.383 0.767 0.000 0.011 Currently using injectables 0.022 0.007 759 293 1.268 0.308 0.008 0.035 Currently using female sterilization 0.020 0.008 759 293 1.604 0.410 0.004 0.036 Currently using rhythm 0.010 0.003 759 293 0.971 0.358 0.003 0.016 Currently using withdrawal 0.009 0.004 759 293 1.200 0.458 0.001 0.017 Used public sector source 0.321 0.046 137 53 1.150 0.143 0.229 0.414 Want no more children 0.297 0.022 759 293 1.300 0.073 0.254 0.340 Want to delay birth at least two years 0.284 0.027 759 293 1.667 0.096 0.230 0.339 Ideal number of children 5.193 0.150 535 200 1.378 0.029 4.893 5.494 Mothers protected against tetanus for last birth 0.087 0.019 507 194 1.499 0.217 0.049 0.125 Births with skilled attendant at delivery 0.530 0.032 719 275 1.451 0.060 0.467 0.593 Had diarrhea in the last two weeks 0.266 0.031 698 267 1.722 0.115 0.205 0.327 Treated with ORS 0.222 0.039 194 71 1.139 0.175 0.144 0.299 Sought medical treatment for diarrhea 0.322 0.037 194 71 0.971 0.114 0.248 0.395 Vaccination card seen 0.460 0.058 133 51 1.318 0.125 0.345 0.575 Received BCG vaccination 0.560 0.065 133 51 1.494 0.116 0.430 0.691 Received penta vaccination (three doses) 0.485 0.064 133 51 1.455 0.132 0.357 0.612 Received polio vaccination (three doses) 0.454 0.060 133 51 1.380 0.133 0.334 0.575 Received measles vaccination 0.488 0.063 133 51 1.442 0.129 0.362 0.615 Received all vaccinations 0.392 0.055 133 51 1.288 0.140 0.282 0.502 Received pnuemococcal vaccination (three doses) 0.369 0.055 133 51 1.313 0.150 0.258 0.480 Height-for-age (-2SD) 0.286 0.030 593 215 1.423 0.104 0.227 0.345 Weight-for-height (-2SD) 0.215 0.021 593 215 1.114 0.099 0.172 0.257 Weight-for-age (-2SD) 0.253 0.028 593 215 1.355 0.112 0.196 0.309 Body Mass Index (BMI) < 18.5 0.206 0.020 1171 450 1.696 0.098 0.166 0.247 Prevalence of anemia (children) 0.936 0.021 129 46 0.944 0.022 0.894 0.978 Prevalence of anemia (women) 0.892 0.020 337 126 1.181 0.023 0.852 0.933 Total fertility rate (three years) 3.961 0.215 3679 1425 1.267 0.054 3.531 4.392 Neonatal mortality rate (last 0-4 years) 20.749 4.540 1472 565 1.131 0.219 11.669 29.829 Postneonatal mortality rate (last 0-4 years) 8.702 3.239 1485 569 1.106 0.372 2.224 15.180 Infant mortality rate (last 0-4 years) 29.451 6.156 1472 565 1.255 0.209 17.139 41.763 Child mortality rate (last 0-4 years) 9.334 2.150 1523 583 0.872 0.230 5.033 13.635 Under-5 mortality rate (last 0-4 years) 38.511 6.233 1475 566 1.143 0.162 26.044 50.977 234 • Appendix B Table B.16 Sampling errors: Sadah sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.139 0.014 1190 823 1.405 0.101 0.111 0.168 Literacy 0.335 0.029 1190 823 2.120 0.087 0.277 0.393 No education 0.645 0.029 1190 823 2.102 0.045 0.587 0.704 Secondary or higher education 0.045 0.011 1190 823 1.796 0.240 0.024 0.067 Never married (never in union) 0.353 0.028 1190 823 1.992 0.078 0.298 0.408 Currently married (in union) 0.612 0.029 1190 823 2.040 0.047 0.555 0.670 Married before age 20 0.635 0.026 876 606 1.595 0.041 0.583 0.687 Currently pregnant 0.099 0.014 1190 823 1.566 0.137 0.071 0.126 Children ever born 2.599 0.147 1190 823 1.678 0.057 2.305 2.894 Children surviving 2.416 0.127 1190 823 1.575 0.053 2.161 2.670 Children ever born to women age 40-49 6.781 0.367 160 115 1.473 0.054 6.047 7.515 Knows any contraceptive method 0.955 0.014 721 504 1.798 0.015 0.928 0.983 Knows any modern contraceptive method 0.955 0.014 721 504 1.798 0.015 0.928 0.983 Currently using any method 0.327 0.028 721 504 1.601 0.086 0.271 0.383 Currently using a modern method 0.269 0.025 721 504 1.530 0.094 0.219 0.320 Currently using a traditional method 0.058 0.013 721 504 1.495 0.225 0.032 0.084 Currently using pill 0.117 0.017 721 504 1.448 0.148 0.082 0.152 Currently using condoms 0.000 0.000 721 504 NA NA 0.000 0.000 Currently using injectables 0.094 0.012 721 504 1.103 0.128 0.070 0.118 Currently using female sterilization 0.005 0.003 721 504 0.974 0.499 0.000 0.011 Currently using rhythm 0.012 0.004 721 504 0.997 0.341 0.004 0.020 Currently using withdrawal 0.045 0.013 721 504 1.637 0.282 0.020 0.070 Used public sector source 0.539 0.049 176 119 1.304 0.091 0.440 0.637 Want no more children 0.411 0.026 721 504 1.405 0.063 0.359 0.463 Want to delay birth at least two years 0.189 0.024 721 504 1.628 0.126 0.142 0.237 Ideal number of children 5.817 0.370 707 491 2.289 0.064 5.076 6.558 Mothers protected against tetanus for last birth 0.054 0.014 457 320 1.337 0.259 0.026 0.083 Births with skilled attendant at delivery 0.303 0.032 682 479 1.547 0.106 0.238 0.367 Had diarrhea in the last two weeks 0.351 0.022 646 454 1.137 0.062 0.307 0.395 Treated with ORS 0.448 0.049 225 159 1.391 0.108 0.351 0.546 Sought medical treatment for diarrhea 0.430 0.039 225 159 1.118 0.091 0.352 0.509 Vaccination card seen 0.174 0.039 124 89 1.162 0.223 0.096 0.252 Received BCG vaccination 0.285 0.045 124 89 1.128 0.158 0.195 0.375 Received penta vaccination (three doses) 0.200 0.039 124 89 1.112 0.197 0.121 0.278 Received polio vaccination (three doses) 0.215 0.044 124 89 1.216 0.205 0.127 0.304 Received measles vaccination 0.443 0.058 124 89 1.312 0.130 0.327 0.559 Received all vaccinations 0.130 0.037 124 89 1.238 0.282 0.057 0.204 Received pnuemococcal vaccination (three doses) 0.127 0.037 124 89 1.247 0.289 0.054 0.200 Height-for-age (-2SD) 0.585 0.037 517 365 1.581 0.063 0.511 0.658 Weight-for-height (-2SD) 0.170 0.023 517 365 1.314 0.136 0.124 0.216 Weight-for-age (-2SD) 0.497 0.026 517 365 1.171 0.053 0.445 0.550 Body mass index (BMI) < 18.5 0.192 0.018 981 675 1.431 0.094 0.156 0.228 Prevalence of anemia (children) 0.990 0.007 177 127 0.947 0.007 0.977 1.004 Prevalence of anemia (women) 0.836 0.025 342 235 1.262 0.030 0.786 0.887 Total fertility rate (three years) 4.024 0.423 3223 2226 2.334 0.105 3.177 4.871 Neonatal mortality rate (last 0-4 years) 23.120 5.390 1488 1052 1.307 0.233 12.340 33.899 Postneonatal mortality rate (last 0-4 years) 20.470 3.522 1479 1047 0.904 0.172 13.425 27.515 Infant mortality rate (last 0-4 years) 43.590 7.202 1488 1052 1.260 0.165 29.185 57.994 Child mortality rate (last 0-4 years) 10.409 3.501 1494 1061 1.195 0.336 3.407 17.410 Under-5 mortality rate (last 0-4 years) 53.544 8.991 1491 1054 1.431 0.168 35.563 71.526 Appendix B • 235 Table B.17 Sampling errors: Sana'a sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.038 0.016 1369 1265 3.101 0.425 0.006 0.070 Literacy 0.484 0.039 1369 1265 2.879 0.081 0.406 0.562 No education 0.502 0.039 1369 1265 2.844 0.077 0.425 0.579 Secondary or higher education 0.106 0.016 1369 1265 1.943 0.152 0.074 0.139 Never married (never in union) 0.314 0.017 1369 1265 1.360 0.054 0.280 0.349 Currently married (in union) 0.657 0.016 1369 1265 1.224 0.024 0.626 0.688 Married before age 20 0.639 0.021 1015 936 1.423 0.034 0.596 0.682 Currently pregnant 0.093 0.010 1369 1265 1.259 0.106 0.074 0.113 Children ever born 2.562 0.105 1369 1265 1.317 0.041 2.352 2.773 Children surviving 2.307 0.086 1369 1265 1.229 0.037 2.134 2.479 Children ever born to women age 40-49 6.950 0.284 147 135 1.106 0.041 6.382 7.519 Knows any contraceptive method 0.994 0.003 904 831 1.402 0.003 0.988 1.001 Knows any modern contraceptive method 0.994 0.003 904 831 1.402 0.003 0.988 1.001 Currently using any method 0.497 0.028 904 831 1.710 0.057 0.440 0.554 Currently using a modern method 0.413 0.029 904 831 1.748 0.069 0.356 0.471 Currently using a traditional method 0.084 0.010 904 831 1.109 0.122 0.063 0.104 Currently using pill 0.160 0.019 904 831 1.586 0.121 0.121 0.199 Currently using condoms 0.010 0.003 904 831 0.978 0.327 0.003 0.016 Currently using injectables 0.034 0.008 904 831 1.328 0.236 0.018 0.050 Currently using female sterilization 0.041 0.008 904 831 1.187 0.191 0.025 0.056 Currently using rhythm 0.011 0.003 904 831 0.867 0.277 0.005 0.017 Currently using withdrawal 0.073 0.010 904 831 1.141 0.135 0.053 0.093 Used public sector source 0.422 0.055 331 300 2.000 0.129 0.313 0.532 Want no more children 0.484 0.023 904 831 1.363 0.047 0.439 0.529 Want to delay birth at least two years 0.277 0.018 904 831 1.223 0.066 0.240 0.313 Ideal number of children 3.524 0.096 861 788 1.327 0.027 3.333 3.715 Mothers protected against tetanus for last birth 0.167 0.029 648 598 1.954 0.172 0.110 0.224 Births with skilled attendant at delivery 0.358 0.031 992 919 1.742 0.087 0.296 0.421 Had diarrhea in the last two weeks 0.340 0.025 943 874 1.494 0.073 0.291 0.390 Treated with ORS 0.290 0.035 322 297 1.228 0.121 0.220 0.360 Sought medical treatment for diarrhea 0.333 0.036 322 297 1.226 0.108 0.261 0.405 Vaccination card seen 0.491 0.055 197 183 1.548 0.113 0.380 0.602 Received BCG vaccination 0.646 0.054 197 183 1.573 0.083 0.538 0.753 Received penta vaccination (three doses) 0.514 0.059 197 183 1.638 0.114 0.397 0.631 Received polio vaccination (three doses) 0.514 0.058 197 183 1.632 0.114 0.397 0.631 Received measles vaccination 0.591 0.048 197 183 1.356 0.081 0.495 0.686 Received all vaccinations 0.379 0.059 197 183 1.691 0.156 0.261 0.497 Received pnuemococcal vaccination (three doses) 0.385 0.057 197 183 1.626 0.148 0.271 0.498 Height-for-age (-2SD) 0.478 0.027 850 735 1.416 0.056 0.425 0.531 Weight-for-height (-2SD) 0.140 0.014 850 735 1.116 0.098 0.113 0.168 Weight-for-age (-2SD) 0.341 0.025 850 735 1.384 0.073 0.292 0.391 Body mass index (BMI) < 18.5 0.217 0.016 1184 1094 1.357 0.075 0.185 0.250 Prevalence of anemia (children) 0.835 0.028 231 205 1.190 0.033 0.779 0.891 Prevalence of anemia (women) 0.651 0.028 416 384 1.217 0.044 0.595 0.708 Total fertility rate (three years) 4.905 0.294 3741 3453 1.433 0.060 4.317 5.492 Neonatal mortality rate (last 0-4 years) 29.329 4.554 1872 1728 1.139 0.155 20.222 38.436 Postneonatal mortality rate (last 0-4 years) 31.240 4.777 1869 1725 1.127 0.153 21.685 40.794 Infant mortality rate (last 0-4 years) 60.568 6.864 1876 1731 1.189 0.113 46.841 74.296 Child mortality rate (last 0-4 years) 11.625 2.916 1859 1715 1.038 0.251 5.793 17.457 Under-5 mortality rate (last 0-4 years) 71.489 7.431 1879 1734 1.178 0.104 56.628 86.351 236 • Appendix B Table B.18 Sampling errors: Aden sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 1.000 0.000 1145 921 NA 0.000 1.000 1.000 Literacy 0.800 0.027 1145 921 2.261 0.033 0.746 0.854 No education 0.146 0.019 1145 921 1.803 0.129 0.108 0.183 Secondary or higher education 0.461 0.034 1145 921 2.295 0.074 0.393 0.528 Never married (never in union) 0.421 0.017 1145 921 1.135 0.039 0.387 0.454 Currently married (in union) 0.529 0.016 1145 921 1.064 0.030 0.497 0.560 Married before age 20 0.345 0.020 896 720 1.285 0.059 0.304 0.386 Currently pregnant 0.056 0.007 1145 921 1.090 0.133 0.041 0.070 Children ever born 1.776 0.078 1145 921 1.126 0.044 1.620 1.931 Children surviving 1.681 0.073 1145 921 1.138 0.044 1.534 1.828 Children ever born to women age 40-49 4.105 0.311 204 162 1.562 0.076 3.483 4.728 Knows any contraceptive method 1.000 0.000 597 487 NA 0.000 1.000 1.000 Knows any modern contraceptive method 1.000 0.000 597 487 NA 0.000 1.000 1.000 Currently using any method 0.469 0.036 597 487 1.782 0.078 0.396 0.542 Currently using a modern method 0.404 0.028 597 487 1.398 0.070 0.348 0.460 Currently using a traditional method 0.065 0.014 597 487 1.345 0.210 0.038 0.092 Currently using pill 0.209 0.021 597 487 1.233 0.098 0.168 0.250 Currently using condoms 0.021 0.006 597 487 0.931 0.258 0.010 0.032 Currently using injectables 0.046 0.011 597 487 1.281 0.239 0.024 0.068 Currently using female sterilization 0.017 0.006 597 487 1.076 0.337 0.006 0.028 Currently using rhythm 0.025 0.006 597 487 0.934 0.241 0.013 0.036 Currently using withdrawal 0.040 0.010 597 487 1.234 0.247 0.020 0.060 Used public sector source 0.566 0.034 225 180 1.015 0.059 0.499 0.634 Want no more children 0.428 0.021 597 487 1.031 0.049 0.386 0.470 Want to delay birth at least two years 0.205 0.018 597 487 1.077 0.087 0.169 0.240 Ideal number of children 3.872 0.168 643 523 1.613 0.043 3.536 4.208 Mothers protected against tetanus for last birth 0.529 0.032 355 291 1.212 0.060 0.466 0.593 Births with skilled attendant at delivery 0.837 0.046 471 389 2.214 0.055 0.745 0.930 Had diarrhea in the last two weeks 0.193 0.018 455 377 0.993 0.095 0.156 0.230 Treated with ORS 0.285 0.061 88 73 1.258 0.213 0.164 0.406 Sought medical treatment for diarrhea 0.435 0.071 88 73 1.345 0.164 0.293 0.578 Vaccination card seen 0.699 0.051 85 72 1.046 0.073 0.597 0.801 Received BCG vaccination 0.902 0.029 85 72 0.928 0.032 0.843 0.960 Received penta vaccination (three doses) 0.729 0.048 85 72 1.006 0.065 0.634 0.824 Received polio vaccination (three doses) 0.754 0.047 85 72 1.033 0.063 0.659 0.848 Received measles vaccination 0.798 0.034 85 72 0.801 0.043 0.730 0.867 Received all vaccinations 0.638 0.056 85 72 1.093 0.088 0.526 0.750 Received pnuemococcal vaccination (three doses) 0.589 0.052 85 72 0.999 0.089 0.484 0.694 Height-for-age (-2SD) 0.237 0.025 429 347 1.226 0.107 0.187 0.288 Weight-for-height (-2SD) 0.182 0.024 429 347 1.210 0.129 0.135 0.229 Weight-for-age (-2SD) 0.272 0.032 429 347 1.376 0.118 0.207 0.336 Body mass index (BMI) < 18.5 0.157 0.012 1003 807 1.044 0.077 0.133 0.181 Prevalence of anemia (children) 0.940 0.024 100 82 1.021 0.025 0.893 0.988 Prevalence of anemia (women) 0.885 0.016 295 242 0.846 0.018 0.854 0.916 Total fertility rate (three years) 2.871 0.161 3226 2590 1.155 0.056 2.549 3.193 Neonatal mortality rate (last 0-4 years) 21.709 5.027 949 783 1.045 0.232 11.654 31.763 Postneonatal mortality rate (last 0-4 years) 13.316 4.727 945 779 1.144 0.355 3.863 22.769 Infant mortality rate (last 0-4 years) 35.025 7.850 949 783 1.171 0.224 19.325 50.724 Child mortality rate (last 0-4 years) 4.894 2.314 923 764 1.001 0.473 0.265 9.523 Under-5 mortality rate (last 0-4 years) 39.747 7.565 949 783 1.087 0.190 24.618 54.876 Appendix B • 237 Table B.19 Sampling errors: Lahj sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.111 0.020 948 678 1.918 0.177 0.071 0.150 Literacy 0.545 0.043 948 678 2.672 0.080 0.459 0.632 No education 0.385 0.040 948 678 2.504 0.103 0.306 0.465 Secondary or higher education 0.283 0.042 948 678 2.872 0.149 0.199 0.368 Never married (never in union) 0.374 0.023 948 678 1.477 0.062 0.327 0.420 Currently married (in union) 0.597 0.027 948 678 1.677 0.045 0.543 0.650 Married before age 20 0.465 0.038 729 521 2.036 0.081 0.389 0.540 Currently pregnant 0.064 0.011 948 678 1.404 0.175 0.041 0.086 Children ever born 2.181 0.121 948 678 1.367 0.055 1.939 2.423 Children surviving 2.077 0.118 948 678 1.406 0.057 1.841 2.314 Children ever born to women age 40-49 5.358 0.371 151 104 1.412 0.069 4.617 6.100 Knows any contraceptive method 0.980 0.007 559 405 1.187 0.007 0.966 0.994 Knows any modern contraceptive method 0.976 0.009 559 405 1.380 0.009 0.958 0.994 Currently using any method 0.332 0.026 559 405 1.320 0.079 0.279 0.385 Currently using a modern method 0.304 0.024 559 405 1.219 0.078 0.256 0.351 Currently using a traditional method 0.029 0.009 559 405 1.338 0.330 0.010 0.047 Currently using pill 0.197 0.026 559 405 1.552 0.133 0.145 0.249 Currently using condoms 0.003 0.003 559 405 1.236 1.014 0.000 0.008 Currently using injectables 0.023 0.007 559 405 1.129 0.309 0.009 0.038 Currently using female sterilization 0.015 0.005 559 405 0.966 0.327 0.005 0.025 Currently using rhythm 0.013 0.006 559 405 1.326 0.490 0.000 0.026 Currently using withdrawal 0.014 0.006 559 405 1.293 0.467 0.001 0.026 Used public sector source 0.775 0.038 140 106 1.065 0.049 0.700 0.851 Want no more children 0.474 0.031 559 405 1.463 0.065 0.412 0.536 Want to delay birth at least two years 0.199 0.025 559 405 1.455 0.124 0.150 0.248 Ideal number of children 4.353 0.191 559 407 1.611 0.044 3.970 4.735 Mothers protected against tetanus for last birth 0.313 0.036 386 276 1.506 0.113 0.242 0.384 Births with skilled attendant at delivery 0.518 0.039 596 416 1.594 0.076 0.439 0.597 Had diarrhea in the last two weeks 0.262 0.027 573 402 1.362 0.103 0.208 0.316 Treated with ORS 0.340 0.042 143 105 1.059 0.125 0.255 0.425 Sought medical treatment for diarrhea 0.386 0.052 143 105 1.180 0.134 0.283 0.490 Vaccination card seen 0.715 0.045 106 75 1.023 0.063 0.625 0.805 Received BCG vaccination 0.738 0.048 106 75 1.106 0.064 0.643 0.833 Received penta vaccination (three doses) 0.731 0.049 106 75 1.135 0.067 0.632 0.829 Received polio vaccination (three doses) 0.717 0.047 106 75 1.069 0.066 0.623 0.811 Received measles vaccination 0.689 0.064 106 75 1.404 0.092 0.562 0.816 Received all vaccinations 0.547 0.067 106 75 1.369 0.122 0.413 0.680 Received pnuemococcal vaccination (three doses) 0.550 0.058 106 75 1.190 0.106 0.434 0.666 Height-for-age (-2SD) 0.379 0.032 500 330 1.351 0.085 0.314 0.443 Weight-for-height (-2SD) 0.143 0.017 500 330 1.041 0.119 0.109 0.177 Weight-for-age (-2SD) 0.342 0.036 500 330 1.516 0.105 0.270 0.415 Body mass index (BMI) < 18.5 0.214 0.021 823 587 1.483 0.099 0.171 0.256 Prevalence of anemia (children) 0.950 0.026 103 65 1.138 0.027 0.898 1.002 Prevalence of anemia (women) 0.903 0.020 245 172 1.039 0.022 0.864 0.943 Total fertility rate (three years) 4.519 0.434 2632 1884 1.700 0.096 3.650 5.388 Neonatal mortality rate (last 0-4 years) 18.283 4.923 1093 782 1.130 0.269 8.436 28.129 Postneonatal mortality rate (last 0-4 years) 10.344 3.111 1096 784 1.041 0.301 4.123 16.565 Infant mortality rate (last 0-4 years) 28.627 5.854 1094 783 1.062 0.205 16.918 40.335 Child mortality rate (last 0-4 years) 5.799 2.359 1056 760 0.886 0.407 1.082 10.516 Under-5 mortality rate (last 0-4 years) 34.260 6.578 1094 783 1.062 0.192 21.105 47.415 238 • Appendix B Table B.20 Sampling errors: Mareb sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.141 0.029 1006 183 2.662 0.208 0.082 0.199 Literacy 0.596 0.028 1006 183 1.796 0.047 0.540 0.651 No education 0.371 0.024 1006 183 1.554 0.064 0.324 0.419 Secondary or higher education 0.240 0.034 1006 183 2.508 0.141 0.172 0.308 Never married (never in union) 0.325 0.025 1006 183 1.719 0.078 0.274 0.376 Currently married (in union) 0.606 0.023 1006 183 1.470 0.037 0.561 0.652 Married before age 20 0.631 0.025 738 135 1.388 0.039 0.582 0.681 Currently pregnant 0.086 0.013 1006 183 1.435 0.147 0.061 0.112 Children ever born 2.683 0.087 1006 183 0.851 0.032 2.509 2.856 Children surviving 2.445 0.074 1006 183 0.807 0.030 2.298 2.593 Children ever born to women age 40-49 7.751 0.461 123 22 1.628 0.059 6.829 8.674 Knows any contraceptive method 0.997 0.002 607 111 1.029 0.002 0.992 1.001 Knows any modern contraceptive method 0.997 0.002 607 111 1.029 0.002 0.992 1.001 Currently using any method 0.257 0.026 607 111 1.485 0.103 0.205 0.310 Currently using a modern method 0.213 0.022 607 111 1.331 0.104 0.168 0.257 Currently using a traditional method 0.045 0.011 607 111 1.356 0.255 0.022 0.067 Currently using pill 0.079 0.012 607 111 1.105 0.153 0.055 0.103 Currently using condoms 0.003 0.003 607 111 1.298 0.981 0.000 0.009 Currently using injectables 0.025 0.007 607 111 1.104 0.282 0.011 0.039 Currently using female sterilization 0.012 0.004 607 111 0.806 0.294 0.005 0.019 Currently using rhythm 0.013 0.007 607 111 1.448 0.512 0.000 0.026 Currently using withdrawal 0.026 0.010 607 111 1.485 0.372 0.007 0.045 Used public sector source 0.541 0.068 114 22 1.452 0.126 0.404 0.678 Want no more children 0.318 0.025 607 111 1.313 0.078 0.268 0.367 Want to delay birth at least two years 0.307 0.023 607 111 1.213 0.074 0.261 0.352 Ideal number of children 5.342 0.205 603 113 1.693 0.038 4.932 5.751 Mothers protected against tetanus for last birth 0.298 0.033 432 78 1.486 0.110 0.233 0.363 Births with skilled attendant at delivery 0.452 0.045 671 120 1.908 0.099 0.363 0.542 Had diarrhea in the last two weeks 0.338 0.033 637 114 1.622 0.097 0.272 0.403 Treated with ORS 0.338 0.033 215 39 0.939 0.097 0.272 0.403 Sought medical treatment for diarrhea 0.358 0.040 215 39 1.098 0.112 0.278 0.438 Vaccination card seen 0.366 0.047 131 24 1.108 0.129 0.272 0.460 Received BCG vaccination 0.553 0.052 131 24 1.187 0.093 0.450 0.657 Received penta vaccination (three doses) 0.419 0.059 131 24 1.365 0.142 0.300 0.537 Received polio vaccination (three doses) 0.458 0.055 131 24 1.256 0.120 0.348 0.568 Received measles vaccination 0.536 0.062 131 24 1.417 0.116 0.412 0.660 Received all vaccinations 0.296 0.050 131 24 1.233 0.168 0.197 0.396 Received pnuemococcal vaccination (three doses) 0.276 0.045 131 24 1.135 0.163 0.186 0.367 Height-for-age (-2SD) 0.413 0.034 586 101 1.471 0.082 0.345 0.481 Weight-for-height (-2SD) 0.138 0.020 586 101 1.277 0.142 0.099 0.177 Weight-for-age (-2SD) 0.313 0.038 586 101 1.768 0.122 0.236 0.390 Body mass index (BMI) < 18.5 0.207 0.021 872 159 1.514 0.100 0.166 0.249 Prevalence of anemia (children) 0.833 0.028 176 31 0.988 0.034 0.777 0.890 Prevalence of anemia (women) 0.786 0.036 325 59 1.601 0.046 0.713 0.858 Total fertility rate (three years) 4.694 0.340 2725 499 1.361 0.072 4.014 5.374 Neonatal mortality rate (last 0-4 years) 31.879 4.914 1340 238 0.996 0.154 22.051 41.707 Postneonatal mortality rate (last 0-4 years) 20.708 4.977 1343 239 1.126 0.240 10.753 30.662 Infant mortality rate (last 0-4 years) 52.587 8.321 1342 239 1.267 0.158 35.944 69.229 Child mortality rate (last 0-4 years) 8.491 2.579 1325 236 0.986 0.304 3.332 13.649 Under-5 mortality rate (last 0-4 years) 60.631 8.291 1344 239 1.183 0.137 44.050 77.212 Appendix B • 239 Table B.21 Sampling errors: Al-Mhweit sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.090 0.006 1079 623 0.693 0.067 0.078 0.103 Literacy 0.392 0.037 1079 623 2.467 0.094 0.318 0.465 No education 0.537 0.032 1079 623 2.073 0.059 0.473 0.600 Secondary or higher education 0.144 0.025 1079 623 2.300 0.171 0.095 0.193 Never married (never in union) 0.286 0.018 1079 623 1.327 0.064 0.250 0.323 Currently married (in union) 0.681 0.018 1079 623 1.269 0.026 0.645 0.717 Married before age 20 0.704 0.020 811 469 1.234 0.028 0.664 0.744 Currently pregnant 0.110 0.011 1079 623 1.189 0.103 0.088 0.133 Children ever born 3.097 0.098 1079 623 0.962 0.032 2.901 3.292 Children surviving 2.760 0.084 1079 623 0.950 0.030 2.592 2.927 Children ever born to women age 40-49 7.499 0.244 155 90 0.952 0.033 7.010 7.987 Knows any contraceptive method 0.961 0.012 736 425 1.715 0.013 0.937 0.986 Knows any modern contraceptive method 0.960 0.013 736 425 1.772 0.013 0.934 0.986 Currently using any method 0.231 0.025 736 425 1.614 0.109 0.181 0.281 Currently using a modern method 0.196 0.020 736 425 1.388 0.104 0.156 0.237 Currently using a traditional method 0.034 0.011 736 425 1.572 0.307 0.013 0.056 Currently using pill 0.067 0.012 736 425 1.281 0.176 0.043 0.091 Currently using condoms 0.000 0.000 736 425 NA NA 0.000 0.000 Currently using injectables 0.040 0.009 736 425 1.306 0.237 0.021 0.058 Currently using female sterilization 0.032 0.010 736 425 1.524 0.308 0.012 0.052 Currently using rhythm 0.011 0.004 736 425 1.157 0.401 0.002 0.020 Currently using withdrawal 0.023 0.008 736 425 1.515 0.362 0.006 0.040 Used public sector source 0.651 0.050 132 73 1.194 0.077 0.552 0.751 Want no more children 0.498 0.021 736 425 1.136 0.042 0.456 0.540 Want to delay birth at least two years 0.210 0.016 736 425 1.060 0.076 0.178 0.242 Ideal number of children 4.046 0.106 725 417 1.162 0.026 3.834 4.258 Mothers protected against tetanus for last birth 0.312 0.037 521 304 1.845 0.119 0.238 0.387 Births with skilled attendant at delivery 0.342 0.047 876 517 2.385 0.137 0.248 0.436 Had diarrhea in the last two weeks 0.431 0.028 832 492 1.502 0.066 0.374 0.488 Treated with ORS 0.223 0.035 345 212 1.406 0.156 0.154 0.293 Sought medical treatment for diarrhea 0.348 0.041 345 212 1.481 0.117 0.266 0.430 Vaccination card seen 0.577 0.055 169 101 1.461 0.095 0.467 0.686 Received BCG vaccination 0.628 0.050 169 101 1.360 0.079 0.529 0.728 Received penta vaccination (three doses) 0.624 0.053 169 101 1.460 0.086 0.517 0.731 Received polio vaccination (three doses) 0.625 0.043 169 101 1.178 0.069 0.539 0.712 Received measles vaccination 0.694 0.050 169 101 1.447 0.073 0.593 0.795 Received all vaccinations 0.407 0.053 169 101 1.423 0.130 0.302 0.513 Received pnuemococcal vaccination (3 doses) 0.477 0.050 169 101 1.315 0.104 0.378 0.577 Height-for-age (-2SD) 0.549 0.027 771 450 1.390 0.049 0.495 0.602 Weight-for-height (-2SD) 0.162 0.018 771 450 1.300 0.110 0.127 0.198 Weight-for-age (-2SD) 0.410 0.026 771 450 1.360 0.063 0.358 0.462 Body mass index (BMI) < 18.5 0.321 0.030 940 543 1.967 0.094 0.261 0.380 Prevalence of anemia (children) 0.958 0.017 237 137 1.238 0.018 0.924 0.993 Prevalence of anemia (women) 0.866 0.020 352 201 1.121 0.024 0.825 0.907 Total fertility rate (three years) 5.800 0.317 2959 1710 1.295 0.055 5.167 6.434 Neonatal mortality rate (last 0-4 years) 34.329 5.085 1708 1009 1.080 0.148 24.160 44.498 Postneonatal mortality rate (last 0-4 years) 20.469 3.216 1709 1009 0.976 0.157 14.038 26.900 Infant mortality rate (last 0-4 years) 54.798 5.557 1708 1009 0.980 0.101 43.683 65.913 Child mortality rate (last 0-4 years) 16.433 3.401 1666 984 1.068 0.207 9.630 23.235 Under-5 mortality rate (last 0-4 years) 70.330 6.019 1715 1013 0.949 0.086 58.293 82.368 240 • Appendix B Table B.22 Sampling errors: Al-Mhrah sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.455 0.044 570 95 2.102 0.097 0.367 0.543 Literacy 0.542 0.041 570 95 1.947 0.075 0.460 0.623 No education 0.338 0.034 570 95 1.723 0.101 0.270 0.407 Secondary or higher education 0.177 0.021 570 95 1.323 0.120 0.134 0.219 Never married (never in union) 0.344 0.031 570 95 1.573 0.091 0.282 0.407 Currently married (in union) 0.640 0.031 570 95 1.544 0.049 0.578 0.702 Married before age 20 0.606 0.037 431 72 1.571 0.061 0.532 0.680 Currently pregnant 0.083 0.011 570 95 0.943 0.132 0.061 0.104 Children ever born 2.600 0.120 570 95 0.970 0.046 2.360 2.841 Children surviving 2.402 0.106 570 95 0.932 0.044 2.191 2.613 Children ever born to women age 40-49 6.834 0.440 84 14 1.407 0.064 5.954 7.714 Knows any contraceptive method 0.914 0.041 363 61 2.752 0.045 0.833 0.996 Knows any modern contraceptive method 0.904 0.040 363 61 2.547 0.044 0.825 0.984 Currently using any method 0.329 0.045 363 61 1.819 0.137 0.239 0.419 Currently using a modern method 0.200 0.045 363 61 2.146 0.227 0.109 0.291 Currently using a traditional method 0.129 0.026 363 61 1.460 0.200 0.077 0.180 Currently using pill 0.077 0.032 363 61 2.265 0.415 0.013 0.141 Currently using condoms 0.001 0.001 363 61 0.613 1.031 0.000 0.003 Currently using injectables 0.012 0.006 363 61 1.035 0.487 0.000 0.024 Currently using female sterilization 0.010 0.005 363 61 0.927 0.490 0.000 0.019 Currently using rhythm 0.025 0.008 363 61 0.987 0.321 0.009 0.042 Currently using withdrawal 0.103 0.025 363 61 1.567 0.243 0.053 0.154 Used public sector source 0.826 0.057 43 7 0.970 0.069 0.712 0.939 Want no more children 0.249 0.021 363 61 0.915 0.084 0.207 0.290 Want to delay birth at least two years 0.348 0.041 363 61 1.648 0.119 0.265 0.430 Ideal number of children 6.511 0.311 348 57 1.808 0.048 5.890 7.133 Mothers protected against tetanus for last birth 0.350 0.044 250 42 1.442 0.124 0.263 0.438 Births with skilled attendant at delivery 0.647 0.060 375 63 2.018 0.092 0.528 0.767 Had diarrhea in the last two weeks 0.193 0.028 362 61 1.216 0.145 0.137 0.249 Treated with ORS 0.253 0.052 69 12 0.940 0.206 0.149 0.357 Sought medical treatment for diarrhea 0.492 0.067 69 12 1.072 0.136 0.358 0.627 Vaccination card seen 0.527 0.068 79 13 1.177 0.129 0.390 0.663 Received BCG vaccination 0.848 0.046 79 13 1.144 0.055 0.755 0.940 Received penta vaccination (three doses) 0.751 0.045 79 13 0.898 0.060 0.660 0.841 Received polio vaccination (three doses) 0.592 0.075 79 13 1.304 0.127 0.441 0.742 Received measles vaccination 0.711 0.065 79 13 1.226 0.091 0.582 0.840 Received all vaccinations 0.460 0.068 79 13 1.184 0.148 0.324 0.596 Received pnuemococcal vaccination (three doses) 0.412 0.063 79 13 1.114 0.153 0.286 0.537 Height-for-age (-2SD) 0.231 0.034 299 48 1.341 0.146 0.163 0.299 Weight-for-height (-2SD) 0.172 0.020 299 48 0.862 0.119 0.132 0.213 Weight-for-age (-2SD) 0.228 0.036 299 48 1.434 0.160 0.155 0.301 Body mass index (BMI) < 18.5 0.173 0.028 498 82 1.634 0.161 0.117 0.229 Prevalence of anemia (children) 0.925 0.026 85 14 0.916 0.028 0.874 0.976 Prevalence of anemia (women) 0.821 0.029 179 31 1.008 0.035 0.764 0.878 Total fertility rate (three years) 4.256 0.410 1576 263 1.682 0.096 3.437 5.075 Neonatal mortality rate (last 0-4 years) 24.769 6.514 728 122 1.115 0.263 11.741 37.797 Postneonatal mortality rate (last 0-4 years) 16.447 4.685 727 121 0.828 0.285 7.077 25.816 Infant mortality rate (last 0-4 years) 41.216 9.676 730 122 1.089 0.235 21.864 60.567 Child mortality rate (last 0-4 years) 11.189 3.731 744 124 0.877 0.333 3.726 18.651 Under-5 mortality rate (last 0-4 years) 51.943 10.114 734 122 1.092 0.195 31.716 72.170 Appendix B • 241 Table B.23 Sampling errors: Amran sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.222 0.013 1164 852 1.026 0.056 0.197 0.247 Literacy 0.390 0.025 1164 852 1.767 0.065 0.340 0.441 No education 0.585 0.025 1164 852 1.742 0.043 0.535 0.635 Secondary or higher education 0.120 0.016 1164 852 1.676 0.133 0.088 0.152 Never married (never in union) 0.279 0.016 1164 852 1.252 0.059 0.246 0.312 Currently married (in union) 0.698 0.017 1164 852 1.271 0.025 0.664 0.732 Married before age 20 0.644 0.024 858 633 1.457 0.037 0.596 0.692 Currently pregnant 0.123 0.013 1164 852 1.313 0.103 0.098 0.148 Children ever born 2.853 0.141 1164 852 1.543 0.049 2.571 3.135 Children surviving 2.525 0.117 1164 852 1.477 0.046 2.291 2.758 Children ever born to women age 40-49 7.677 0.310 138 103 1.205 0.040 7.057 8.297 Knows any contraceptive method 0.989 0.006 811 595 1.582 0.006 0.978 1.001 Knows any modern contraceptive method 0.989 0.006 811 595 1.582 0.006 0.978 1.001 Currently using any method 0.483 0.023 811 595 1.300 0.047 0.438 0.529 Currently using a modern method 0.419 0.025 811 595 1.432 0.059 0.370 0.469 Currently using a traditional method 0.064 0.012 811 595 1.424 0.191 0.039 0.089 Currently using pill 0.101 0.014 811 595 1.348 0.141 0.072 0.129 Currently using condoms 0.008 0.003 811 595 0.907 0.350 0.002 0.014 Currently using injectables 0.047 0.010 811 595 1.403 0.221 0.026 0.068 Currently using female sterilization 0.027 0.006 811 595 1.050 0.221 0.015 0.039 Currently using rhythm 0.007 0.004 811 595 1.190 0.494 0.000 0.014 Currently using withdrawal 0.057 0.011 811 595 1.348 0.193 0.035 0.079 Used public sector source 0.619 0.038 201 147 1.112 0.062 0.543 0.695 Want no more children 0.458 0.017 811 595 0.970 0.037 0.424 0.492 Want to delay birth at least two years 0.272 0.025 811 595 1.598 0.092 0.222 0.322 Ideal number of children 4.147 0.096 803 590 1.564 0.023 3.955 4.338 Mothers protected against tetanus for last birth 0.328 0.031 608 445 1.597 0.093 0.267 0.389 Births with skilled attendant at delivery 0.353 0.037 916 670 1.984 0.105 0.279 0.428 Had diarrhea in the last two weeks 0.359 0.018 862 632 1.091 0.051 0.323 0.395 Treated with ORS 0.308 0.033 307 227 1.221 0.109 0.241 0.375 Sought medical treatment for diarrhea 0.309 0.036 307 227 1.209 0.115 0.238 0.380 Vaccination card seen 0.483 0.052 168 125 1.354 0.108 0.379 0.587 Received BCG vaccination 0.590 0.055 168 125 1.463 0.094 0.480 0.701 Received penta vaccination (three doses) 0.626 0.054 168 125 1.464 0.087 0.517 0.735 Received polio vaccination (three doses) 0.635 0.040 168 125 1.095 0.064 0.554 0.716 Received measles vaccination 0.632 0.052 168 125 1.408 0.082 0.528 0.737 Received all vaccinations 0.420 0.049 168 125 1.300 0.117 0.321 0.518 Received pnuemococcal vaccination (three doses) 0.390 0.048 168 125 1.289 0.124 0.293 0.486 Height-for-age (-2SD) 0.577 0.019 821 602 1.065 0.033 0.539 0.616 Weight-for-height (-2SD) 0.132 0.015 821 602 1.200 0.112 0.102 0.162 Weight-for-age (-2SD) 0.404 0.024 821 602 1.282 0.059 0.356 0.452 Body mass index (BMI) < 18.5 0.250 0.021 964 711 1.504 0.084 0.208 0.292 Prevalence of anemia (children) 0.914 0.024 219 165 1.271 0.027 0.865 0.963 Prevalence of anemia (women) 0.748 0.032 359 263 1.408 0.043 0.683 0.812 Total fertility rate (three years) 6.053 0.387 3208 2351 1.264 0.064 5.280 6.827 Neonatal mortality rate (last 0-4 years) 30.657 3.631 1869 1360 0.817 0.118 23.396 37.918 Postneonatal mortality rate (last 0-4 years) 28.012 5.546 1862 1358 1.189 0.198 16.921 39.103 Infant mortality rate (last 0-4 years) 58.669 6.973 1869 1360 1.070 0.119 44.723 72.615 Child mortality rate (last 0-4 years) 16.085 3.191 1854 1350 1.002 0.198 9.702 22.467 Under-5 mortality rate (last 0-4 years) 73.810 6.990 1874 1365 0.942 0.095 59.830 87.791 242 • Appendix B Table B.24 Sampling errors: Aldhalae sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.152 0.024 1328 641 2.456 0.160 0.103 0.200 Literacy 0.515 0.034 1328 641 2.462 0.066 0.447 0.582 No education 0.449 0.029 1328 641 2.113 0.064 0.391 0.507 Secondary or higher education 0.176 0.028 1328 641 2.656 0.158 0.120 0.231 Never married (never in union) 0.369 0.019 1328 641 1.420 0.051 0.332 0.407 Currently married (in union) 0.598 0.022 1328 641 1.637 0.037 0.554 0.643 Married before age 20 0.641 0.023 980 475 1.469 0.035 0.596 0.686 Currently pregnant 0.083 0.008 1328 641 1.041 0.095 0.067 0.099 Children ever born 2.742 0.107 1328 641 1.219 0.039 2.528 2.956 Children surviving 2.526 0.098 1328 641 1.225 0.039 2.331 2.722 Children ever born to women age 40-49 7.209 0.216 186 94 0.966 0.030 6.776 7.642 Knows any contraceptive method 0.990 0.007 781 384 1.969 0.007 0.977 1.004 Knows any modern contraceptive method 0.990 0.007 781 384 1.969 0.007 0.977 1.004 Currently using any method 0.342 0.024 781 384 1.401 0.070 0.294 0.389 Currently using a modern method 0.291 0.022 781 384 1.353 0.076 0.247 0.335 Currently using a traditional method 0.050 0.013 781 384 1.650 0.257 0.024 0.076 Currently using pill 0.089 0.014 781 384 1.380 0.158 0.061 0.117 Currently using condoms 0.002 0.001 781 384 0.906 0.711 0.000 0.005 Currently using injectables 0.052 0.009 781 384 1.189 0.183 0.033 0.070 Currently using female sterilization 0.056 0.011 781 384 1.313 0.193 0.034 0.078 Currently using rhythm 0.021 0.009 781 384 1.703 0.413 0.004 0.039 Currently using withdrawal 0.027 0.008 781 384 1.356 0.291 0.011 0.043 Used public sector source 0.553 0.049 197 94 1.372 0.088 0.456 0.651 Want no more children 0.473 0.024 781 384 1.331 0.050 0.426 0.521 Want to delay birth at least 2 years 0.206 0.018 781 384 1.251 0.088 0.170 0.242 Ideal number of children 5.046 0.131 754 371 1.320 0.026 4.784 5.308 Mothers protected against tetanus for last birth 0.284 0.036 514 251 1.808 0.126 0.213 0.356 Births with skilled attendant at delivery 0.449 0.043 785 384 2.045 0.095 0.363 0.534 Had diarrhea in the last two weeks 0.356 0.021 761 373 1.139 0.059 0.315 0.398 Treated with ORS 0.238 0.028 272 133 1.018 0.117 0.183 0.294 Sought medical treatment for diarrhea 0.335 0.030 272 133 0.972 0.089 0.276 0.395 Vaccination card seen 0.299 0.071 133 67 1.831 0.239 0.156 0.442 Received BCG vaccination 0.561 0.075 133 67 1.741 0.133 0.412 0.711 Received penta vaccination (three doses) 0.420 0.072 133 67 1.711 0.172 0.276 0.565 Received polio vaccination (three doses) 0.441 0.070 133 67 1.651 0.159 0.300 0.581 Received measles vaccination 0.522 0.062 133 67 1.445 0.119 0.398 0.647 Received all vaccinations 0.338 0.069 133 67 1.710 0.204 0.200 0.476 Received pnuemococcal vaccination (three doses) 0.236 0.066 133 67 1.815 0.278 0.105 0.367 Height-for-age (-2SD) 0.519 0.026 677 333 1.282 0.051 0.466 0.571 Weight-for-height (-2SD) 0.136 0.016 677 333 1.183 0.119 0.104 0.169 Weight-for-age (-2SD) 0.394 0.026 677 333 1.247 0.065 0.343 0.446 Body mass index (BMI) < 18.5 0.210 0.016 1154 556 1.312 0.075 0.178 0.241 Prevalence of anemia (children) 0.807 0.031 209 106 1.133 0.038 0.745 0.869 Prevalence of anemia (women) 0.678 0.040 394 193 1.725 0.060 0.598 0.759 Total fertility rate (three years) 4.503 0.326 3635 1757 1.649 0.072 3.852 5.154 Neonatal mortality rate (last 0-4 years) 32.658 4.844 1640 808 0.966 0.148 22.971 42.346 Postneonatal mortality rate (last 0-4 years) 10.036 2.429 1639 808 0.938 0.242 5.177 14.894 Infant mortality rate (last 0-4 years) 42.694 4.280 1641 808 0.813 0.100 34.135 51.253 Child mortality rate (last 0-4 years) 4.893 1.686 1620 797 0.961 0.345 1.521 8.264 Under-5 mortality rate (last 0-4 years) 47.378 5.155 1642 809 0.933 0.109 37.067 57.689 Appendix B • 243 Table B.25 Sampling errors: Reimah sample, Yemen 2013 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE Urban residence 0.010 0.000 1097 520 0.162 0.049 0.009 0.011 Literacy 0.294 0.033 1097 520 2.412 0.113 0.228 0.361 No education 0.644 0.035 1097 520 2.388 0.054 0.575 0.714 Secondary or higher education 0.072 0.017 1097 520 2.118 0.230 0.039 0.105 Never married (never in union) 0.327 0.017 1097 520 1.168 0.051 0.294 0.360 Currently married (in union) 0.635 0.017 1097 520 1.163 0.027 0.601 0.669 Married before age 20 0.675 0.022 801 381 1.335 0.033 0.630 0.719 Currently pregnant 0.112 0.011 1097 520 1.136 0.096 0.091 0.134 Children ever born 3.110 0.136 1097 520 1.290 0.044 2.838 3.382 Children surviving 2.776 0.111 1097 520 1.192 0.040 2.555 2.998 Children ever born to women age 40-49 8.156 0.333 130 64 1.159 0.041 7.491 8.821 Knows any contraceptive method 0.980 0.007 686 330 1.333 0.007 0.965 0.994 Knows any modern contraceptive method 0.980 0.007 686 330 1.333 0.007 0.965 0.994 Currently using any method 0.140 0.020 686 330 1.510 0.143 0.100 0.180 Currently using a modern method 0.124 0.018 686 330 1.466 0.149 0.087 0.161 Currently using a traditional method 0.016 0.005 686 330 1.072 0.321 0.006 0.026 Currently using pill 0.054 0.012 686 330 1.338 0.215 0.030 0.077 Currently using condoms 0.002 0.002 686 330 1.123 0.997 0.000 0.006 Currently using injectables 0.034 0.008 686 330 1.213 0.246 0.017 0.051 Currently using female sterilization 0.007 0.003 686 330 0.964 0.429 0.001 0.014 Currently using rhythm 0.006 0.003 686 330 0.950 0.471 0.000 0.011 Currently using withdrawal 0.007 0.003 686 330 1.015 0.457 0.001 0.014 Used public sector source 0.572 0.075 91 39 1.432 0.131 0.422 0.722 Want no more children 0.426 0.028 686 330 1.478 0.066 0.370 0.482 Want to delay birth at least two years 0.175 0.014 686 330 0.988 0.082 0.147 0.204 Ideal number of children 4.340 0.176 650 315 1.887 0.041 3.989 4.692 Mothers protected against tetanus for last birth 0.143 0.022 507 246 1.432 0.154 0.099 0.187 Births with skilled attendant at delivery 0.126 0.020 867 423 1.436 0.155 0.087 0.165 Had diarrhea in the last two weeks 0.306 0.029 826 401 1.538 0.096 0.248 0.365 Treated with ORS 0.339 0.045 243 123 1.216 0.133 0.249 0.430 Sought medical treatment for diarrhea 0.334 0.050 243 123 1.366 0.151 0.233 0.435 Vaccination card seen 0.537 0.070 158 77 1.779 0.131 0.397 0.677 Received BCG vaccination 0.697 0.041 158 77 1.137 0.059 0.615 0.780 Received penta vaccination (three doses) 0.610 0.057 158 77 1.483 0.093 0.496 0.724 Received polio vaccination (three doses) 0.528 0.056 158 77 1.431 0.107 0.415 0.640 Received measles vaccination 0.677 0.050 158 77 1.364 0.074 0.577 0.778 Received all vaccinations 0.343 0.056 158 77 1.483 0.163 0.231 0.455 Received pnuemococcal vaccination (three doses) 0.398 0.057 158 77 1.478 0.144 0.284 0.513 Height-for-age (-2SD) 0.627 0.029 774 388 1.452 0.045 0.570 0.684 Weight-for-height (-2SD) 0.153 0.019 774 388 1.371 0.122 0.116 0.190 Weight-for-age (-2SD) 0.509 0.024 774 388 1.221 0.047 0.462 0.557 Body mass index (BMI) < 18.5 0.255 0.028 950 448 1.950 0.109 0.199 0.310 Prevalence of anemia (children) 0.894 0.020 227 116 0.873 0.022 0.855 0.934 Prevalence of anemia (women) 0.783 0.033 310 153 1.430 0.042 0.717 0.848 Total fertility rate (three years) 5.874 0.336 2989 1422 1.476 0.057 5.202 6.545 Neonatal mortality rate (last 0-4 years) 32.602 3.764 1759 853 0.831 0.115 25.075 40.130 Postneonatal mortality rate (last 0-4 years) 21.520 5.052 1752 848 1.243 0.235 11.415 31.624 Infant mortality rate (last 0-4 years) 54.122 5.840 1760 853 0.979 0.108 42.442 65.802 Child mortality rate (last 0-4 years) 13.043 3.214 1758 854 1.158 0.246 6.616 19.470 Under-5 mortality rate (last 0-4 years) 66.459 6.897 1764 855 1.014 0.104 52.666 80.253 Appendix C • 245 DATA QUALITY TABLES Appendix C Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Yemen 2013 Ever-married women Never-married women Ever-married women Never-married women Age Number Percent Number Percent Age Number Percent Number Percent 0 1,656 2.9 1,632 3.1 37 446 0.8 328 0.6 1 1,462 2.6 1,516 2.9 38 562 1.0 418 0.8 2 1,468 2.6 1,571 3.0 39 377 0.7 287 0.5 3 1,429 2.5 1,547 2.9 40 772 1.4 844 1.6 4 1,488 2.6 1,610 3.1 41 213 0.4 186 0.4 5 1,255 2.2 1,292 2.5 42 332 0.6 348 0.7 6 1,811 3.2 1,865 3.5 43 363 0.6 269 0.5 7 1,751 3.1 1,844 3.5 44 173 0.3 155 0.3 8 1,855 3.3 1,775 3.4 45 621 1.1 662 1.3 9 1,513 2.7 1,490 2.8 46 216 0.4 155 0.3 10 1,793 3.2 1,856 3.5 47 192 0.3 163 0.3 11 1,273 2.2 1,480 2.8 48 332 0.6 260 0.5 12 1,661 2.9 1,912 3.6 49 152 0.3 154 0.3 13 1,680 3.0 1,682 3.2 50 830 1.5 650 1.2 14 1,487 2.6 1,475 2.8 51 380 0.7 185 0.4 15 1,379 2.4 1,449 2.8 52 509 0.9 253 0.5 16 1,306 2.3 1,247 2.4 53 396 0.7 216 0.4 17 1,258 2.2 1,097 2.1 54 209 0.4 115 0.2 18 1,559 2.8 1,375 2.6 55 654 1.2 491 0.9 19 1,150 2.0 902 1.7 56 187 0.3 166 0.3 20 1,613 2.8 1,319 2.5 57 126 0.2 129 0.2 21 797 1.4 641 1.2 58 208 0.4 136 0.3 22 1,066 1.9 894 1.7 59 98 0.2 93 0.2 23 1,089 1.9 805 1.5 60 587 1.0 723 1.4 24 825 1.5 627 1.2 61 83 0.1 104 0.2 25 1,509 2.7 1,049 2.0 62 132 0.2 163 0.3 26 833 1.5 601 1.1 63 117 0.2 132 0.3 27 800 1.4 601 1.1 64 63 0.1 82 0.2 28 979 1.7 692 1.3 65 329 0.6 397 0.8 29 679 1.2 455 0.9 66 58 0.1 82 0.2 30 1,353 2.4 1,184 2.3 67 60 0.1 73 0.1 31 424 0.8 322 0.6 68 63 0.1 94 0.2 32 623 1.1 561 1.1 69 30 0.1 41 0.1 33 522 0.9 370 0.7 70+ 1,503 2.7 1,769 3.4 34 420 0.7 291 0.6 Don’t know/missing 6 0.0 11 0.0 35 1,043 1.8 944 1.8 36 408 0.7 314 0.6 Total 56,593 100.0 52,621 100.0 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. 246 • Appendix C Table C.2 Age distribution of eligible and interviewed women De facto household population of women age 10-54, interviewed women age 15-49; and percent distribution and percentage of eligible women who were interviewed (weighted), by five-year age groups, Yemen 2013 Household population of women age 10-54 Interviewed women age 15-49 Percentage of eligible women interviewed Age group Number Percentage 10-14 7,893 na na na 15-19 6,651 6,265 24.9 94.2 20-24 5,390 5,139 20.4 95.4 25-29 4,801 4,598 18.3 95.8 30-34 3,342 3,193 12.7 95.5 35-39 2,837 2,742 10.9 96.7 40-44 1,853 1,779 7.1 96.0 45-49 1,512 1,444 5.7 95.5 50-54 2,324 na na na 15-49 26,386 25,161 100.0 95.4 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the Household Questionnaire. na = Not applicable Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Yemen 2013 Subject Reference group Percentage with information missing Number of cases Birth date Births in the 15 years preceding the survey Month only 25.39 45,831 Month and year 0.10 45,831 Age at death Deceased children born in the 15 years preceding the survey 2.61 2,856 Age/date at first union1 Ever-married women age 15-49 0.79 16,564 Respondent’s education All women age 15-49 0.00 25,434 Diarrhea in last 2 weeks Living children 0-59 months 0.63 15,170 Anthropometry of children Living children age 0-59 months from the Household Questionnaire Height 7.27 15,616 Weight 5.73 15,616 Height or weight 7.41 15,616 Anthropometry of women All women 15-49 from the Household Questionnaire Height 6.18 26,385 Weight 6.01 26,385 Height or weight 6.29 26,385 Anemia Children Living children age 6-59 months from the Household Questionnaire 15.94 4,500 Women All women from the Household Questionnaire 12.74 8,463 1 Both year and age missing Appendix C • 247 Table C.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio by calendar year, according to living (L), dead (D), and total (T) children (weighted), Yemen 2013 Number of births Percentage with complete birth date1 Sex ratio at birth2 Calendar year ratio3 Calendar year L D T L D T L D T L D T 2013 2,722 112 2,834 100.0 99.9 100.0 97.9 99.1 97.9 na na na 2012 3,129 144 3,273 100.0 98.4 99.9 103.4 150.3 105.1 na na na 2011 3,052 128 3,180 100.0 99.3 99.9 106.7 146.0 108.0 101.1 87.8 100.4 2010 2,911 147 3,058 100.0 100.0 100.0 107.7 151.5 109.5 95.5 103.6 95.8 2009 3,048 155 3,203 100.0 98.3 99.9 106.4 111.8 106.7 112.9 94.1 111.8 2008 2,489 184 2,673 99.9 97.9 99.8 105.3 125.8 106.6 76.3 97.0 77.4 2007 3,479 223 3,702 65.5 54.2 64.8 105.7 99.7 105.3 120.8 114.5 120.4 2006 3,273 206 3,479 61.7 51.1 61.0 104.6 107.9 104.8 97.7 88.9 97.1 2005 3,221 241 3,462 61.3 46.5 60.3 99.5 113.7 100.5 109.6 122.8 110.5 2004 2,603 186 2,789 57.9 45.3 57.1 101.8 91.9 101.1 83.0 81.1 82.9 2009-2013 14,862 685 15,548 100.0 99.1 99.9 104.5 130.6 105.5 na na na 2004-2008 15,065 1,041 16,105 68.1 57.9 67.5 103.4 107.2 103.6 na na na 1999-2003 12,935 1,093 14,028 55.4 44.1 54.5 107.1 144.4 109.6 na na na 19941998 8,500 1,127 9,627 51.8 42.6 50.7 103.9 114.7 105.1 na na na < 1994 7,202 1,349 8,551 47.3 38.8 46.0 104.5 122.3 107.1 na na na All 58,563 5,295 63,858 68.5 52.3 67.1 104.7 122.6 106.0 na na na na = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)x100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]x100, where Bx is the number of births in calendar year x Table C.5 Reporting of age at death in days Distribution of reported deaths under 1 month by age at death in days and the percentage of neonatal deaths reported to occur at age 0-6 days, for five-year periods of birth preceding the survey (weighted), Yemen 2013 Number of years preceding the survey Total 0-19 Age at death (days) 0-4 5-9 10-14 15-19 <1 80 89 72 74 315 1 109 126 104 89 427 2 35 23 52 14 125 3 55 52 53 41 201 4 22 21 20 10 73 5 12 11 14 10 47 6 7 7 5 6 25 7 19 22 24 31 96 8 4 5 3 6 19 9 3 3 1 1 8 10 6 10 18 7 42 11 0 0 3 0 3 12 5 7 3 9 23 13 3 2 2 3 9 14 12 11 13 4 40 15 9 11 27 25 72 17 0 0 1 0 1 18 0 0 1 7 8 19 0 0 0 0 0 20 9 9 10 7 35 21 7 4 2 7 20 22 5 0 2 1 8 23 0 2 2 0 4 24 0 0 0 1 2 25 2 5 2 0 9 Total 0-30 405 424 432 352 1,612 Percentage early neonatal1 79.2 77.9 74.1 69.0 75.3 1 0-6 days / 0-30 days 248 • Appendix C Table C.6 Reporting of age at death in months Distribution of reported deaths under age 2 by age at death in months and percentage of infant deaths reported at age under 1 month, by five-year periods preceding the survey, Yemen 2013 Number of years preceding the survey Total 0-19 Age at death (months) 0-4 5-9 10-14 15-19 <1a 405 424 432 352 1,612 1 37 64 77 63 241 2 43 33 58 40 174 3 23 35 45 36 140 4 23 37 34 55 150 5 12 34 19 33 98 6 23 43 34 30 130 7 19 44 48 45 156 8 20 26 27 39 112 9 9 28 17 34 88 10 5 14 16 7 41 11 4 11 4 8 27 12 39 55 97 124 315 13 3 1 0 2 5 14 0 5 2 1 8 15 1 1 2 0 5 16 6 0 1 0 8 17 0 2 3 0 5 18 3 10 7 3 22 19 0 0 6 2 9 20 0 1 0 2 3 21 3 3 0 1 6 22 0 0 2 2 4 Total 0-11 623 793 809 742 2,968 Percentage neonatal1 64.9 53.5 53.4 47.4 54.3 a Includes deaths under 1 month reported in days 1 Under 1 month / under 1 year Appendix C • 249 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population Percentage of children under age 5 classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by background characteristics, based on the NCHS/CDC/WHO International Reference Population, Yemen 2013 Height-for-age1 Weight-for-height Weight-for-age Number of children Background characteristic Percent- age below -3 SD Percent- age below -2 SD2 Mean Z-score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z-score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z-score (SD) Age in months <6 2.5 10.2 -0.4 2.2 8.8 4.7 -0.3 1.2 9.1 3.0 -0.5 1,364 6-8 6.9 23.2 -1.0 3.3 17.3 2.2 -0.9 10.0 33.3 0.2 -1.5 730 9-11 8.4 23.3 -1.1 4.3 18.5 1.5 -1.1 10.8 39.8 0.1 -1.7 671 12-17 16.0 37.3 -1.6 4.7 24.3 1.5 -1.1 15.9 49.6 0.1 -1.9 1,640 18-23 22.6 48.6 -2.0 3.6 19.0 0.9 -1.1 14.7 46.9 0.4 -1.9 1,131 24-35 20.9 44.1 -1.8 2.0 12.9 0.6 -1.0 16.8 49.3 0.3 -2.0 2,804 36-47 24.2 50.6 -2.1 2.0 11.7 0.7 -1.0 13.5 49.5 0.3 -2.0 2,668 48-59 24.4 51.4 -2.1 1.4 11.5 1.0 -1.0 12.4 51.0 0.3 -2.0 2,791 Sex Male 19.4 41.3 -1.7 2.7 15.1 1.3 -1.0 12.7 43.9 0.4 -1.8 7,038 Female 17.9 40.5 -1.7 2.4 13.6 1.5 -0.9 13.0 44.6 0.7 -1.8 6,762 Residence Urban 10.2 28.3 -1.3 2.1 12.2 1.8 -0.9 7.0 33.7 0.7 -1.5 3,782 Rural 21.8 45.7 -1.9 2.7 15.2 1.2 -1.0 15.0 48.2 0.5 -1.9 10,018 Governorate Ibb 17.9 41.5 -1.7 1.4 7.9 1.5 -0.7 9.5 35.6 0.3 -1.6 1,553 Abyan 5.3 18.4 -0.9 2.0 18.1 0.4 -1.1 4.7 31.8 0.4 -1.4 284 Sana’a City 7.8 25.3 -1.2 1.5 9.0 1.8 -0.8 5.0 27.0 0.9 -1.4 1,166 Al-Baidha 12.5 29.9 -1.3 4.3 12.8 0.5 -0.9 9.0 33.6 0.2 -1.5 534 Taiz 15.9 39.7 -1.7 1.6 13.6 1.2 -1.0 13.2 44.7 0.9 -1.8 1,859 Al-Jawf 25.1 49.4 -2.0 1.9 8.1 1.3 -0.8 11.1 44.4 0.3 -1.8 130 Hajjah 28.5 52.8 -2.2 2.3 18.3 0.9 -1.1 21.1 61.2 0.5 -2.2 933 Al-Hodiedah 20.3 43.2 -1.8 5.2 25.2 1.0 -1.3 20.0 61.1 0.1 -2.2 1,808 Hadramout 10.0 25.4 -1.1 3.2 16.0 2.5 -0.9 5.8 31.5 0.5 -1.4 517 Dhamar 29.0 54.1 -2.1 1.7 12.0 1.0 -0.8 17.2 49.5 0.9 -1.9 1,097 Shabwah 11.4 24.3 -0.9 5.3 19.8 4.5 -0.9 6.8 30.0 1.0 -1.3 214 Sadah 31.2 54.6 -2.2 5.3 14.9 2.1 -0.9 18.6 55.4 1.4 -2.0 372 Sana’a 17.3 41.5 -1.7 2.2 13.4 1.2 -0.8 10.4 37.8 0.2 -1.7 731 Aden 5.4 19.3 -0.9 0.8 14.6 1.9 -1.0 5.4 32.0 0.6 -1.4 345 Lahj 11.4 31.0 -1.4 2.0 14.2 1.9 -1.0 7.6 38.4 0.6 -1.7 332 Mareb 14.9 36.4 -1.5 2.0 11.9 1.6 -0.8 10.6 36.8 0.8 -1.6 101 Al-Mhweit 22.1 47.7 -1.9 3.0 14.9 1.6 -0.9 12.9 46.8 0.4 -1.9 450 Al-Mhrah 5.4 19.1 -0.9 2.1 14.6 1.3 -0.9 3.4 30.5 0.5 -1.3 48 Amran 25.5 54.3 -2.1 1.3 10.0 1.2 -0.8 12.5 47.9 0.1 -1.9 599 Aldhalae 21.7 44.8 -1.9 1.8 11.4 1.0 -0.9 12.6 42.2 0.8 -1.8 338 Reimah 32.4 58.7 -2.3 2.6 12.9 1.5 -0.9 19.0 56.4 0.1 -2.1 390 Wealth quintile Lowest 28.2 53.6 -2.1 3.6 19.5 0.9 -1.1 22.6 59.9 0.5 -2.2 3,128 Second 23.7 49.3 -2.0 2.5 15.8 1.1 -1.0 15.2 50.7 0.3 -1.9 2,979 Middle 19.6 42.6 -1.8 2.3 11.5 1.3 -0.9 11.6 41.7 0.6 -1.7 2,797 Fourth 12.0 32.4 -1.4 2.2 12.4 2.0 -0.9 7.3 36.5 0.6 -1.6 2,504 Highest 5.8 20.8 -1.0 1.7 11.2 1.6 -0.8 4.2 26.8 0.8 -1.3 2,392 Total 18.7 40.9 -1.7 2.5 14.3 1.4 -0.9 12.8 44.2 0.5 -1.8 13,800 Note: Table is based on children who slept in the household the night before the interview. Each of the indices is expressed in standard deviation units (SDs) from the median of the NCHS/CDC/WHO International Reference Population. Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. 1 Recumbent length is measured for children under age 2, or in the few cases where the age of the child is unknown and the child is less than 85 cm, standing height is measured for all other children to be consistent with Table 11.1.1. 2 Includes children who are below -3 standard deviations (SDs) from the International Reference Population median. 250 • Appendix C Table C.8 Need and demand for family planning for currently married women (definition used in 1997) Percentage of currently married women age 15-49 with unmet need for family planning, the percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Yemen 2013 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Age 15-19 26.4 2.4 28.8 11.9 1.3 13.2 38.3 3.7 42.0 31.4 28.7 1,084 20-24 21.8 5.4 27.2 19.9 5.6 25.4 41.7 11.0 52.7 48.3 43.6 2,968 25-29 19.1 9.2 28.2 23.3 13.1 36.4 42.3 22.3 64.6 56.3 50.7 3,574 30-34 11.8 15.0 26.8 18.1 22.0 40.2 30.0 37.0 67.0 59.9 53.0 2,675 35-39 9.1 21.1 30.3 11.6 28.9 40.5 20.7 50.1 70.7 57.2 48.7 2,409 40-44 3.5 21.2 24.7 4.4 32.9 37.4 7.9 54.1 62.0 60.2 49.3 1,579 45-49 1.7 19.5 21.2 2.7 26.6 29.2 4.4 46.0 50.4 58.0 45.4 1,277 Residence Urban 10.5 8.0 18.4 23.9 23.5 47.5 34.4 31.5 65.9 72.0 61.0 4,949 Rural 16.1 15.2 31.3 11.6 15.3 27.0 27.7 30.5 58.3 46.3 41.2 10,617 Governorate Ibb 18.9 13.2 32.1 14.9 17.8 32.7 33.8 31.0 64.8 50.5 47.4 1,678 Abyan 7.1 10.0 17.2 19.2 13.2 32.4 26.3 23.2 49.6 65.4 59.6 326 Sana’a City 7.4 6.0 13.4 29.8 26.4 56.2 37.2 32.4 69.6 80.8 69.1 1,510 Al-Baidha 14.8 14.1 28.9 15.3 18.6 33.9 30.1 32.6 62.8 54.0 48.1 702 Taiz 12.9 11.2 24.1 13.4 18.0 31.4 26.3 29.2 55.5 56.6 49.9 2,053 Al-Jawf 19.0 15.1 34.1 13.6 12.7 26.3 32.6 27.9 60.5 43.6 42.9 124 Hajjah 21.5 25.5 47.0 4.7 12.4 17.1 26.1 37.9 64.0 26.7 25.7 867 Al-Hodiedah 18.0 19.7 37.8 5.7 10.9 16.5 23.7 30.6 54.3 30.4 25.3 1,891 Hadramout 12.2 4.2 16.4 27.2 10.1 37.3 39.4 14.3 53.8 69.4 51.2 884 Dhamar 15.8 14.7 30.6 17.4 17.8 35.2 33.2 32.6 65.8 53.5 50.5 1,106 Shabwah 19.1 9.9 29.0 11.9 9.4 21.3 31.0 19.3 50.3 42.3 38.5 293 Sadah 11.3 10.7 22.0 16.4 16.3 32.7 27.7 27.0 54.7 59.8 49.2 504 Sana’a 10.7 10.7 21.4 21.3 28.4 49.7 32.0 39.1 71.1 69.9 58.1 831 Aden 7.8 6.2 14.0 17.3 29.5 46.9 25.1 35.7 60.9 77.0 66.4 487 Lahj 9.9 12.8 22.8 12.6 20.6 33.2 22.5 33.4 56.0 59.3 54.2 405 Mareb 20.7 11.2 31.8 15.3 10.5 25.7 35.9 21.6 57.6 44.7 37.0 111 Al-Mhweit 20.0 20.2 40.2 7.1 16.0 23.1 27.1 36.2 63.3 36.5 31.0 425 Al-Mhrah 9.8 5.4 15.2 21.6 11.3 32.9 31.4 16.7 48.0 68.4 41.6 61 Amran 10.6 9.4 20.0 20.4 28.0 48.3 31.0 37.4 68.4 70.7 61.3 595 Aldhalae 12.7 12.2 24.9 12.2 22.0 34.2 24.9 34.2 59.1 57.8 49.3 384 Reimah 20.5 19.2 39.7 5.3 8.7 14.0 25.8 27.9 53.7 26.1 23.1 330 Education No education 13.4 18.2 31.6 9.2 18.7 28.0 22.6 36.9 59.5 47.0 41.6 8,336 Fundamental 16.0 7.7 23.7 20.4 17.3 37.7 36.4 25.0 61.5 61.4 52.8 5,090 Secondary 15.3 5.3 20.6 27.2 15.4 42.6 42.5 20.7 63.2 67.4 59.1 1,511 Higher 10.1 3.3 13.3 31.4 19.0 50.4 41.5 22.3 63.8 79.1 64.0 629 Wealth quintile Lowest 19.1 22.5 41.6 5.1 9.4 14.5 24.3 31.9 56.1 25.9 24.3 2,840 Second 17.2 15.2 32.3 9.6 14.4 24.0 26.7 29.6 56.4 42.6 37.3 3,076 Middle 14.5 12.8 27.3 14.0 19.8 33.8 28.5 32.6 61.1 55.3 50.0 3,141 Fourth 12.0 8.8 20.8 21.2 21.1 42.2 33.2 29.8 63.0 67.0 56.9 3,147 Highest 9.6 6.7 16.3 25.9 23.8 49.7 35.5 30.5 66.0 75.3 64.0 3,362 Total 14.3 12.9 27.2 15.5 18.0 33.5 29.8 30.9 60.7 55.2 48.0 15,566 Note: Numbers in this table correspond to the OLD definition of unmet need. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, and lactational amenorrhea method (LAM). Appendix D • 251 YNHDS PERSONNEL Appendix D YNHDS STEERING COMMITTEE Minster of MOHP Committee President President of CSO Committee Vice President Deputy of MOHP for Planning Sector Survey National Manager, Committee Member Deputy of MOHP for Population Sector Committee Member Deputy of MOHP for Care Sector Committee Member Deputy of CSO Committee Member General Secretary of National Council for Population Committee Member General Secretary of Supreme Council for Motherhood and Childhood Committee Member General Manager of Information and Survey Executive Manager, Research Management, MOHP Committee Member General Manager of MOHP Minister’s Office Committee Member General Manager of Policies Unit, MOHP Committee Member President of Survey Technical Committee, CSO Committee Member Survey Technical Manager Committee Member General Manager of Planning, MOHP Committee Member Representative of Financial Ministry Committee Member Representative of Planning Ministry Committee Member Representative of Education Ministry Committee Member Representative of Media Ministry Committee Member Representative of Social Affairs and Work Ministry Committee Member Representative of Interior Ministry Committee Member Representative of Local Management Ministry Committee Member Representative of Social Fund for Development Committee Member Representative of Sana’a University Committee Member Representative of WHO Committee Member Representative of EKN Committee Member Representative of UNFPA Committee Member Representative of UNICEF Committee Member Representative of USAID Committee Member Representative of WB Committee Member Representative of EN Committee Member Representative of GIZ Committee Member Representative of DFID Committee Member 252 • Appendix D TECHNICAL COMMITTEE Mr. Abdul Latif Ali Al-Shaibani, CSO President Mr. Faisal Mohsen Al-Gohali, MOHP Vice President Mr. Ahmed Abdullah Al-Kibsi, CSO, Survey Technical Manager Committee Member Ms. Magda Awasah, Supreme Council for Motherhood and Childhood Committee Member D. Abdullah Abdul Aziz Muharram, Sana’a University Committee Member A. Abdul Malik Abdul Rahman Al-Thami, Committee Member General Secretary of National Council for Population Mr. Lutfi Abdul Latif Ismail, Planning Sector, MOHP Committee Member D. Najeebeh Abdul Ghani, Population Sector, MOHP Committee Member D. Nasib Mansour Al-Molagem, Curative Medicine Sector, MOHP Committee Member D. Lotf Hassan Al-Zkar, Care Sector, MOHP Committee Member D. Inas Ali Taher, Donors Representative Committee Member Ms. Lena Al-Iryani, Nutrition Manager, MOHP Committee Member Mr. Mohammed Abdullah Khalil, Survey Managing Director, MOHP Committee Member Ms. Ashwag Mansoor, National Committee for Women Committee Member Mr. Adnan Muraysi, Head of Data Processing Team, CSO Committee Member Mr. Labib Al-Absi, Head of Fieldwork Team, CSO Committee Member Mr. Ibrahim Al-Shawkaani, Head of Office and Committee Member Documents Preparation Team, CSO Mr. Ahmed Al-Mithali, Head of Samples Team, CSO Committee Member Management Team Survey National Manager Dr. Jamal Thabit Nasher Survey Executive Manager Dr. Abdul-Jabbar Ali Ghaithi Survey Technical Manager Mr. Ahmed Abdullah Al-Kibsi Survey Managing Director Mohammed Abdullah Khalil Survey Accountant Ahmed Amer Hamati Survey Secretary Eyesha Saleh Manshaline Second: Office and Document Preparation Team First: Secretarial Team Team Leader Ibrahim Abdul Latif Al-Shawkaani Team Leader Abdullah Maaodah Team Member Dr. Nora Ahmed Mahdi Team Member Sadiq Al-Ashwal Team Member Radiah Qasim Farei Team Member Abdul Malik Al-Wosabi Team Member Fatima Saif Monasar Team Member Nasr Salem Fourth: Fieldwork Team Third: Data Processing Team Team Leader Labib Ahmad Al-Absi Team Leader, Framework Phase Mr. Abdullah Shmsan Team Member Ahmed Algohali Team Leader, Main Survey Phase Mr. Adnan Al-Muraysi Team Member D. Abdul Salam Hanash Team Member Mr. Helmi Al-Maqtari Team Member Ola Mohammed Jerizaa Team Member Mr. Fawaz Khulaidi Team Member Wahbeeah Mohammed Al-Yemeni Team Member Mr. Arafat Shmsan Team Member Yasmin Mohammed Osrb Team Member Mr. Mohammed Aladhi Team Member Adel Ali Rpad Team Member Ahd Jameel Ghanem Team Member Abdul-Latif Al-Nunu Team Member Majid Ayed Al-Sabri Team Member Iman Al-Turki Appendix D • 253 Sixth: Maps Team Fifth: Sample Team Team Leader Mr. Helmi Al-Maqtari Team Leader Ahmed Nasser Al-Mithala Team Member Mr. Fawaz Khulaidi Team Member Mr. Helmi Al-Maqtari Team Member Abdul-Latif Al-Nunu Team Member Zaid Ghashm Team Member Arafat Shamsan Team Member Abdullah Maaodah Team Member Nasar Salelm HOUSEHOLD LISTING UPDATE Document Preparation Mr. Ahmed Al-Kibsi (Survey Technical Manager) Training Team Editing Team Khaled Taha Al-Madani Dr. Abdul-Jabbar Ali Ghaithi Abdullah Naji Al Hammadi Mohammed Abdullah Khalil Adnan Hussein Ibrahim Abdul Latif Al-Shawkaani Sam Al-Bashiri Dr. Nora Ahmed Mahdi Abdullah Mohammed Shamsan Ahmed Nasser Al-Mithala Ibrahim Abdul Latif Al-Shawkaani Labib Ahmad Al-Absi Labib Ahmad Taher Ahmed Amer Hamati Ahmed Al-Mithali Abdullah Maaodah Household Listing Update and Enumeration: Fieldwork Teams Position Name Team Number Governorate Team Leader Hassan Ali Mohammed Al-Arami 1 Ibb Interviewer Ahmed Sorour Interviewer Abdullah Mohammed Rageh Interviewer Akram Abdullah Eida Interviewer Osama Khalid Mcrad Driver Ibrahim Al-Khawlaani Team Leader Mohammad Ali Qasim Al-Maitami 2 Ibb Interviewer Mohammed Yahya Al-Aerami Interviewer Salah Al-Hubaishi Interviewer Ibrahim Al-Kibsi Driver Khaled Ahmad Mosaad Team Leader Mohammed Ali Al-Fatmi 1 Abbyan Interviewer Mohammed Abdullah Mouzahem Interviewer Salem Mohammed Interviewer Ahmed Mohamed Al-Shubaily Driver Khaled Al-Barkani Team Leader Saleh Waheeb Ali 2 Abbyan Interviewer Hassan Afif Hassan Interviewer Nasser Ahmed Interviewer Fadel Muhammad Hydra Interviewer Nasser Ali Ebadi Driver Muhammad Ali Al-Dmdmi 254 • Appendix D Position Name Team Number Governorate Team Leader Tahir Abdlwali Haider 1 Sana’a City Interviewer Amin Saeed Ismail Interviewer Ali Abdul Rahim Ahmad Interviewer Ziad Mohammed Al-Mashriki Interviewer Abd Al-Bari Lotf Al-Hadrami Driver Bandar Alecoqbani Team Leader Ahmed Ahmed Sayani 2 Sana’a City Interviewer Ali Ahmed Faqih Interviewer Nizar Abdel-Mogni Interviewer Ahmed Abdel Karim Jobran Interviewer Bashir Hamid Alnafish Driver Hamid Alecoqbani Team Leader Aref Ali Qahtan 1 Al-Baidha Interviewer Abdullah Al-Badani Interviewer Abdel Moneim Al-Museibli Interviewer Abdullah Al-Jalal Interviewer Ammar Al-Wosabi Driver Ali Al-Badani Team Leader Mustafa Ahmed Kamli 2 Al-Baidha Interviewer Mokbel Al-Dhahiri Interviewer Mujahid Almdhraie Interviewer Saleh Alhsaisai Interviewer Salem Alqrfush Driver Zaid Dhmh Team Leader Mohammed Al-Ghannam 1 Taiz Interviewer Abdo Saad bin Saad Qradah Interviewer Amin Mohammed Radman Interviewer Fouad Raweh Haider Interviewer Waheeb Al-awadi Driver Mohammed Ahmed Al-Othri Team Leader Amin HSA Dgesh 2 Taiz Interviewer AbduleIlah Noman Al-Barkani Interviewer Amer Wali Al-Mufich Interviewer Abdullah Abdu Saif Al-Zoreiky Interviewer Fuad Yahya Muharram Driver Abdul Karim Al-Kadi Team Leader Saeed Saif 1 Socotra Team Leader Saleh Ali Abbar 1 Al-Jawf Interviewer Arafat Ali Saeed Interviewer Abdullah Abdullah Al-Haimi Interviewer Essam Al-Sanabani Interviewer Nabil Youssef Najmei Driver Saleh Al-Qasimi Appendix D • 255 Position Name Team Number Governorate Team Leader Khaled Saleh Al-Shabei 2 Al-Jawf Interviewer Ali Ali Moqadar Interviewer Abdullah Al-Fadhli Interviewer Abed Rabbo Ahmd Hussein Interviewer Abdulsalam Al-Dorani Driver Saleh Al-Qasimi Team Leader Iskandar Abdo Ali 1 Hajah Interviewer Mohammed Abdullah Damaqi Interviewer Mohammad Hossein Al-Batahi Interviewer Abdel Basset Azi Alskie Interviewer Aidroos Nasser Al-Wadi’i Driver Abdu Qasim Ali Ismail Team Leader Abbas Mohammed Al-Ashram 2 Hajah Interviewer Khalid Abdullah Sora Interviewer Hadrami Hadi Al-Hadrami Interviewer Khaled Ahmed Mohamed Jomal Interviewer Hashim Mohammed Hamza Fadaeel Driver Abdul Razak Abdullah Murashed Team Leader Omar Salem Bamkhtar 1 Hadramout Al-Mukla Interviewer Mohammad Ba Fadl Interviewer Khaled Alcaldi Interviewer Jihad Salmeen Interviewer Ahmed Baharoon Driver Bandar Abdo Saeed Team Leader Hesham Mohamed Mnibari 1 Hadramout Seiyun Interviewer Mahfouz Salem Gafzan Interviewer Abdullah Mubarak Badhaoui Interviewer Sabri Said bin Sawad Driver Hamed Al-Shamiri Team Leader Najib Mohammed Al-Komaim 1 Dhamar Interviewer Abdul Jabbar Saad Al-Ansi Interviewer Ahmed Mohammed Al-Shabibi Interviewer Mohammed Al-Omaisi Interviewer Majid Ali Naji Ayed Driver Mohammed Hassan Ahmed Aobbad Team Leader Mohammed Hamoud Alqawani 2 Dhamar Interviewer Bakil Mohammed Al-Kherash Interviewer Tariq Abdullah Aidah Interviewer Wadah Mohamed Othman Interviewer Ezzedine Al-Humaidah Driver Ali Al-Hassani Team Leader Saeed Ahmed Taleb Jaol 1 Shabwah Interviewer Ali Abdul-Malik Interviewer Abd AlKarim Al-Radhi Interviewer Ahmed Saeed Ba htir Interviewer Walid Tawfiq Al-Absi Driver Ali Abdullah Saeed 256 • Appendix D Position Name Team Number Governorate Team Leader Mehdi Salem Boraq 2 Shabwah Interviewer Abdullah Saleh Aboud Interviewer Abdullah Abu Bakr Al-Aqeel Interviewer Jamal Omar Alaittali Interviewer Ali Breek Abdullah Driver Ahmed Al-Hasel Team Leader Mohammed Salman Al-Mahdlj 1 Sadah Interviewer Ahmed Raji Al-Mhdhira Interviewer Khaled Yahya Al-Marrani Interviewer Mohammed Abdullah Al-Muzhar Interviewer Amin Ahmed Al-Kibsi Driver Ahmed Al-Gurabei Team Leader Sadiq Moqbel Grsan 2 Sadah Interviewer Adnan Ali Mohamed Ibrahim Interviewer Hamdi Faisal Mohammed Zafar Interviewer Mohammed Ali Al-Huthi Interviewer Ibrahim Hassan Al-Moaed Driver Muhammad Ali Al-Bishari Team Leader Mehdi Ahmed Mahdi 1 Al-Hodeidah Interviewer Ahmed Alfaz Interviewer Morshed Hussein Ali Interviewer Abdulkarim Al-Moalimei Interviewer Hazza Almsorei Driver Kamal Alois Team Leader Abdel Wahed Mohamed Ahmed 2 Al-Hodeidah Interviewer Wajdi Mojamed Shaher Interviewer Amin Al-Sharif Interviewer Abdullah Barakat Shami Interviewer Yasser Awad Driver Mohammed Mohsen Al-Arows Team Leader Abed Rabbo Abdulwahab Al-Sobahi 1 Sana’a Interviewer Abd Alnasser Interviewer Najib Al-Harazi Interviewer Muthanna Abdullatif Al-Shaibani Interviewer Ali Naji Jubair Driver Ali Hamid Khala Team Leader Bakil Mohammed Azam 2 Sana’a Interviewer Badr Alqradi Interviewer Khalid Al-Dar Interviewer Ali Al-Harazi Interviewer Taha Al-Shwkani Driver Ali Al-Na’ami Team Leader Ali Abdu Saleh 1 Aden Interviewer Yusuf Mohamed Saleh Interviewer Ali Qaid Massoud Interviewer Abdulrahman Abdullah Al Hammadi Interviewer Jamal Mujahid Al-Athuri Driver Abdel Nasser Mohammed Abdullah Appendix D • 257 Position Name Team Number Governorate Team Leader Bassel Ahmed Abdullah 2 Aden Interviewer Mohammed Abdulwase Interviewer Rami Ahmed Saleh Interviewer Khaled Taher Interviewer Ahmed Haza Driver Mohammed Hamid Gosailh Team Leader Fadel Saleh Salami 1 Lahj Interviewer Badr Ahmed Fadel Interviewer Abalhafez Hazem Hamood Interviewer Salah Aladimi Interviewer Haitham Othman Al-Qurashi Driver Marwan Abdullah Abbas Team Leader Sami Mohammed Saeed 2 Lahj Interviewer Mahmoud Ramadan Said Interviewer Monasar Ahmed Mohsen Interviewer Hani Al-Dosari Interviewer Mohammed Farea Alzoreiky Driver Khaled Saqeer Team Leader Sadiq Hameed Alsamey 1 Mareb Interviewer Abdu Rashid Interviewer Mohammed Hussein Al-Saleh Interviewer Fawaz Ghalib Al-Salihi Interviewer Abed Rabbo Moftah Driver Said Salhi Team Leader Abdulhakim Muhammad Sabei 2 Mareb Interviewer Abdulqawi Abdullah Ali Interviewer Maher Sultan Al-Maqtari Interviewer Aِbdo Raboh Moftah Driver Sinan Al Abbasi Team Leader Ismail Lotf Al-Sormi 1 Al-mhweit Interviewer Ghamdan Rashid Abdul Kader Interviewer Majeed Sharaf Al-Wadi’i Interviewer Waheed Ali Fjkhal Interviewer Nasser Hamid Al-Sadiq Driver Faisal Abdullah Awad Team Leader Muhammad Ali Sfran 2 Al-mhweit Interviewer Mohammed Al-Absi Interviewer Mohammed Alhvashi Interviewer Khad Omar Al-Waelah Driver Walid Gosailh Team Leader Rdeim Mustahail Mubarak 1 Al-Mahrah Interviewer Rajab Said Awad Interviewer Ali Omar Salim Al-Adl Interviewer Mustafa Hydra Saleh Interviewer Ahmed Qael Balhaf Driver Mohammed Yehia Al-Khatabi 258 • Appendix D Position Name Team Number Governorate Team Leader Jubran Abdullah Ahmad 1 Al-Dhalee Interviewer Yusuf Mohamed Said Interviewer Zayed Mohammed Hassan Interviewer Eliaa Abdallah Mohammed Abubakar Interviewer Nagib Mahmoud Morgan Driver Sadiq Ali Mohammed Team Leader Abdulkadir Ali Obadi Hassan 2 Al-Dhalee Interviewer Muhammad Ali Abboud Interviewer Tariq Mosaeed Mohammed Interviewer Ibrahim Ahmed Mohsen Interviewer Saddam Mahmoud Saleh Driver Abdulrahman Ali Naji Team Leader Kaid Favor Al-Hujairi 1 Amran Interviewer Fayez Morfaq Interviewer Akram Haider Hazza Interviewer Mansour Abdul Jalil Interviewer Mokbel Hezam Ziad Driver Abdul Khaliq Abdo Mohammed Team Leader Yassin Ibrahim Saif 2 Amran Interviewer Ziad Al-Bashari Interviewer Abdulrahman Al Harfi Interviewer Ibrahim Al-Tmah Interviewer Ibrahim Al-Shamsi Driver Mujahid Al-snhani Team Leader Abdo Mohammed Abdullah Yahya 1 Rymah Interviewer Abdul Rahman Saleh Interviewer Yahya Mahdi Saleh Interviewer Ahmed Abdo Kaid Interviewer Adel Saad Ali Driver Mohammed Abdo Salah Team Leader Ahmed Mahdi Mohammed Al-Aoqbi 2 Rymah Interviewer Amin Abdo Mohammed Interviewer Abdulsalam Almsori Interviewer Mushtaq Al-Absi Interviewer Muammar Numan Moqbel Driver Ali Mohamed Azman Operations Team for Household Listing Update and Enumeration Ahmed Sawab Mohammed Khalil Ahmed Al-Hamati Jamal Al-Duais Adel Al-Sanhani Appendix D • 259 Editing Team Abdullah Maaodah Radiah Qasim Farei Hayat Nassar Fatmah Saif Rana Al-Mrich Nabeel Al-Ghaithi Ahmad Waheeb Wahbeia Al-Yemeni Mustafa Al-Baidhani Iman Al-Turkey Majid Al-Sabri Yasmin Othrb Abdul Salam Hanash Abdul-Latif Al-Nunu Fatehieah Abo Qaid Hanan Al-Akwa Hanan Abo Qaid Bushra Al-Sanani Ola Al-Jerizaa Nasr Salem Elham Saleh Manshaline Ibrahim Abdul Latif Al-Shawkaani Salwa Al-Ahdal Data Processing Team Abdullah Ahmad Hanash Redha Mohammad Ammar Abdlwah Al-Wosabi Abdul-Aziz Al-Obeidi Mohammed Ahmed Alehizana Alaa Al-Hakami Muhammad Ali Al-Sharafi Mona Abdel-Rahman Commander Nadia Ahmed Al-Romaih Omar Mohamed Abdel Mogni Amr Abdel-Ghani Al-Obeidi Ahmed Ali Al-Ashwal Haitham Kassem Alwtari Najib Morgan Amat Al-Salam Mohammed IssaSalah Ali Al-Wadi’i Mukhtar Al-HawafaAmat Al Salam Fatehi PRE-TEST First: Training Team Mr. Ahmed Abdullah Al-Kibsi Dr. Nora Ahmed Mahdi Fieldwork Team Teams Position Names Sana’a City Team Leader Chakib Abdou Abdel Lord Al Hotheily Editor Murtada Abdul Al-Hadi First Team (Urban) Interviewer Lamia Abdullah Al-Akwa Interviewer Khiria Abdullah Al-Shami Interviewer Rana Abdul Wahid Youssef Interviewer Iman Yahya Al-Marrani Sana’a City Team Leader Nabeel Haider Jeder Editor Ihab Jafar Second Team (Urban) Interviewer Hayat Muhammad Naseer Ahmad Interviewer Hanan Abdullah Ali Interviewer Fetehiye Ali Abdullah Interviewer Sahar Abdu Rashid Sana’a City Team Leader Dammaj Mohammed Abdo Jameel Al-Hawri Editor Khalid Abdullah Ibrahim Hamdan District Interviewer Mona Omar Alohjeri 260 • Appendix D Teams Position Names Third Team (Rural) Interviewer Amira Abdel-Hamid Khaled Interviewer Entesar of Mohammed Ali Jawad Interviewer Bushra Mohammed Al-Sanani Sana’a City Team Leader Riad Hammoud Al-Saloi Al-Jaki Editor Saad Mohammed Al-Qurashi Sanhan, Bani Bahlol Interviewer Ishraq Ahmed Al-Kidny Fourth Team (Rural) Interviewer Ibtisam Mohammed Azzan Interviewer Fatima Mohammed Ishaq Interviewer Khadija Hamad Shwk MAIN SURVEY Preparation and Document Review Dr. Abdul-Jabbar Ali Ghaithi Mr. Mohammed Abdullah Khalil Mr. Ahmed Kibsi Dr. Nora Ahmed Mahdi Shawkaani-Mr. Ibrahim Abdul Latif Al Radiah Qasim Farei Ms. Training Team Technical Survey Manager Mr. Ahmed Kibsi Samples Team Head Mr. Ahmed Almithali Leader of Fieldwork Team Mr. Labib Taher Leader of Office Documents Preparation Mr. Ibrahim Al-Shawkaani Member of office Documents Preparation Dr. Nora Mehdi Nutrition Management MOHP Mr. Mansour Mohammed Al-Qadasi Nutrition Management MOHP Mr. Abdo Saeed Al-Qudsi Nutrition Management MOHP Ms. Noor Ahmed Tantawi Nutrition Management MOHP Ms. Sally Ahmad Al-Iryani Position Name Team Number Governorate Team Leader Salah Al-Hubaishi 1 Ibb Editor Mohammed Yahya Al-Aerami Interviewer Lamia Hussein Abdul Razak Interviewer Afrah Mahmoud Al-Qudsi Interviewer Noha Abdullah Mohammed Interviewer Bodoor Hussein Ali Abdu Driver Khalid Al-Fareh Team Leader Adel Abdullah Murshid 2 Ibb Editor Abdullah Mohammed Rageh Interviewer Samira Ali Al-Rahbi Interviewer Rabab Hamoud Al Ameri Interviewer Hana Fuad Al-Ariqi Interviewer Amal Abdul Mohammed Saif Driver Sameer Al-Haimi Appendix D • 261 Position Name Team Number Governorate Team Leader Mohammed Al-Fatimi 1 Abyn Editor Nasser Ali Obadi Interviewer Raja Abdo Mohammed Interviewer Slimah Ali Hassan Interviewer Wedad Omar Hassan Interviewer Sarah Wahab Mohammed Abubakar Driver Khalid Harun Team Leader Nasser yslim Al-Awlaki 2 Abyn Editor Hassan Afif Hassan Interviewer Asrar Mohammed Saeed Interviewer Noria Abdulkarim Interviewer Pune Awad Nqatha Interviewer Najla Noman Ali Driver Mohammed Ahmed Al-Saadi Team Leader Ahmed Ahmed Al-Sayani 1 Sana’a City Editor Mohammed Ali Al-Absi Interviewer Bushra Mohammed Al-Ward Interviewer Afrah Yahya Qaheem Interviewer Bushra Al-Sanani Interviewer Samar Al-Ghanimi Driver Bandar Ali Abdullah Al-Coqbani Team Leader Abdulsalam Hanash 2 Sana’a City Editor Abdulrahman Hassan Thabet Interviewer Lamia Abdullah Al-Akwa Interviewer Bushra Abdullah Al-Sakkaf Interviewer Hayat Ahmed Naseer Interviewer Hanan Ali Aboukaaid Driver Hamid Abdullah Al-Coqbani Team Leader Ahmed Hussein Dheifallah Awadi 1 Al-Baidhaa Editor Fatehi Fadel Jadaan Interviewer Amna Jabl Al-Saadi Interviewer Wafaa Mohamed Abdo Interviewer Fadia Abdalferd Interviewer Hana Sufi Mohammad Driver Saddam Hammoud Abdo Team Leader Saleh Salem Nasser 2 Al-Baidhaa Editor Mustafa Ahmed Al-Kamli Interviewer Jameelan Ali Masar Interviewer Salwa Zain Allah Interviewer Saadia Mohammed Arman Interviewer Nossebah Al-Arabi Driver Ahmed Hammoud Al-Hassel 262 • Appendix D Position Name Team Number Governorate Team Leader Fayez Abdo Hamoud Al-Taj 1 Taiz Editor Ziad Mohammed Al-Mashriqi Interviewer Glila Hameed Hezam Interviewer Najat Abdullah Al-Hakimi Interviewer Ishraq Mohammed Sarhan Interviewer Anisa Abdasameea Al-Arifi Driver Abdul Razak Abdullah Murshed 2 Taiz Team Leader Amin Mohammed Radman Editor Khaled Taher + Radhwan Qhtan Interviewer Fawzia Abdullah Hassan Interviewer Samah Ali Kaid Interviewer Leila Khaled Said Interviewer Lina Abdul Salam Ali Mohammed Driver Mohammed Ahmed Al-Ahjeri Team Leader Ali Ali Moqadar 1 Al-Jawf Editor Fadel Ghanem Jezelan Interviewer Vzna Hassan Yahya Hagras Interviewer Arwa Abdullah Awad Interviewer Hyay Yahya Hamoud Al-Jabali Interviewer Fatima Saleh Abadan Driver Saleh Al-Qasimi Team Leader Zyad Al-Raebi 2 Al-Jawf Editor Ibrahim Al-Mohaqery Interviewer Khamisa Saleh Qaswah Interviewer Mvlha Muhammad Ali Al-Aekm Interviewer Sayedah Ali Hassan Ezzedine Interviewer Jamilah Muhammad Hajar Driver Khalid Al-Sheaibi Team Leader Iskandar Abdo Ali 1 Hjjah Editor Muetasim Ali Abdalmagna Interviewer Angam Sadeq Al-Hadrami Interviewer Afaf Ahmed Bekele Abdullah Interviewer AmatAllah Ahmed Qashwah Interviewer Muntaha Ali Dhoush Driver Iskandar Abdo Team Leader Abbas Mohammed Al-Ashram 2 Hjjah Editor Hadrami Hadi Al-Hadrami Interviewer AFrah Saleh Qaswah Interviewer Salwa Hammoud Aljaboubi Interviewer Reza Al-Qaedi Interviewer Mariam Ahmed Al-Hussam Driver Abbas Mohammed Al-Sherah Appendix D • 263 Position Name Team Number Governorate Team Leader Omar Salem Bamkhtar 1 Hdaramout Al-Mukala Editor Mohammed BaFadal Interviewer Sukeinah Omar Baothman Interviewer Afrah Saeed Belala Interviewer Zakeeah Saeed Ali Interviewer Rasha Abdul-Khaliq Al-Banaa Driver Mohammed Saleh Al-Shawesh Editor Saeed Saif Socotra Interviewer Zamzam Ali Khalid Ali Team Leader Hesham Mohamed Mnibara 1 Hadramout Seiyun Editor Jaman Kchmim Interviewer Mona Ashour bin Mshmos Interviewer Afrah Yasleem bin Cleep Interviewer Thowani Hadi Obad Interviewer Intesar Berak Al-Batati Driver Labib Al-Absi Team Leader Najib Mohammed Al-Komim 1 Dhmar Editor Abdullatif Al-Nunu Interviewer Iman Al-Arashi Interviewer Enas Mahmoud Lotf Al-Haimi Interviewer Fawzia Ahmed Al-Faqih Interviewer Amani Majid Al-Wosabi Driver Ali Hammoud Ahmed Al-Mukhtar Team Leader Mohammed Hamoud Al-Qawana 2 Dhmar Editor Abdullatif Jubair Interviewer Amira Abdullah Al-Samet Interviewer Bodoor the Sultan Interviewer Ahlam Ali Abd Al Moghni Interviewer Najla Al-Yadomi Driver Mohammed Hassan Ahmed Team Leader Abdulhakim Al-Sabaee 1 Shabwah Editor Mustafa Al-Baidhani Interviewer Fatima Abdullah Saeed Interviewer Rania Ali Abdullah Interviewer Nabiha Diamond Mohammed Taleb Interviewer Mohammed Al-Zaidi solution Driver Rashid Al-Khaddabi Team Leader Saeed Ahmed Taleb Jaol 2 Shabwah Editor Samir Ahmed Ali Interviewer Bodoor Ali Salah Interviewer Ishraq Mohammed Mubarak Interviewer Waheedah Zine El Abidine Interviewer Jamaica Ahmed Nasser Salem Driver Ali Mohammed Naji 264 • Appendix D Position Name Team Number Governorate Team Leader Hamdi Faisal Mohammed Zafar 1 Sadah Editor Ahmed Hussein Raji Interviewer Nujood Saleh Faraj Interviewer Taqwa Khaled Ahmed Interviewer Jojood Mohsen Sifan Interviewer Nora Hassan Kassem Driver Abdul Ghani Mohammed Hussein Team Leader Ibrahim Hassan Al-Moaeed 2 Sadah Editor Jamil Nasher Grsan Interviewer Ibtisam Ali Nasser Al-Qodimi Interviewer Fadia Mohammed Al-Mutawakil Interviewer Nabila Yahya Hadi Interviewer Amatul-Rauf Khalid Driver Zaid Mohammed Al-Moaed Team Leader Adel Ali Rpad 1 Al-Hodiedah Editor Mehdi Ahmed Mahdi Interviewer Hanan Yahya Ahmed Interviewer Huda Ahmed Al-Hakami Interviewer Aswan Hassan Al-Ahumaighani Interviewer Hanan Nabil Al-Aladimi Driver Mohammed Mohsen Al-Arows Team Leader Abdel Wahed Mohamed Ahmed 2 Al-Hodiedah Editor Ahmed Alfaz Interviewer Fatima Ishaq Interviewer Khadija Hamad Ezi Shawk Interviewer Ibtisam Ahmed Abdul Jalil Interviewer Sawud Jaber Haron Driver Hiav Abdullah Team Leader Abed Rabbo Abdulwahab Al-Sabahi 1 Sana’a Editor Maeen Mohamed Barakat Interviewer Inteasar Abed Rabbo Abdulwahab Interviewer Jihad Lotf Alzkar Interviewer Tareed Shamsan Interviewer Zainab Al-Kahlani Driver Ali Hamid Hammoud Khlaa Team Leader Bakil Mohammed Azam 2 Sana’a Editor Majid Al-Sabri Interviewer Saeedah Muhammad Al-Khawlaani Interviewer Altaf Naji Al-Zubayri Interviewer Rana Abdul Wahid Almrich Interviewer Jamilah Yahya Al-Ansi Driver Mohammed Ahmed Abdullah Al-Coqbani Appendix D • 265 Position Name Team Number Governorate Team Leader Ali Abdu Saleh 1 Aden Editor Mohammed Abdulwase Interviewer Salwa Abdul-Halim Abdul-Wadood Interviewer Fawzia Abdul Rab Rajah Interviewer Rana Mahmood Abdulrahman Interviewer Manal Mahioub Mohammed Radman Driver Abdel Nasser Mohammed Abdullah Team Leader Mazen Jaafar 2 Aden Editor Ahd Jamil Ghanem Interviewer Zahra Saleh Ali Interviewer Rana Mohammed Imam Aldein Interviewer Ghada Ahmed Ali Abdu Interviewer Afaf Abdullah Muthanna Driver Shaya Ali Arabi Team Leader Badr Ahmed Fadel 1 Lahj Editor Noah Allan Interviewer Donia Abdo AlJabbar Ali Interviewer Jamilah Mohammed Al-Maqtari Interviewer Sana Khalid Fadel Interviewer Wafa Ali Alawi Driver Abdullah Al-Sharei Team Leader Mahmoud Said Ramadan 2 Lahj Editor Sami Mohammed Saeed Interviewer Jawdah Abdo Ali Interviewer Ibtisam Ayyash Awad Interviewer Nojood Mansour Sobeait Interviewer Huda Nasser Awad Driver Adnan Qasim Team Leader Sadiq Abdul-Hameed Al-Samey 1 Mareb Editor Amin Mgidea Interviewer Jamilah Qaid Thaber Maodah Interviewer Rabab Ali Hassan Dhabayl Interviewer Salhah Saleh Obad Interviewer Fatima Ali Ali Al-Montaser Driver Hassan Rajh Team Leader Ismail Lotf Al-Surmi 1 Al-mahweit Editor Muhammad Ali Sfran Interviewer Ibtisam Ahmed Al-Kebzra Interviewer Sabah Mohammed Al-Shwbah Interviewer Fatima Sharaf Al-Qadasi Interviewer Ahlam Abdul Alkhaliq Mohammed Driver Ismail Lotf Al-Surmi 266 • Appendix D Position Name Team Number Governorate Team Leader Khaled Omar Alwealah 2 Al-mahweit Editor Hamid Nasir Al-Akhram Interviewer Safaa Sharaf Mohammed Salem Interviewer Majida Al-Qarni Interviewer Ahlam Mohammed Al-Saheer Interviewer Hana Noman Al-Keibibi Driver Hassan Rajh Team Leader Ali Omar Salim Al-Adal 1 Al-Marah Editor Rajab Said Awad Interviewer Samira Salem Awad Al-Nubian Interviewer Ayedah Saeed Abdullah Interviewer Amina Saad Khayef Interviewer Fawzia Afraid Faraj Driver Mohammed Yehia Al-Khatabi Team Leader Jubran Abdullah Ahmad 1 Al-Dhalee Editor Yusuf Mohamed Said Hadi Interviewer Haifa Mohammed bin Mohammed Hussein Interviewer Intesar Ali Bin Ali Interviewer Yasmin Mohammed Ali Interviewer Elham Mohammad Ali Mohammed Driver Sadiq Ali Mohammed Saeed Team Leader Abdulkadir Ali Hassan Ebadi 2 Al-Dhalee Editor Muhammad Ali Abboud Interviewer Intesar Ali Abdullah Interviewer Olom Hamoud Abdullah Interviewer Afrah Abdulkadir Hussein Interviewer Aitzaz Ahmed Sufian Driver Abdul Karim Fadel Team Leader Kaid Saleh Al-Hujairi 1 Amran Editor Yassin Ibrahim Saif Interviewer Amal Abdul Rahman Sharaf Al-Din Interviewer Aman Naji AlFarji Interviewer Khiria Abdullah Al-Shami Interviewer Amatul-Khaleq Abbas Al-Mahdi Driver Ali Saleh Anbar Team Leader Ibrahim Al-Tmah 2 Amran Editor Akram Abdullah Eida Interviewer Halima Hussein Muqbel Al-Ssar Interviewer Hanan Ali Lotf Ata Interviewer Fateheah Mohamed Ahmed Al-Wari Interviewer Siham Ali Ahmed Marsh Driver Saleh Al-Mdriki Team Leader Abdullah Abdo Mohammed Yahya 1 Raymah Editor Ammar Abdul Wahab A-Wosabi Interviewer Yasmin Mansoor Ali Haider Interviewer Nadia Ali Mohamed Hassan Interviewer Fateheah Nahishal Interviewer Fatheah Ahmed Al-Salf Driver Mohammed Salah Abdu-Salafi Appendix D • 267 Position Name Team Number Governorate Team Leader Ahmed Mahdi Mohammed Al-Oqbi 2 Raymah Editor Ali Mujahid Al-Samawi Interviewer Noria Ahmed Abdamahmoud Interviewer Aidah Abas Saleh Interviewer Latifa Mohammed Al-Amrani Driver Jalal Mohammed Ali Al-Dobaibi Operations Team for Fieldwork Zaid Al-Qashm Mohammed Abdullah Khalil Nabil Najm Mr. Ahmed Abdullah Al-Kibsi Moamar Noaman Ibrahim Abdul Latif Al-Shawkaani Abdullah Maaodah Labib Ahmad Al-Absi Sadiq Al-Ashwal Ahmed Nasser Al-Mithala Majd Mohammed Jawad Mr. Adnan Al-Muraysi Nasr Salem Mr. Helmi Al-Maqtari Coding Team Khaled Abu Talib Abdullah Maodah Niebel Al-Ghaithi Essam Al-Bayadi Fetehiye Abu Qaid Abdul Bari Abdul Latif Bakeel Ahmed Ali Yasmin Othrob Ola Al-Jerizaa Fouad Muharram Wahbia Al-Yemeni Ahmad Waheeb Office Editing Team Zaid Mohammed Al-Ghashm Adnan Yahya Al-Snhani Adel Ali Rpad Mohammed Ismail Al-Kibsi Abdul Aziz Hussein Al-Kibsi Mazen Ahmed Farhan Abdul Latif Yahia Al-Nunu Majid Ali Ayed Ahd Jamil Ghanem Data Processing Supervisors Mr. Adnan Al-Muraysi Mr. Mohammed Alaadi Mr. Arafat Shamsan Mr. Fawaz Al-Khulaidi Data Processing Operators: Data Entry, Double-Entry, and Correction Ahmed Saleh Ali Mojamel Abdul-Majeed Sharaf Abdullah Al-Wadi’i Ahmed Abdulkarim Ahmed Al-Olofi Jamilah Abdul-Karim Ahmed Al-Wajeeh Ahmed Ali Ahmd Al-Ashwal Abdul-Malik Hassan Mohammed Al-Faqeeh Ahmed Yahya Ahmed Al-Dwi Abeer Ghalib Mohammed Shmsan Ahmed Yehia Ahmed Al-Nomani Adnan Ahmed Mansour Alrmida Osama Ahmed Saeed Al-Azazi Alaa Abdo Hamoud Al-Hakami Osama Ahmed Abdel-Wadood Al-Aghbari Ali Abdel-Latif Ali Al-Shaibani Osama Othman Mohamed Al-Qurashi Ali Abdullah Hussein Al-Dhfiri Asma Muhammad Ali Awda Ali Ali Al-Amrani Amani Ahmed Al-Bana Ali Yahya Mohammed Al-Rymi Amatul-Salam Mohammed Hussein Issa Amr Abdul Ghani Ali Al-Obeidi Amira Hassan Thabet Alsamhi Ayoub Abdel Hafez Hammoud Al-Qabaty 268 • Appendix D Data Processing Operators: Data Entry, Double-Entry, and Correction Anisa Hussein Saleh Jawas Fares Mansour Mohammed Al-Qabaty Ziad Mohammed Abdullah virtual Hashim Yahya Motahar Almadoahi Saba Yahya Ali Alsaidi Hazza Abdullah Abdullah Almsori Saad Mohammed Salam al-Hakimi Helmi Muhammad Ali Al-Msagda Sultan Abdu Ahmed Al-Sabri Hisham Ali Thabet Farea Samah Yahya Ahmed Al-Shalali Hossam Qaid abdallah Amogales Samiha Ali Abdu Wosabi Hussein Ali Abdullah Al-Salahi Susan Abdalrguib Ghalib Al-Maqtari Jamal Ahmed Musleh Qaban Shaima Ahmed Saleh Al-Sanabani Jamilah Ahmed Humaid Al Hammadi Shaima Sami Said Alkoshap Jihad Khaled Ahmed Abdel Moghni Saddam Abdul Ghaffar Mohammed Muthana Khaled Ismail Mohammed Al-Aizra Safaa Mohamed Ahmed Ali Al-Shalali Mohamed Ahmed Ali Abdullah al-Shehri Salah Ali Naji Al-Sabri Mohammed Ali Ahmed Al-Sarraji Abdulrahman Ahmed Ahmed Al-Matari Mohammed Hamid Hamid Al-Qalthi Abdulrahman Abdullah Mohammed Al-Hammadi Munir Abdul Qadir Abdul Latif Al-Humairi Abdul Aziz Abdul Ghani Qasim Muhammad Mustafa Amin Dahane Al-Badani Abdulaziz Faraj Saleh Al-Awlaki Nadia Ahmed Abdullah Al-Romaih Haitham Kassem Ahmd AlWatari Omar Abdel Rahman Aziz Salah Wadih Mujahid Ahmad Al-Hakimi Omar Abdul-Aziz Abdul Rahman Al-Thobhani Wafa Ahmed Abdo Samih Ramzi Sharaf Mohammed Al-Atwani Wafa Abdo Qaid Ahmed Aklan Rana Abdul Rashid Abdul Salam Al-Absi Sana Abdul Hafiz Muhammad Ali Tamween Said Abdul-Jabbar Mcard Data Consistency Team Dr. Nora MehdiD. Abdul-Jabbar Al-Ghaithi Maean BarakatMr. Ahmed Abdullah Kibsi Radwan QahtanRadhiah Qasim Farea Ibrahim Al-ShawkaaniFatehi Jadaan PREPARATION OF FINAL REPORT Editing Team Mr. Mohammed Abdullah Khalil D. Abdul-Jabbar Al-Ghaithi Mr. Ahmed Abdullah Kibsi Appendix D • 269 TECHNICAL ASSISTANCE ICF International Survey Design Dr. Mohamed Ayad Coordinator Mr. Bernard Barrère Sampler Dr. Alfredo Aliaga Sampler Dr. Ruilin Ren Sampler Mr. Mahmoud Elkasabi Data Processing Mr. Noureddine Abderrahim Analysis Dr. Annie Cross Analysis Ms. Kimberly Peven Report Production Ms. Natalie La Roche Report Production Mr. Chris Gramer Dissemination Ms. Erica Nybro ICF Consultant Mr. Housni El Arbi ICF Consultant Mr. M’hammed Aljem El-Zanaty & Associates (Cairo) – ICF Consultant Dr. Fatma El-Zanaty El-Zanaty & Associates (Cairo) – ICF Consultant Mr. Mahmoud Shehata El-Zanaty & Associates (Cairo) – ICF Consultant Mr. Sameh Said El-Zanaty & Associates (Cairo) – ICF Consultant Mr. Muhammad Al-Ghazali El-Zanaty & Associates (Cairo) – ICF Consultant Dr. Ibrahim Ismail El-Zanaty & Associates (Cairo) – ICF Consultant Mr. Moustafa Faragallah PAPFAM Dr. Ahmed Abdel Monem Survey Coordinator and Implementer Ms. Mona El-Sayed Arara Data Processing and Analysis Ms. Nevin Wanis Analysis Mr. Rabah Halimi Report Production Mr. Maissara Kailani Report Production Ms. Sally Yassin Report Production Dr. Mohamed F. Aboulata Consultant Dr. Magda M. Abdel Hamid Consultant Dr. Tarek Y. Al-Kebsi Consultant Dr. Abdel Halim Al-Kharabsheh Consultant Dr. Soaad El-Hawary Consultant Dr. Hanaa Al-Hossiani Consultant Dr. Mervet M. Khalil Consultant QUESTIONNAIRES Appendix E • 271Appendix E REPUBLIC OF YEMEN MINISTRY OF PUBLIC HEALTH & POPULATION CENTRAL STATISTICAL ORGANIZATION NATIONAL HEALTH & DEMOGRAPHIC SURVEY 2013 HOUSEHOLD QUESTIONNAIRE IDENTIFICATION ADMINISTRATIVE INFORMATION LISTING INFORMATION GOVERNORATE SECTOR NUMBER DIRECTORATE NAME SECTION NUMBER SUB-DIRECTORATE NAME CLUSTER NUMBER URBAN = 1 RURAL = 2 HOUSEHOLD NUMBER HOUSEHOLD CLUSTER NUMBER NAME OF HOUSEHOLD HEAD IS THIS HOUSEHOLD SELECTED FOR ANEMIA TESTING? YES = 1 NO= 2 INTERVIEWER VISITS FINAL VISIT DATE DAY MONTH YEAR INTERVIEWER'S NAME INT. NUMBER RESULT* RESULT NEXT VISIT: DATE ./ ./ 2013 ./ ./ 2013 TOTAL NUMBER TIME OF VISITS *RESULT CODES: TOTAL PERSONS IN HOUSEHOLD 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT TOTAL ELIGIBLE EVER MARRIED 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD WOMEN IN AGE 15-49 OF TIME 4 POSTPONED TOTAL ELIGIBLE NEVER MARRIED 5 REFUSED WOMEN IN AGE 15-49 6 DWELLING VACANT OR ADDRESS NOT A DWELLING 7 DWELLING DESTROYED TOTAL CHILDREN 0-5 8 DWELLING NOT FOUND 9 OTHER (SPECIFY) LINE NO. OF RESPONDENT IN HH FIELD EDITOR SUPERVISOR OFFICE EDITOR KEYER NAME SIGNATURE DATE / / 2013 / / 2013 / / 2013 / / 2013 CODE 1 2 / / 2013 / / 2013 2 / / 2013 6/19/2013 QUES. NO. 3 0 1 3 • 273Appendix E INTRODUCTION AND CONSENT INFORMED CONSENT RESPONDENT AGREES TO BE INTERVIEWED . 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . 2 END SIGNATURE OF INTERVIEWER: DATE: Hello. My name is _______________________________________. I am working on the National Health & Demographic Survey which is implemented (by the Ministry of Public Health & Population and the Central Statistical Organization). We are conducting a survey about health all over Yemen. The information we collect will help the government to plan health services. Your household was selected for the survey. All of the answers you give will be confidential under Article (5) of the Statistics Law No. (28) for the year 1995 and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time. Do you have any questions? May I begin the interview now? 274 • Appendix E IF AGE 10 OR OLDER LINE USUAL RESIDENTS AND AGE NO. VISITORS 1 9 9a 10 CIRCLE CIRCLE CIRCLE LINE LINE LINE NUMBER NUMBER NUMBER OF ALL OF ALL OF ALL IF 95 EVER NEVER- CHILDREN OR MORE, 1 = MARRIED MARRIED MARRIED AGE 0-5 SEE CODES RECORD 2 = DIVORCED/ WOMEN WOMEN BELOW. '95'. 3 = WIDOWED AGE AGE AFTER LISTING THE 4 = NEVER- 15-49 15-49 NAMES AND RECORDING MARRIED THE RELATIONSHIP IF LESS AND SEX FOR EACH THAN 1 PERSON, ASK YEAR QUESTIONS 2A-2C RECORD TO BE SURE THAT THE '00'. LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-35 FOR EACH PERSON. M F Y N Y N IN YEARS 01 1 2 1 2 1 2 01 01 01 02 1 2 1 2 1 2 02 02 02 03 1 2 1 2 1 2 03 03 03 04 1 2 1 2 1 2 04 04 04 05 1 2 1 2 1 2 05 05 05 06 1 2 1 2 1 2 06 06 06 07 1 2 1 2 1 2 07 07 07 08 1 2 1 2 1 2 08 08 08 09 1 2 1 2 1 2 09 09 09 10 1 2 1 2 1 2 10 10 10 11 1 2 1 2 1 2 11 11 11 12 1 2 1 2 1 2 12 12 12 13 1 2 1 2 1 2 13 13 13 14 1 2 1 2 1 2 14 14 14 15 1 2 1 2 1 2 15 15 15 TICK HERE IF CONTINUATION SHEET USED CODES FOR Q. 3: RELATIONSHIP TO HEAD OF HOUSEHOLD 01 = HEAD 08 = BROTHER OR SISTER 02 = WIFE OR HUSBAND 09 = OTHER RELATIVE YES NO 03 = SON OR DAUGHTER 10 = ADOPTED/FOSTER/ 04 = SON-IN-LAW OR CHILD DAUGHTER-IN-LAW 11 = STEPCHILD YES NO 05 = GRANDCHILD 12= NOT RELATED 06 = PARENT 98 = DON'T KNOW 07 = PARENT-IN-LAW YES NO 2A) Just to make sure that I have a complete listing: are there any other persons such as small children or infants that we have not listed? ADD TO TABLE 2B) Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here? ADD TO TABLE Did (NAME) stay here last night? How old is (NAME)? What is (NAME)'s current marital status? 2C) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed? ADD TO TABLE Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household. What is the relationship of (NAME) to the head of the household? Is (NAME) male or female? Does (NAME) usually live here? 0 1 2 3 4 5 6 7 8 TO HEAD OF STATUS HOUSEHOLD RELATIONSHIP SEX RESIDENCE MARITAL ELIGIBILITY 1. HOUSEHOLD SCHEDULE - GENERAL INFORMATION • 275Appendix E IF AGE 0-17 YEARS IF AGE 5 YEARS OR OLDER 0-4 YEARS LINE SURVIVORSHIP AND RESIDENCE OF EVER ATTENDED CURRENT/RECENT BIRTH NO. BIOLOGICAL PARENTS SCHOOL SCHOOL ATTENDANCE REGIS- ONLY IF THE ANSWER IS 01. 02 Did (NAME) OR 07 TO Q. 11A, ASK: attend school at any time during the current school IF NO, PROBE: 01 = WORKING year 02 = NOT WORKIN- (2013-2014)? G/USED TO WORK SEE CODES 03 = NOT WORKIN- BELOW. G/NEVER WORKED 04=STUDENT 05=HOUSEWIFE 1 = HAS 06=SELF CERTIFICATE 07=RETIRED 2 = REGISTERED 08=HANDICAPPED RECORD RECORD SEE CODES 3 = NEITHER 96= OTHER MOTHER'S FATHER'S BELOW. 8 = DON'T (SPECIFY) LINE LINE KNOW NUMBER. NUMBER. IF NO, IF NO, '00'. '00'. Y N DK Y N DK Y N DK LEVEL GRADE Y N DK LEVEL GRADE 01 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 02 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 03 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 04 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 05 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 06 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 07 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 08 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 09 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 10 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 11 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 12 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 13 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 14 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 15 1 2 8 1 2 8 1 2 8 1 2 8 GO TO 14 GO TO 16 GO TO Q21 GO TO Q21 CODES FOR Qs. 17 AND 19: EDUCATION LEVEL GRADE 0= PRE-PRIMARY 00 = LESS THAN 1 YEAR COMPLETED 1= PRIMARY (USE '00' FOR Q. 17 ONLY. 2= FUNDAMENTAL (PREPARATORY, UNIFIED) THIS CODE IS NOT ALLOWED 3= DIPLOMA BEFORE SECONDARY FOR Q. 19) 4= SECONDARY 98 = DON'T KNOW 5= DIPLOMA AFTER SECONDARY 6= UNIVERSITY/HIGHER 8= DON'T KNOW Was (NAME) working most of the time last month? OCCUPATION CODE During this/that school year, what level and grade [is/was] (NAME) attending? Does (NAME) have a birth certificate? What was/is your main Has (NAME)'s birth ever been registered with the civil authority? occupation? What is the highest grade (NAME) completed at that level?IF YES: Is (NAME)'s natural mother alive? 14 17 Does (NAME)'s natural mother usually live in this household or was she a guest last night? Is (NAME)'s natural father alive? Does (NAME)'s natural father usually live in this household or was he a guest last night? Has (NAME) ever attended school? What is the highest level of school (NAME) has attended? IF YES: 15 TRATION 1816 19 2011A 11B 12 13 STATUS STATUS IF AGE OR MORE OR MORE EMPLOYMENT EMPLOYMENT IF 6 YEARS IF 15 YEARS IF AGE 5-24 YEARS 276 • Appendix E SOCIAL HABITS LINE NO. 1 What is the disease What is the second suffered by (NAME)? disease suffered by (NAME)? 8 = DON'T 4 = NEVER Y N Y N Y N Y N Y N Y N 01 1 2 1 2 1 2 1 2 1 2 1 2 02 1 2 1 2 1 2 1 2 1 2 1 2 03 1 2 1 2 1 2 1 2 1 2 1 2 04 1 2 1 2 1 2 1 2 1 2 1 2 05 1 2 1 2 1 2 1 2 1 2 1 2 06 1 2 1 2 1 2 1 2 1 2 1 2 07 1 2 1 2 1 2 1 2 1 2 1 2 08 1 2 1 2 1 2 1 2 1 2 1 2 09 1 2 1 2 1 2 1 2 1 2 1 2 10 1 2 1 2 1 2 1 2 1 2 1 2 11 1 2 1 2 1 2 1 2 1 2 1 2 12 1 2 1 2 1 2 1 2 1 2 1 2 13 1 2 1 2 1 2 1 2 1 2 1 2 14 1 2 1 2 1 2 1 2 1 2 1 2 15 1 2 1 2 1 2 1 2 1 2 1 2 CODES FOR Qs.22-26: CHRONIC DISEASE 01=BLOOD PRESSURE 10=ARTHRITIS 19=PROSTATITIS 02=DIABETES 11=TB 20=CATARACT 03=INFLAMMATION OR ULCERS 12=CHRONIC HEADACHE 21=OPACITY OF EYE LENS 04=ANEMIA 13=STROKE 22= CHRONIC BACK PAIN OR PROBLEMS IN THE SPINAL CORD 05=SICKLE CELL ANEMIA 14=EPILEPSY 23=MENTAL/PSYCHOLOGICAL ILLNESS 06=THALASSAMIA 15= ASTHMA 24=SKIN DISEASE 07=HEART DISEASE 16=LUNG DISEASE 25= CANCEROUS TUMORS 08=KIDNEY DISEASE 17=HYPERACTIVE THYROID 26= GUM AND MOUTH DISEASE 09=LIVER DISEASE 18=HYPOACTIVE THYROID 96= OTHER (SPECIFY) 2. PREVALENCE OF CHRONIC DISEASES & SOME HARMFUL PRACTICES 27a CODE BEFORE 3029 1 = YES 8 = DK 4 = YES 23 24 25 TIMES TIMES Does (NAME) take treatment regularly? 28 3 = SOME- 27 TIMES 8 = DK 4 = NEVERKNOW 2 = YES Does (NAME) smoke cigarettes, or any other kind of tobacco, or was smoking in the past? 5 = NEVER BEFORE 3 = SOME- 2621 22 RECORD THE NAME OF THE SECOND DISEASE AND THE CODE I would now like to ask you some questions about the health of all family members. Does (NAME) suffer from any chronic disease? DAILY Does (NAME) currently chew al- Qat? 3 = SOME- Does (NAME) get treat- ment regularly? GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 DISEASE GO TO 28 GO TO 28 DISEASE IF 10 YEARS OR PLUS 1 = YES CURRENTLY 2 = YES 2 = YES SPREAD OF CHRONIC DISEASES Does (NAME) use orange snuff, or was using snuff in the past? Does (NAME) suffer from any other chronic disease? Does any physician inform (NAME) that (s)he suffers from this disease? RECORD THE NAME OF THE DISEASE AND THE CODE Does any physic- ian inform (NAME) that (s)he suffers from this second disease? BEFORE WEEKLY 1 = YES CURRENTLY GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 CODECODECODE GO TO 28 GO TO 28 GO TO 28 GO TO 28 CODE GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 GO TO 28 • 277Appendix E LINE NO. A = SIGHT? B = HEARING? C = COMPREHENSION & A = MEDICAL CARE COMMUNICATION? B = WELFARE D = MOBILITY? C = FINANCIAL E = SELF-CARE? SUPPORT F = DEALING WITH PEOPLE? D = NUTRITIONAL 95=AT BIRTH SUPPORT IF 'YES' PROBE BY 98=DON'T Y = NO CARE/SUPPORT ASKING: KNOW Does this state severely CIRCLE ALL MENTIONED WITH THE EXCEPTION OF or moderately limit exer- Y' CIRCLE ALL cising or daily activities? MENTIONED IF YES CIRCLE TYPE OF 1 = YES, SEVERELY CARE OR SUPPORT 2 = YES, FAIRLY 3 = NO 8 = DON'T KNOW Y-S Y-F N DK 01 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 02 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 03 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 04 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 05 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 06 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 07 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 08 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 09 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 10 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 11 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 12 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 13 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 14 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 15 1 2 3 8 A B C D E F A B C D Y GO TO NEXT LINE OR 41 DISABILITY 3. DISABILITY MODULE CODE AGE CODE What is the main reason for (NAME)'s disability? 01=CONGENITAL 02=CONDITIONS 343231 3533 How old was (NAME) when this condition started? 06=AGING During the last 12 moths did (NAME) receive any care or support? CHILDBIRTH Has (NAME) suffered from any physical or mental conditions in the past 6 months or more that would limit from exercising or performing normal daily activities as other people of the same age? Does (NAME) face limitations of any of the following: RELATED TO 98=DON'T KNOW CODE 03=CONTAGIOUS 04=OTHER DISEASE 05=PHYSICAL & PSYCH. ABUSE 07=INJURY/ ACCEDIENT 08=ENVY/MAGIC 96=OTHER 278 • Appendix E 41 YES . 1 NO . 2 41A NO. OF HH WITH INJURIES LINE NO. CIRCLE INJURY OR ACCIDENT CODE AS SHOWN BELOW. 01 A B C D E F G H I X 02 A B C D E F G H I X 03 A B C D E F G H I X 04 A B C D E F G H I X 05 A B C D E F G H I X 06 A B C D E F G H I X 07 A B C D E F G H I X 08 A B C D E F G H I X 09 A B C D E F G H I X 10 A B C D E F G H I X CODE Q. 43: A = TRAFFIC ACCIDENT B = FALL C = BLOW/BY A PERSON OR OBJECT D = STABBED E = GUNSHOT F = BURNS (FIRE, THERMAL FLAMES) G = DROWNING H = POISONING I = ELECTRIC SHOCK X = OTHER (SPECIFY) CODE (SPECIFY) FOR HOUSEHOLD MEMBERS WITH INJURIES 4. INJURIES, ACCIDENTS & HEALTH SERVICES IN THE TWO YEARS PRECEDING THE SURVEY 42 43 MODULE 5 Have you and/or any member of your household been injured or had an accident in the two years preceding the survey? IF (NAME) IS NOT DEAD, GO TO NEXT LINE OR Q.45 Who are the members of your household injured in the two years preceding the survey? Please provide their names. NAME What injury or accident did you or any member of your household have? 44 IF (NAME) IS DEAD, ASK: What is the injury or the accident that caused the death? INJURY/ACCIDENT/ (SPECIFY) CODE • 279Appendix E NO. QUESTIONS AND FILTERS SKIP 45 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . . . . 8 51 46 PUBLIC HEALTH FACILITY . . . . . . . . . . . . 1 PRIVATE HEALTH FACILITY . . . . . . . . . . . . 2 MILITARY/POLICE HEALTH FACILITY . . . . . 3 NGOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 FREE MEDICAL CAMPS . . . . . . . . . . . . . . 5 OTHER 6 (SPECIFY) 47 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 49 48 THE PERSON HIMSELF . . . . . . . . . . . . . . . . 01 EMPLOYER . . . . . . . . . . . . . . . . . . . . . . . . . . 02 FAMILY MEMBER . . . . . . . . . . . . . . . . . . . . 03 HEALTH INSURANCE . . . . . . . . . . . . . . . . . . 04 PHILANTHROPIST . . . . . . . . . . . . . . . . . . . . 05 OTHER 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . 98 49 Were the following health services were provided: YES NO DK 1- Medical examination? MEDICAL EXAMINATION . 1 2 8 2- Laboratory work? LABORATORY . 1 2 8 3- Radiology? RADIOLOGY . 1 2 8 4- Operations OPERATIONS . 1 2 8 5- Hospital stay? HOSPITAL STAY . 1 2 8 6- Medicine? MEDICINE . 1 2 8 7- Physiotherapy? PHYSIOTHERAPY . 1 2 8 CODING CATEGORIES Where did (s)he receive the health services last time? Did you have to pay a fee for the service? Did a member of your household go to any health facility for treatment in the two years preceding the survey? Who paid for the fees? 280 • Appendix E TABLE 1: FOR CHILDREN AGE 2-14 YEARS 55 LINE NO. MALE FEMALE 01 . 1 2 02 . 1 2 03 . 1 2 04 . 1 2 05 . 1 2 06 . 1 2 07 . 1 2 08 . 1 2 RECORD THE TOTAL NUMBER OF CHILDREN AGE 2-14 YEARS TABLE 2: RANDOM SELECTION OF THE CHILD FOR THE QUESTIONS ON CHILDREN BEHAVIOR FIRST DIGITAL NO. FROM HH NO. IN COVER PAGE 1 2 3 4 5 6 7 8 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 ENTER THE NUMBER OF THE SELECTED CHILD IN THE BOX AGE 57 TOTAL NUMBER OF CHILDREN 2-14 YEARS (Q.56) 58 CHECK Q.56, IF ONLY ONE CHILD AGE 2-14, SKIP TABLE 2, AND GO TO Q.58. ENTER THE LINE NO. FROM TABLE 1 Q.51AND CONTINUE 56 USE THIS TABLE TO SELECT A CHILD IN THE AGED GROUP 2-14 YEARS, IF THERE IS MORE THAN ONE CHILD IN THAT CATEGORY IN THE HOUSEHOLD. CHECK THE HOUSEHOLD NUMBER OF THE COVER PAGE AND THE FIRST DIGIT OF THE HOUSEHOLD NUMBER IS THE ROW NUMBER AND THE TOTAL NUMBER OF CHILDREN 2-14 YEARS RECORDED IN Q.56 IS THE COLUMN NUMBER. THE NUMBER IN THE BOX WHICH MEETS THE SELECTED ROW AND COLUMN IS THE ORDINAL NUMBER OF THE CHILD THAT WILL BE SELECTED TO THE QUESTIONS ON CHILDREN'S BEHAVIOR. ENTER THIS NUMBER IN Q.58, AND IN Q. 59, RECORD THE LINE NUMBER AND THE NAME OF THE SELECTED CHILD AS INDICATED IN Qs. 52 AND 53. THEN LOOK FOR THE MOTHER/CARETAKER OF THE CHILD AND ASK HER THE QUESTIONS STARTING WITH Q. 61. 51 LINE NO. 5. MODULE ON CONTROLLING CHILDREN'S BEHAVIOR SEX FROM THE HOUSEHOLD SCHEDULE, COL.4 AGE FROM THE HOUSEHOLD SCHEDULE, COL.7 RECORD IN THE FOLLOWING TABLE IN ORDER THE LINE NUMBER IN THE FIRST COLUMN AND DON'T TAKE INTO ACCOUNT INDIVIDUALS OUTSIDE THE AGE GROUP 2-14 YEARS. ENTER THE CHILDREN'S LINE NUMBERS, THE NAME, SEX AND AGE OF CHILDREN, AND IN Q.56, ENTER THE TOTAL OF CHILDREN AGED 2-14 YEARS. 53 54 LINE NUMBER FROM THE HOUSEHOLD SCHEDULE, COL.1 52 FROM THE HOUSEHOLD SCHEDULE, COL.2 CHILDREN 'S NAMES • 281Appendix E NO. QUESTIONS AND FILTERS SKIP 59 NAME CHILD LINE NUMBER RECORD MOTHER/CARETAKER'S LINE NUMBER WHO WILL ANSWER THE FOLLOWING QUESTIONS MOTHER/CARETAKER'S LINE NO. 60 61 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 62 Explain to the child why his/her behavior is wrong YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 63 Hitting the child on the shoulder or spanking on the rear YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 64 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 65 Hitting the child in the face or hitting the child's head or ear YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 66 Hitting the child's hand, arm, or leg YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 67 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 68 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW/NO OPINION . . . . . . . . . . . . 8 5. MODULE ON CONTROLLING CHILDREN'S BEHAVIOR REFER TO Qs. 52 & 53 AND ENTER THE NAME AND THE LINE NUMBER OF THE SELECTED CHILD BASED ON THE ORDINAL NUMBER OF Q.58 Punishing the child by using a tool, and then continuing to hit the child very hard PROBE FOR MORE INFORMATION, IF NECESSARY Do you think that a child must be punished physically in order to be raised in an appropriate way? CODING CATEGORIES IDENTIFY THE ELIGIBLE CHILDREN AGED 2-14 YEARS USING THE TABLES IN THE PREVIOUS PAGE ACCORDING TO THE INSTRUCTIONS. ASK TO INTERVIEW THE MOTHER/CARETAKER OF THE SELECTED CHILD IDENTIFIED BY THE MOTHER’S/CARETAKER’S LINE NUMBER IN 58. Many parents use some of these ways to teach their children proper behavior or to deal with behavioral problems. I will tell you some of the ways that are used and I would like you to tell me if you or anyone in the household used this method with (NAME) during last month: Taking away a privilege from (NAME), taking away something (s)he wants or loves, or not letting him/her leave the house Hitting on the rear or on any other place of the child's body using something such as a belt, a hair brush, a stick, or something solid 282 • Appendix E NO. QUESTIONS AND FILTERS SKIP 100 What type of dwelling unit does your household live in? INDEPENDENT HOUSE/ROOM . . . . . . . . . . 01 VILLA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 APARTMENT IN BUILDING . . . . . . . . . . . . . . 03 TENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 HUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 TEMPORARY SHELTER . . . . . . . . . . . . . . . . 06 OTHER . 96 (SPECIFY) 102 What is the main source of drinking water for members of your PIPED GOVERNMENT NETWORK . . . . . 01 household? PIPED LOCAL NETWORK . . . . . . . . . . . . . . 02 TUBE WELL OR BOREHOLE . . . . . . . . . . . . 03 REGULAR WELL . . . . . . . . . . . . . . . . . . . . 04 WATER FROM SPRING . . . . . . . . . . . . . . . . 05 SURFACE WATER/PROTECTED . . . . . . . . 06 SURFACE WATER/UNPROTECTED. . . . . . . . 07 TANKER TRUCK . . . . . . . . . . . . . . . . . . . . 08 RAIN WATER COLLECTION . . . . . . . . . . . . 09 BOTTLED WATER . . . . . . . . . . . . . . . . . . . . 10 OTHER 96 (SPECIFY) 103 IN OWN DWELLING . . . . . . . . . . . . . . . . . . 1 IN OWN YARD/PLOT . . . . . . . . . . . . . . . . 2 105 ELSEWHERE 6 (SPECIFY) 104 MINUTES . . . . . . . . . . . . . . . . DON'T KNOW . . . . . . . . . . . . . . . . . . . . 998 105 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . 8 107 106 BOIL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A ADD BLEACH/CHLORINE . . . . . . . . . . . . B STRAIN THROUGH A CLOTH . . . . . . . . . . C USE WATER FILTER . . . . . . . . . . . . . . . . D RECORD ALL MENTIONED. TREATED AT SOURCE . . . . . . . . . . . . . . . . E LET IT STAND AND SETTLE . . . . . . . . . . . . F OTHER X (SPECIFY) 107 YES IN DWELLING . . . . . . . . . . . . . . . . . . 1 YES OUTSIDE DWELLING . . . . . . . . . . 2 108 NO TOILET FACILITY IN DWELLING 3 107A IN OPEN AIR . . . . . . . . . . . . . . . . . . . . . . . . . 1 PUBLIC TOILET . . . . . . . . . . . . . . . . . . . . . . . 2 109 OTHER 6 (SPECIFY) 108 YES SHARED . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO, NOT SHARED . . . . . . . . . . . . . . . . . . . . 2 What do you usually do to make the water safer to drink? Is there a special room or closed space used as a toilet facility inside or outside the dwelling? Where do you go or what do you use when you need to go to the toilet? Do you share this toilet facility with other households? 6.HOUSEHOLD CHARACTERISTICS CODING CATEGORIES Where is that water source located? How long does it take to go there, get water, and come back? Do you do anything to the water to make it safer to drink? • 283Appendix E NO. QUESTIONS AND FILTERS SKIPCODING CATEGORIES 108A What type of toilet? FLUSH TO PIPED SEWER SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . . 1 FLUSH TO SEPTIC TANK . . . . . . . . . . . . . . 2 BUCKET . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 PIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 LATRINE . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 (SPECIFY) 109 YES INSIDE THE DWELLING . . . . . . . . . . . . 1 YES OUTSIDE THE DWELLING . . . . . . . . . . 2 NO KITCHEN . . . . . . . . . . . . . . . . . . . . . . . . . 3 110 ELECTRICITY . . . . . . . . . . . . . . . . . . . . . . . . . 01 BIOGAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 KEROSENE . . . . . . . . . . . . . . . . . . . . . . . . . 03 CHARCOAL . . . . . . . . . . . . . . . . . . . . . . . . . 04 WOOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 ANIMAL DUNG . . . . . . . . . . . . . . . . . . . . . . . 06 NO FOOD COOKED IN HOUSEHOLD . . . . . . . . . . . . . . . . . . . . 95 OTHER 96 (SPECIFY) 111 What is the main source of light? PUBLIC ELECTRIC NETWORK . . . . . . . . . . 01 COOP. ELECTRIC NETWORK . . . . . . . . . . 02 PRIVATE ELECTRIC NETWORK . . . . . . . . 03 SPECIAL GENERATOR . . . . . . . . . . . . . . . . 04 SOLAR ENERGY . . . . . . . . . . . . . . . . . . . . 05 GAZ (KEROSENE) . 06 OTHER 96 (SPECIFY) NO LIGHTING .97 112 MAIN MATERIAL OF THE FLOOR CEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 PLAIN TILE . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 RECORD OBSERVATION. PLASTER . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 DIRT/CLAY . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 STONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 MARBLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 OTHER 96 (SPECIFY) 113 MAIN MATERIAL OF THE ROOF CONCRETE ROOF/CEMENT . . . . . . . . . . . . 01 WOOD AND CEMENT . . . . . . . . . . . . . . . . . . 02 RECORD OBSERVATION. WOOD AND DIRT . . . . . . . . . . . . . . . . . . . . 03 WOOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 METAL PLATES (ZINC) . . . . . . . . . . . . . . . . 05 STRAW/CANE . . . . . . . . . . . . . . . . . . . . . . . . . 06 CANE AND MUD . . . . . . . . . . . . . . . . . . . . . . . 07 METAL PLATES AND MUD . . . . . . . . . . . . . . 08 OTHER 96 (SPECIFY) What type of fuel does your household mainly use for cooking? Is there a special room used for cooking inside or outside the dwelling? 284 • Appendix E NO. QUESTIONS AND FILTERS SKIPCODING CATEGORIES 114 MAIN MATERIAL OF THE EXTERIOR WALLS CARVED STONE . . . . . . . . . . . . . . . . . . . . . . . 01 PLAIN STONE . . . . . . . . . . . . . . . . . . . . . . . . . 02 CEMENT BLOCKS . . . . . . . . . . . . . . . . . . . . 03 LOCAL ADOBE . . . . . . . . . . . . . . . . . . . . . . . 04 COVERED ADOBE . . . . . . . . . . . . . . . . . . . . 05 DIRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 STRAW/CANE . . . . . . . . . . . . . . . . . . . . . . . . . 07 CLOTH/WOOL . . . . . . . . . . . . . . . . . . . . . . . . . 08 OTHER 96 (SPECIFY) 115 ROOMS . . . . . . . . . . . . . . . . . . . . . . . 116 ROOMS . . . . . . . . . . . . . . . . . . . . . . . 117 YES NO 1- A bicycle? BICYCLE . . . . . . . . . . . . . . . . . . . . 1 2 2- A motorcycle or motor scooter? MOTORCYCLE/SCOOTER . . . . . 1 2 3- An animal-drawn cart? ANIMAL-DRAWN CART . . . . . . . . 1 2 4- A car or truck? CAR/TRUCK . . . . . . . . . . . . . . . . 1 2 5- A boat with a motor? BOAT WITH MOTOR . . . . . . . . . . 1 2 6- A radio? RADIO . . . . . . . . . . . . . . . . . . . . 1 2 7- A TV? TV . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 8- A cell phone? CELL PHONE . . . . . . . . . . . . . . . . 1 2 9- A fixed phone? FIXED PHONE . . . . . . . . . . . . . . . . 1 2 10- A refrigerator? REFRIGERATOR . . . . . . . . . . . . 1 2 11- A washer? WASHER . . . . . . . . . . . . . . . . . 1 2 12- An air conditioner? AIR CONDITIONER . . . . . . . . . . . . 1 2 13- A fan? FAN . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 14- A generator? GENERATOR . . . . . . . . . . . . . . . . 1 2 15- A water heater? WATER HEATER . . . . . . . . . . . . . . 1 2 118 YES NO 1- Agricultural land? AGRICULTURAL LAND . . . . . . . . 1 2 2- Real state? REAL STATE . . . . . . . . . . . . . . . . 1 2 3- Commercial or industrial property? COMMER. OR INDUS. PROPERTY. 1 2 121 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 137 122 IF NONE, ENTER '00'. IF 95 OR MORE, ENTER '95'. IF DON'T KNOW, ENTER '98'. 1- Cows? COWS . . . . . . . . . . . . . . . . . . . . . . . . . 2- Horses, donkeys, or mules? HORSES/DONKEYS/MULES . . . . . 3- Camels? CAMELS . . . . . . . . . . . . . . . . . . . . . . . 4- Goats? GOATS . . . . . . . . . . . . . . . . . . . . . . . 5- Sheep? SHEEP . . . . . . . . . . . . . . . . . . . . . . . 6- Chickens? CHICKENS . . . . . . . . . . . . . . . . . . . . Does this household own any livestock, herds, other farm animals, or poultry? How many of the following animals does this household own? How many rooms in this household are used by the family? Does any member of your household own: Does any member of this household own any: How many rooms in this household are used for sleeping? • 285Appendix E NO. QUESTIONS AND FILTERS SKIP 137 OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . 1 NOT OBSERVED, NOT IN DWELLING/YARD/PLOT . . . . . . . 2 NOT OBSERVED, NO PERMISSION TO SEE . . . . . . . . . . . . 3 NOT OBSERVED, OTHER REASON 6 (SPECIFY) 138 OBSERVATION ONLY: WATER IS AVAILABLE . . . . . . . . . . . . . . 1 WATER IS NOT AVAILABLE . . . . . . . . . . . . 2 OBSERVE PRESENCE OF WATER AT THE PLACE FOR HAND WASHING. 139 OBSERVATION ONLY: SOAP OR DETERGENT (BAR, LIQUID, POWDER, PASTE) . . . . . A OBSERVE PRESENCE OF SOAP, DETERGENT, OR ASH, MUD, SAND . . . . . . . . . . . . . . . . . . . . B OTHER CLEANSING AGENT. NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y 140 ASK RESPONDENT FOR A TEASPOONFUL OF IODINE PRESENT . . . . . . . . . . . . . . . . . . . . 1 COOKING SALT. NO IODINE . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO SALT IN HOUSEHOLD . . . . . . . . . . . . 3 TEST SALT FOR IODINE SALT NOT TESTED 6 (SPECIFY REASON) 140A RARELY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . . 2 OFTEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 140B RARELY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . . 2 OFTEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 140C RARELY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . . 2 OFTEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 In the last four weeks, were there cases where you or anyone from your family spent the whole day without eating because there was not enough food? CODING CATEGORIES 140 Please show me where members of your household most often wash their hands. In the last four weeks, were there cases where you did not have any kind of food to eat because of the lack of resources? In the last four weeks, were there cases where you or a family member went to bed hungry because there was not enough food? 286 • Appendix E 201 CHECK COLUMN 10 IN HOUSEHOLD SCHEDULE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTION 202. IF MORE THAN THREE CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S). 202 LINE NUMBER FROM LINE NUMBER . LINE NUMBER . LINE NUMBER . COLUMN 10 NAME FROM COLUMN 2 NAME . NAME . NAME . 203 IF MOTHER INTERVIEWED, DAY . DAY . DAY . COPY MONTH AND YEAR OF BIRTH FROM BIRTH HISTORY MONTH . MONTH . . MONTH . . AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK: YEAR YEAR YEAR What is (NAME)'s birth date? 204 CHECK 203: YES . 1 YES . 1 YES . 1 CHILD BORN IN JANUARY NO . 2 NO . 2 NO . 2 2008 OR LATER? (GO TO 203 FOR NEXT CHILD OR, (GO TO 203 FOR NEXT CHILD OR, (GO TO 203 FOR NEXT CHILD OR, IF NO MORE CHILDREN, GO TO 214) IF NO MORE CHILDREN, GO TO 214) IF NO MORE CHILDREN, GO TO 214) 205 WEIGHT IN KILOGRAMS KG. . KG. . KG. . NOT PRESENT . NOT PRESENT . NOT PRESENT . REFUSED . REFUSED . REFUSED . OTHER . OTHER . OTHER . 206 HEIGHT IN CENTIMETERS CM. CM. CM. NOT PRESENT . 9994 NOT PRESENT . 9994 NOT PRESENT . 9994 REFUSED . 9995 REFUSED . 9995 REFUSED . 9995 OTHER . 9996 OTHER . 9996 OTHER . 9996 207 MEASURED LYING DOWN LYING DOWN . 1 LYING DOWN . 1 LYING DOWN . 1 OR STANDING UP? STANDING UP . 2 STANDING UP . 2 STANDING UP . 2 NOT MEASURED . 3 NOT MEASURED . 3 NOT MEASURED . 3 207A CHECK COVER PAGE: YES NO 213 208 CHECK 203: 0-5 MONTHS . . 1 0-5 MONTHS . . 1 0-5 MONTHS . . 1 IS CHILD AGE 0-5 MONTHS, (GO TO 203 FOR NEXT CHILD OR, (GO TO 203 FOR NEXT CHILD OR, (GO TO 203 FOR NEXT CHILD OR, I.E., WAS CHILD BORN IN IF NO MORE CHILDREN, GO TO 214) IF NO MORE CHILDREN, GO TO 214) IF NO MORE CHILDREN, GO TO 214) MONTH OF INTERVIEW OR FIVE PREVIOUS MONTHS? OLDER . 2 OLDER . 2 OLDER . 2 209 LINE NUMBER OF PARENT/ OTHER ADULT RESPONSIBLE FOR THE CHILD(FROM COLUMN 1 OF HOUSEHOLD SCHEDULE). LINE NUMBER . LINE NUMBER . LINE NUMBER . RECORD '00' IF NOT LISTED. 7- WEIGHT, HEIGHT, HEMOGLOBIN MEASUREMENT FOR CHILDREN AGE 0-5 CHILD 1 CHILD 2 CHILD 3 . 9995 9996 IS THIS HOUSEHOLD SELECTED FOR ANEMIA TESTING? 9994 9994 9996 . 9994 9995 . 9995 9996 • 287Appendix E LINE NUMBER FROM LINE NUMBER . LINE NUMBER . LINE NUMBER . COLUMN 10 NAME FROM COLUMN 2 NAME . NAME . NAME . 210 ASK CONSENT FOR As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually ANEMIA TEST FROM results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat PARENT/OTHER ADULT anemia. IDENTIFIED IN 209 AS We ask all children born in 2008 or later to take part in anemia testing in this survey and give a few drops of blood from a finger or heel. RESPONSIBLE FOR CHILD. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. The blood will be tested for anemia immediately, and the result will be told to you right away. The result will be kept strictly confidential and will not be shared with anyone other than members of our survey team. Do you have any questions? You can say yes to the test, or you can say no. It is up to you to decide. Will you allow (NAME OF CHILD) to participate in the anemia test? 211 CIRCLE THE APPROPRIATE GRANTED . 1 GRANTED . 1 GRANTED . 1 CODE AND SIGN YOUR REFUSED . 2 REFUSED . 2 REFUSED . 2 NAME. (SIGN) (SIGN) (SIGN) 212 RECORD HEMOGLOBIN G\DL G\DL G\DL LEVEL HERE AND IN THE NOT PRESENT . 994 NOT PRESENT . 994 NOT PRESENT . 994 ANEMIA PAMPHLET . REFUSED . 995 REFUSED . 995 REFUSED . 995 OTHER . 996 OTHER . 996 OTHER . 996 213 GO BACK TO 203 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE; IF NO MORE CHILDREN, GO TO 214. CHILD 1 . . CHILD 3 . CHILD 2 288 • Appendix E 214 CHECK COLUMN 9 AND 9A IN HOUSEHOLD SCHEDULE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 215. IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONAL QUESTIONNAIRE(S). 215 LINE NUMBER FROM LINE NUMBER . LINE NUMBER . LINE NUMBER . COLUMN 9, 9A NAME FROM COLUMN 2 NAME . NAME . NAME . 216 WEIGHT IN KILOGRAMS KG. KG. KG. NOT PRESENT . 9994 NOT PRESENT . 9994 NOT PRESENT . 9994 REFUSED . 9995 REFUSED . 9995 REFUSED . 9995 OTHER . 9996 OTHER . 9996 OTHER . 9996 217 HEIGHT IN CENTIMETERS CM. CM. CM. NOT PRESENT . 9994 NOT PRESENT . 9994 NOT PRESENT . 9994 REFUSED . 9995 REFUSED . 9995 REFUSED . 9995 OTHER . 9996 OTHER . 9996 OTHER . 9996 217A MID-UPPER ARM CM. CM. CM. CIRCUMFERENCE NOT PRESENT . 994 NOT PRESENT . 994 NOT PRESENT . 994 IN CENTIMETERS REFUSED . 995 REFUSED . 995 REFUSED . 995 OTHER . 996 OTHER . 996 OTHER . 996 217B CHECK COVER PAGE: YES NO 228 218 AGE: CHECK 15-17 YEARS . 1 15-17 YEARS . 1 15-17 YEARS . 1 COLUMN 7. 18-49 YEARS . 2 18-49 YEARS . 2 18-49 YEARS . 2 (GO TO 223) (GO TO 223) (GO TO 223) 219 MARITAL STATUS: NEVER MARRIED . 1 NEVER MARRIED . 1 NEVER MARRIED . 1 CHECK COLUMN 8. MARRIED OR EVER MARRIED . 2 MARRIED OR EVER MARRIED . 2 MARRIED OR EVER MARRIED . 2 (GO TO 223) (GO TO 223) (GO TO 223) 220 RECORD LINE NUMBER OF PARENT/OTHER ADULT- RESPONSIBLE FOR LINE NUMBER OF PARENT OR OTHER LINE NUMBER OF PARENT OR OTHER LINE NUMBER OF PARENT OR OTHER ADOLESCENT. RECORD '00' RESPONSIBLE ADULT . RESPONSIBLE ADULT . RESPONSIBLE ADULT . IF NOT LISTED. 221 ASK CONSENT FOR ANEMIA As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually TEST FROM PARENT/ results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat OTHER ADULT IDENTIFIED anemia. IN 220 AS RESPONSIBLE For the anemia testing, we will need a few drops of blood from a finger. The equipment used to take the blood is clean and completely FOR NEVER IN UNION safe. It has never been used before and will be thrown away after each test. WOMEN AGE 15-17. The blood will be tested for anemia immediately, and the result will be told to you and (NAME OF ADOLESCENT) right away. The result will be kept strictly confidential and will not be shared with anyone other than members of our survey team. Do you have any questions? You can say yes to the test, or you can say no. It is up to you to decide. Will you allow (NAME OF ADOLESCENT) to take the anemia test? IS THIS HOUSEHOLD SELECTED FOR ANEMIA TESTING? . . WOMAN 3 . . . . WOMAN 2 . . WOMAN 1 7- WEIGHT, HEIGHT, HEMOGLOBIN MEASUREMENT FOR WOMEN AGE 15-49 . • 289Appendix E LINE NUMBER FROM LINE NUMBER . LINE NUMBER . LINE NUMBER . COLUMN 9, 9A NAME FROM COLUMN 2 NAME . NAME . NAME . 222 CIRCLE THE APPROPRIATE GRANTED . 1 GRANTED . 1 GRANTED . 1 CODE AND SIGN REFUSED . 2 REFUSED . 2 REFUSED . 2 YOUR NAME. (SIGN) (SIGN) (SIGN) (IF GRANTED, GO TO 227) (IF GRANTED, GO TO 227) (IF GRANTED, GO TO 227) (IF REFUSED, GO TO 228) (IF REFUSED, GO TO 228) (IF REFUSED, GO TO 228) 223 ASK CONSENT FOR As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually ANEMIA TEST FROM results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat RESPONDENT. anemia. For the anemia testing, we will need a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. The blood will be tested for anemia immediately, and the result will be told to you and (NAME OF ADOLESCENT) right away. The result will be kept strictly confidential and will not be shared with anyone other than members of our survey team. Do you have any questions? You can say yes to the test for (NAME OF ADOLESCENT), or you can say no. It is up to you to decide. Will you take the anemia test? 224 CIRCLE THE APPROPRIATE GRANTED . 1 GRANTED . 1 GRANTED . 1 CODE AND SIGN REFUSED . 2 REFUSED . 2 REFUSED . 2 YOUR NAME. (SIGN) (SIGN) (SIGN) (IF REFUSED, GO TO 228) (IF REFUSED, GO TO 228) (IF REFUSED, GO TO 228) 225 PREGNANCY STATUS: YES . 1 YES . 1 YES . 1 CHECK 226 IN WOMAN'S NO . 2 NO . 2 NO . 2 QUESTIONNAIRE SINGLE WOMEN . 3 SINGLE WOMEN . 3 SINGLE WOMEN . 3 OR ASK: DK . 8 DK . 8 DK . 8 Are you pregnant? 226 CHECK 224 AND PREPARE EQUIPMENT AND SUPPLIES ONLY FOR THE TEST(S) FOR WHICH CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST(S). 227 RECORD HEMOGLOBIN G\DL G\DL G\DL LEVEL HERE AND IN NOT PRESENT . 994 NOT PRESENT . 994 NOT PRESENT . 994 ANEMIA PAMPHLET REFUSED . 995 REFUSED . 995 REFUSED . 995 OTHER . 996 OTHER . 996 OTHER . 996 228 GO BACK TO 215 IN NEXT COLUMN OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE; IF NO MORE WOMEN, END THE HOUSEHOLD INTERVIEW. . . WOMAN 1 WOMAN 2 WOMAN 3 . 290 • Appendix E INTERVIEWER'S OBSERVATIONS TO BE FILLED IN AFTER COMPLETING INTERVIEW COMMENTS ABOUT RESPONDENT: COMMENTS ON SPECIFIC QUESTIONS: ANY OTHER COMMENTS: SUPERVISOR'S OBSERVATIONS NAME OF SUPERVISOR: DATE: EDITOR'S OBSERVATIONS NAME OF EDITOR: DATE: • 291Appendix E REPUBLIC OF YEMEN MINISTRY OF PUBLIC HEALTH & POPULATION CENTRAL STATISTICAL ORGANIZATION NATIONAL HEALTH & DEMOGRAPHIC SURVEY 2013 EVER MARRIED WOMAN'S QUESTIONNAIRE IDENTIFICATION ADMINISTRATIVE INFORMATION LISTING INFORMATION GOVERNORATE SECTOR NUMBER DIRECTORATE NAME SECTION NUMBER SUB-DIRECTORATE NAME CLUSTER NUMBER URBAN = 1 RURAL = 2 HOUSEHOLD NUMBER HOUSEHOLD CLUSTER NUMBER NAME OF HOUSEHOLD HEAD NAME AND LINE NUMBER OF WOMAN INTERVIEWER VISITS FINAL VISIT DATE DAY MONTH YEAR INTERVIEWER'S NAME INT. NUMBER RESULT* RESULT NEXT VISIT: DATE ./ ./ 2013 ./ ./ 2013 TOTAL NUMBER TIME OF VISITS *RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER (SPECIFY) FIELD EDITOR SUPERVISOR OFFICE EDITOR KEYER NAME SIGNATURE DATE / / 2013 / / 2013 / / 2013 / / 2013 CODE 2 0 1 3 6/19/2013 QUES. NO. 1 2 3 / / 2013 / / 2013 / / 2013 292 • Appendix E INTRODUCTION AND CONSENT INFORMED CONSENT RESPONDENT AGREES TO BE INTERVIEWED . . . 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . . . 2 END SIGNATURE OF INTERVIEWER: DATE: SECTION 1. RESPONDENT'S BACKGROUND NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 RECORD THE TIME. HOUR . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . 102 MONTH . . . . . . . . . . . . . . . . . . DON'T KNOW MONTH . . . . . . . . . . . . 98 YEAR . . . . . . . . . . . . DON'T KNOW YEAR . . . . . . . . . . . . 9998 103 AGE IN COMPLETED YEARS COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT. 104 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 108 105 What is the highest level of school you attended: primary, PRIMARY . 1 fundamental (preparatory, unified), diploma before secondary, FUNDAMENTAL (PREPARATORY, secondary, diploma after secondary, or university/higher? UNIFIED) . 2 DIPLOMA BEFORE SECONDARY . 3 SECONDARY . . . . . . . . . . . . . . . . . . . . 4 DIPLOMA AFTER SECONDARY…. 5 UNIVERSITY/HIGHER . 6 106 GRADE/YEAR . . . . . . . IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'. 107 CHECK 105 PRPRIMARY OTHER FUNDAMENTAL 1-6 LEVELS 110 Hello. My name is _______________________________________. I am working on the National Health & Demographic Survey which is implemented (by the Ministry of Public Health & Population and the Central Statistical Organization). We are conducting a survey about health all over Yemen. The information we collect will help the government to plan health services. Your household was selected for the survey. All of the answers you give will be confidential under Article (5) of the Statistics Law No. (28) for the year 1995 and will be used for statistical and researches purposes only and will not be shared with anyone other than members of our survey team. but we hope you will agree to answer the questions since your views are important. If you don't want to answer any question, just let me know and I will go on to the next question or you can stop the interview at any time. Do you have any questions? May I begin the interview now? In what month and year were you born? How old were you on your last birthday? Have you ever attended school? What is the highest (grade/year) you completed at that level? • 293Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 108 CANNOT READ AT ALL . . . . . . . . . . . . 1 ABLE TO READ ONLY PARTS OF SHOW CARD TO RESPONDENT SENTENCE . . . . . . . . . . . . . . . . . . . . 2 ABLE TO READ WHOLE SENTENCE 3 IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, BLIND/VISUALLY IMPAIRED . . . . . . . 4 PROBE: Can you read any part of the sentence to me? 109 CHECK 108: CODE '2' CODE '1' OR '4' OR '3' CIRCLED 111 CIRCLED 110 EVERY DAY . 1 AT LEAST ONCE A WEEK . . . . . . . 2 NOT AT ALL . . . . . . . . . . . . . . . . . . . . 3 111 EVERY DAY . 1 AT LEAST ONCE A WEEK . . . . . . . 2 NOT AT ALL . . . . . . . . . . . . . . . . . . . . 3 112 EVERY DAY . 1 AT LEAST ONCE A WEEK . . . . . . . 2 NOT AT ALL . . . . . . . . . . . . . . . . . . . . 3 112A YES, MARRIED . . . . . . . . . . . . . . . . . . 1 112C NO, NOT MARRIED . . . . . . . . . . . . . . . . 2 112B WIDOWED . . . . . . . . . . . . . . . . . . . . . . 1 DIVORCED 2 112C ONLY ONCE . . . . . . . . . . . . . . . . . . . . 1 MORE THAN ONCE . . . . . . . . . . . . . . . . 2 112D CHECK 112C: MARRIED MARRIED ONLY ONCE MORE THAN ONCE MONTH . . . . . . . . . . . . . . . . . . DON'T KNOW MONTH . . . . . . . . . . . . . . 98 YEAR . . . . . . . . . . . . 201 DON'T KNOW YEAR . . . . . . . . . . . . 9998 112E AGE . . . . . . . . . . . . . . . . . . . . Do you read a newspaper or magazine every day, at least once a week, or not at all? . . . . . . . . . . . . . . . . . . . . . . Do you watch television every day, at least once a week, or not at all? Now I would like you to read this sentence to me. Do you listen to the radio every day, at least once a week, or not at all? In what month and year did you start living with your husband? Now I would like to ask about your first husband. In what month and year did you start living with him? How old were you when you started living with your (first) husband? Are you currently married? What is your marital status now: are you widowed or divorced? Have you been married only once or more than once? 294 • Appendix E SECTION 2. REPRODUCTION NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 202 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 204 203 SONS AT HOME . . . . . . . . . . . . DAUGHTERS AT HOME . . . . . IF NONE, RECORD '00'. 204 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 205 SONS ELSEWHERE . . . . . . . DAUGHTERS ELSEWHERE IF NONE, RECORD '00'. 206 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 IF NO, PROBE: NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 208 207 BOYS DEAD . . . . . . . . . . . . . . GIRLS DEAD . . . . . . . . . . . . . . IF NONE, RECORD '00'. 208 SUM ANSWERS OF 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'. TOTAL . . . . . . . . . . . . . . . . . . . . 209 CHECK 208: PROBE AND YES NO CORRECT 201-208 AS NECESSARY. 210 CHECK 208: ONE OR MORE NO BIRTHS BIRTHS 226 Now I would like to ask about all the births you have had during your life. Have you ever given birth? Do you have any sons or daughters whom you have given birth who are now living with you? How many sons live with you? And how many daughters live with you? Do you have any sons or daughters who are alive but do not live with you? Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct? How many sons do not live with you? And how many daughters do not live with you? Have you ever given birth to a boy or girl who was born alive but died later? Any baby who cried or showed signs of life but did not survive? How many boys have died? And how many girls have died? • 295Appendix E 211 Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS ON SEPARATE ROWS. IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, (STARTING WITH THE SECOND ROW AND CHANGE IT TO 13). DEAD: RECORD HOUSE- HOLD LINE NUMBER OF IF '1 YR', PROBE: PROBE: CHILD How many months old RECORD (RECORD '00' was (NAME)? AGE IN IF CHILD NOT RECORD DAYS IF COM- LISTED IN LESS THAN 1 MONTH; PLETED HOUSE- MONTHS IF LESS YEARS. HOLD). THAN 2 YEARS, OR RECORD YEARS IF MORE THAN 2 YEARS. 01 MONTH HOUSEHOLD DAYS . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER YEAR MONTHS 2 GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 YEARS . . 3 220 (NEXT BIRTH) 02 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 03 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 04 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 05 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 06 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 07 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH Is (NAME) a boy or a girl? Is (NAME) single or twins? When is his/her birthday? Is (NAME) still alive? What name was given to your (first/next) baby? 221218 219 AGE IN YEARS Is (NAME) living with you? How old was (NAME) when he/she died? Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth? IF ALIVE: 217 220212 In what month and year was (NAME) born? How old was (NAME) at his/her last birthday? YEARS 213 215 216214 AGE IN AGE IN YEARS YEARS AGE IN AGE IN YEARS YEARS AGE IN AGE IN YEARS 296 • Appendix E DEAD: RECORD HOUSE- HOLD LINE NUMBER OF IF '1 YR', PROBE: PROBE: CHILD How many months old RECORD (RECORD '00' was (NAME)? AGE IN IF CHILD NOT RECORD DAYS IF COM- LISTED IN LESS THAN 1 MONTH; PLETED HOUSE- MONTHS IF LESS YEARS. HOLD). THAN 2 YEARS, OR RECORD YEARS IF MORE THAN 2 YEARS. 08 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 09 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 10 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 11 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 12 MONTH HOUSEHOLD DAYS . . . 1 YES . . . . 1 BOY 1 SING 1 YES . . 1 YES . . . 1 LINE NUMBER ADD YEAR MONTHS 2 BIRTH GIRL 2 MULT 2 NO . . . 2 NO . . . . 2 NO . . . . . 2 YEARS . . 3 NEXT 220 (GO TO 221) BIRTH 222 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 223 COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS NUMBERS ARE ARE SAME DIFFERENT (PROBE AND RECONCILE) 224 CHECK 215: NUMBER OF BIRTHS . . . . . . . . . . . . . . . . ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER. IF NONE, CIRCLE CODE (0) AND GO TO 226 NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 226 What name was given to your (first/next) baby? 212 215213 214 221220217216 218 219 Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth? In what month and year was (NAME) born? When is his/her birthday? Is (NAME) still alive? Is (NAME) living with you? How old was (NAME) when he/she died? How old was (NAME) at his/her last birthday? IF ALIVE: Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE. YEARS AGE IN AGE IN AGE IN YEARS YEARS AGE IN YEARS Is (NAME) a boy or a girl? Is (NAME) single or twins? AGE IN YEARS • 297Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 225 * FOR EACH BIRTH SINCE JANUARY 2008, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. * FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. * (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) 226 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . 8 230 227 MONTHS . . . . . . . . . . . . . . . . . . . RECORD NUMBER OF COMPLETED MONTHS. * ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED PREGNANCY MONTHS. 228 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 230 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 229 LATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO MORE . . . . . . . . . . . . . . . . . . . . . . . 2 230 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 237a 231 MONTH . . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . 232 CHECK 231: LAST PREGNANCY LAST PREGNANCY ENDED IN ENDED BEFORE 237a JAN. 2008 OR LATER JAN. 2008 233 MONTHS . . . . . . . . . . . . . . . . . . . RECORD NUMBER OF COMPLETED MONTHS. * ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS. 234 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 236 235 ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2008 * ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS FOR EACH PREGNANCY THAT MISCARRIED, WAS ABORTED, OR END IN STILLBIRTH. 236 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 237A 237 MONTH . . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . C C Are you pregnant now? How many months pregnant are you? When you got pregnant, did you want to get pregnant at that time? Did you want to have a baby later on or did you not want any (more) children? Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth? When was the last pregnancy that miscarried, was aborted, or ended in stillbirth? C C How many months pregnant were you when the last such pregnancy ended? (pregnancy that miscarried, was aborted, or ended in stillbirth) Since January 2008, have you had any other pregnancies that did not result in a live birth? Did you have any miscarriages, abortions, or stillbirths that ended before 2008? When did the last pregnancy that terminated before 2008 end? 298 • Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 237A How old were you when you had your first menstrual period? 238 DAYS AGO . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . 2 MONTHS AGO . . . . . . . . . . 3 (DATE, IF GIVEN) YEARS AGO . . . . . . . . . . 4 IN MENOPAUSE/ HAS HAD HYSTERECTOMY . . . 994 BEFORE LAST BIRTH . . . . . . . . . . . . 995 NEVER MENSTRUATED . . . . . . . . . . 996 When did your last menstrual period start? AGE IN YEARS ……………. • 299Appendix E SECTION 3. CONTRACEPTION 301 01 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 02 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 03 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 04 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 05 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 06 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 07 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 08 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 09 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 10 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 11 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 12 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 13 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 14 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ________________________________ (SPECIFY) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 301A CHECK 112A, 112B: MARRIED DIVORCED, WIDOWED 311 Diaphragm. PROBE It is a soft latex with a spring that creates a seal against the walls of the vagina. Female Condom. PROBE: Women can place a sheath in their vagina before sexual intercourse to avoid pregnancy. Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months. Pill. PROBE: Women can take a pill every day to avoid becoming pregnant. Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse to avoid pregnancy. Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or two years. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)? Female Sterilization. PROBE: Women can have an operation to avoid having any more children. Male Sterilization. PROBE: Men can have an operation to avoid having any more children. IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse or midwife. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? Lactational Amenorrhea Method (LAM): Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy. Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant. Withdrawal. PROBE: Men can be careful and pull out before climax. 300 • Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 302 CHECK 226: NOT PREGNANT PREGNANT OR UNSURE 311 303 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 311 304 FEMALE STERILIZATION . . . . . . . . . . A MALE STERILIZATION . . . . . . . . . . . . B CIRCLE ALL MENTIONED. IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C INJECTABLES . . . . . . . . . . . . . . . . . . D IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . E INSTRUCTION FOR HIGHEST METHOD IN LIST. PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F CONDOM . . . . . . . . . . . . . . . . . . . . . . . G FEMALE CONDOM . . . . . . . . . . . . . . H DIAPHRAGM . . . . . . . . . . . . . . . . . . . . I 308A LACTATIONAL AMEN. METHOD . . . . . J RHYTHM METHOD . . . . . . . . . . . . . . . . K WITHDRAWAL . . . . . . . . . . . . . . . . . . L OTHER MODERN METHOD . . . . . . . . X OTHER TRADITIONAL METHOD . . . Y 307 GOVT. HOSPITAL . . . . . . . . . . . . . . 11 GOVT. HEALTH CENTER . . . . . . . . 12 PROBE TO IDENTIFY THE TYPE OF SOURCE. PRIMARY HEALTH CENTER . 13 FAMILY PLANNING CLINIC . . . . . . . . 14 IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, MOBILE CLINIC . . . . . . . . . . . . . . . . 15 WRITE THE NAME OF THE PLACE. PRIVATE SECTOR (HOSPITAL/CLINIC/DOCTOR) . 21 (NAME OF PLACE) NON GOVERNMENT ORGANIZATIONS PR. HOSPITAL/CENTER/ CLINIC/MOBILE CLINIC .31 OTHER 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . 98 Which method are you using? Are you currently doing something or using any method to delay or avoid getting pregnant? In what facility did the sterilization take place? • 301Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 308 308A MONTH . . . . . . . . . . . . . . . . . . YEAR . . . . . . . . . . . . 309 CHECK 215, 231 AND 308/308A: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YES NO YEAR OF START OF USE OF CONTRACEPTION IN 308/308A PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION). 310 CHECK 308/308A: YEAR IS 2008 OR LATER YEAR IS 2007 OR EARLIER ENTER CODE FOR METHOD USED IN MONTH ENTER CODE FOR METHOD USED IN MONTH OF OF INTERVIEW IN THE CALENDAR INTERVIEW IN THE CALENDAR AND AND IN EACH MONTH BACK TO THE DATE EACH MONTH BACK TO JANUARY 2008 STARTED USING. THEN SKIP TO 311 I would like to ask you some questions about the times you or your husband may have used a method to avoid getting pregnant during the last few years. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2008 USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH. ILLUSTRATIVE QUESTIONS: * * * IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN (2) MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN (1). ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT. ILLUSTRATIVE QUESTIONS: * * In what month and year was the sterilization performed? 314 C Since what month and year have you been using (CURRENT METHOD) without stopping? C PROBE: For how long have you been using (CURRENT METHOD) now without stopping? C IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER ‘0’ IN EACH SUCH MONTH IN COLUMN (1). When was the last time you used a method? Which method was that? When did you start using that method? How long after the birth of (NAME)? Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? How long did you use the method then? 302 • Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 312 CHECK THE CALENDAR (FOR INTERVIEWER: USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH?) NO METHOD USED ANY METHOD USED 314 313 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 323A 314 CHECK 304: NO CODE CIRCLED . . . . . . . . . . . . . . 00 323A FEMALE STERILIZATION . . . . . . . . . . 01 317A CIRCLE METHOD CODE: MALE STERILIZATION . . . . . . . . . . . . 02 326 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 IF MORE THAN ONE METHOD CODE CIRCLED IN 304, INJECTABLES . . . . . . . . . . . . . . . . . . . . 04 CIRCLE CODE FOR HIGHEST METHOD IN LIST. IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . 05 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . . . . . . . . 07 FEMALE CONDOM . . . . . . . . . . . . . . . . 08 DIAPHRAGM . . . . . . . . . . . . . . . . . . . . 09 LACTATIONAL AMEN. METHOD . . . . . 10 RHYTHM METHOD . . . . . . . . . . . . . . . . 11 315A WITHDRAWAL . . . . . . . . . . . . . . . . . . 12 OTHER MODERN METHOD . . . . . . . . 95 326 OTHER TRADITIONAL METHOD . . . . . 96 315 You first started using (CURRENT METHOD) in (DATE FROM GOVT. HOSPITAL . . . . . . . . . . . . . . 11 308/308A). Where did you get it at that time? GOVT. HEALTH CENTER . . . . . . . . 12 PRIMARY HEALTH CENTER 13 FAMILY PLANNING CLINIC . . . . . . . . 14 MOBILE CLINIC . . . . . . . . . . . . . . . . 15 PRIVATE SECTOR 315A (HOSPITAL/CLINIC/DOCTOR) . 21 amenorrhea method? PHARMACY .22 NON GOVERNMENT ORGANIZATIONS PR. HOSPITAL/CENTER/ CLINIC/MOBILE CLINIC. 31 PROBE TO IDENTIFY THE TYPE OF SOURCE. OTHER 96 IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, (SPECIFY) WRITE THE NAME OF THE PLACE. (NAME OF PLACE) Have you ever used anything or tried in any way to delay or avoid getting pregnant? Where did you learn how to use the rhythm/lactational • 303Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 316 CHECK 304: IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 INJECTABLES . . . . . . . . . . . . . . . . . . . . 04 CIRCLE METHOD CODE: IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . 05 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CONDOM . . . . . . . . . . . . . . . . . . . . . . . 07 323 CIRCLE CODE FOR HIGHEST METHOD IN LIST. FEMALE CONDOM . . . . . . . . . . . . . . . . 08 DIAPHRAGM . . . . . . . . . . . . . . . . . . . . 09 320 LACTATIONAL AMEN. METHOD . . . . . 10 RHYTHM METHOD . . . . . . . . . . . . . . . . 11 326 317 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 319 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 317A 318 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 320 319 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 320 CHECK 314: CODE '1' CODE '1' CIRCLED NOT CIRCLED YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 322 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 321 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 322 CHECK 304: FEMALE STERILIZATION . . . . . . . . . . 01 MALE STERILIZATION . . . . . . . . . . . . 02 326 CIRCLE METHOD CODE: IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 INJECTABLES . . . . . . . . . . . . . . . . . . . . 04 IF MORE THAN ONE METHOD CODE CIRCLED IN 304, IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . 05 CIRCLE CODE FOR HIGHEST METHOD IN LIST. PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 CONDOM . . . . . . . . . . . . . . . . .