Yemen - Multiple Indicator Cluster Survey - 2006

Publication date: 2006

YEMEN Monitoring the situation of children and women Multiple Indicator Cluster Survey 2006 Ministry of Public Health & Population Pan-Arab Project for Family Health (PAPFAM) United Nations Children’s Fund 2 The Yemen Multiple Indicator Cluster Survey (MICS) was carried by the Ministry of Health. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) and The Pan Arab Project for Family Health (PAPFAM), League of Arab States. The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out around the world in more than 50 countries, in 2005-2007, following the first two rounds of MICS surveys that were conducted in 1995 and the year 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org. Ministry of Health and Population and UNICEF 2008. Yemen Multiple Indicator Cluster Survey 2006, Final Report. 3 Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Yemen, 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY 1 Under-five mortality rate 78 per thousand Child mortality 2 Infant mortality rate 69 per thousand NUTRITION Breastfeeding 45 Timely initiation of breastfeeding 30 percent Vitamin A 43 Vitamin A supplementation (post-partum mothers) 16 percent Low birth weight 10 Infants weighed at birth 8 percent CHILD HEALTH 25 Tuberculosis immunization coverage 67 percent 26 Polio immunization coverage 60 percent 27 DPT immunization coverage 60 percent 28 15 Measles immunization coverage 59 percent 31 Fully immunized children 18 percent Immunization 29 Hepatitis B immunization coverage 19 percent Tetanus toxoid 32 Neonatal tetanus protection 31 percent 33 Use of oral rehydration therapy (ORT) 87 percent 34 Home management of diarrhoea 31 percent Care of illness 22 Antibiotic treatment of suspected pneumonia 38 percent Solid fuel use 24 29 Solid fuels 36 percent ENVIRONMENT 11 30 Use of improved drinking water sources 59 percent 13 Water treatment 5 percent Water and Sanitation 12 31 Use of improved sanitation facilities 52 percent REPRODUCTIVE HEALTH 21 19c Contraceptive prevalence 28 percent 98 Unmet need for family planning 24 percent Contraception and unmet need 99 Demand satisfied for family planning 54 percent 20 Antenatal care 47 percent Maternal and newborn health 44 Content of antenatal care Blood test taken 37 percent Blood pressure measured 40 percent Urine specimen taken 34 percent Weight measured 27 percent 4 17 Skilled attendant at delivery 36 percent 5 Institutional deliveries 24 percent Fertility Total Fertility Rate 5.2 rate CHILD DEVELOPMENT 46 Support for learning 26 percent 47 Father's support for learning 32 percent 48 Support for learning: children’s books 10 percent 49 Support for learning: non-children’s books 59 percent 50 Support for learning: materials for play 18 percent Child development 51 Non-adult care 31 percent 4 Topic MICS Indicator Number MDG Indicator Number Indicator Value EDUCATION 52 Pre-school attendance 3 percent 54 Net intake rate in basic education 40 percent 55 6 Net primary school attendance rate 68 percent 56 Net secondary school attendance rate 24 percent 57 7 Children reaching grade five 79 percent 58 Transition rate to secondary school 66 percent 59 7b Primary completion rate 18 percent Education 61 9 Gender parity index basic education secondary school 0.80 0.60 ratio ratio Literacy Adult literacy rate (Ever married women only) 35 percent CHILD PROTECTION Birth registration 62 Birth registration 22 percent 71 Child labour 23 percent 72 Labourer students 60 percent Child labour 73 Student labourers 23 percent Child discipline 74 Child discipline Any psychological/physical punishment 94 percent 67 Marriage before age 15 Marriage before age 18 14 52 percent percent 68 Young women age 15-19 currently married 19 percent Early marriage 69 Spousal age difference Women age 15-19 Women age 20-24 16 18 percent percent Disability 101 Child disability 25 percent 75 Prevalence of orphans 5 percent Orphans 78 Children’s living arrangements 2 percent 5 Topic MICS Indicator Number MDG Indicator Number Indicator Value HIV and AIDS 89 Knowledge of mother- to-child transmission of HIV* 32 percent 86 Attitude towards people with HIV/AIDS* 5 percent 87 Women who know where to be tested for HIV* 12 percent 88 Women who have been tested for HIV* 2 percent 90 Counselling coverage for the prevention of mother- to-child transmission of HIV 2 percent HIV and AIDS knowledge and attitudes 91 Testing coverage for the prevention of mother-to- child transmission of HIV 1 percent * Ever-married women only 6 Table of Contents Summary Table of Findings .3 List of Tables.8 List of Figures .10 List of Figures .10 Preface .12 Foreword .13 .13 Executive Summary.14 I. Introduction.18 Survey Objectives .19 II. Sample and Survey Methodology.20 Sample Design .20 Questionnaires.20 Training and Fieldwork.21 Data Processing.21 III. Sample Coverage and the Characteristics of Households.22 and Respondents .22 Sample Coverage .22 Characteristics of Households .22 Characteristics of Respondents .23 IV. Child Mortality .25 Levels and Trends in Infant and Child Mortality .25 V. Nutrition .28 Breastfeeding.28 Vitamin A Supplements .29 Low Birth Weight .29 VI. Child Health.31 Immunization .31 Tetanus Toxoid.33 Oral Rehydration Treatment.34 Care Seeking and Antibiotic Treatment of Pneumonia .36 Solid Fuel Use .37 VII. Environment .38 Water and Sanitation .38 VIII. Fertility.42 Current Fertility.42 Fertility Differentials.43 IX. Reproductive Health .44 Contraception .44 Unmet Need .44 Antenatal Care.45 Assistance at Delivery.46 X. Child Development .48 XI. Education .50 7 Pre-School Attendance and School Readiness .50 School Participation .50 Adult Literacy .53 XII. Child Protection.54 Birth Registration .54 Child Labour .54 Child Discipline .55 Early Marriage .56 Child Disability .57 Children’s Living Arrangements.57 XIII. HIV and AIDS .59 Knowledge of HIV Transmission.59 List of References.62 Appendix A. Sample Design.130 Appendix B. List of Personnel Involved in the Survey.136 Appendix C. Estimates of Sampling Errors .138 Appendix D. Data Quality Tables .143 Appendix E. MICS Indicators: Numerators and Denominators.149 Appendix F. Questionnaires .153 8 List of Tables Table HH.1: Results of household and individual interviews.64 Table HH.2: Household age distribution by sex .65 Table HH.3: Household composition .66 Table HH.4: Women's background characteristics.67 Table HH.5: Children's background characteristics.68 Table CM.1: Childhood mortality rates .69 Table CM.2: Child mortality by sex and residence characteristics.69 Table NU.1: Initial breastfeeding.70 Table NU.2: Post-partum mothers' vitamin A supplementation.71 Table NU.3: Child size at birth.72 Table CH.1: Vaccinations in first year of life.73 Table CH.1c: Vaccinations in first year of life (continued).74 Table CH.2: Vaccinations by background characteristics.75 Table CH.2c: Vaccinations by background characteristics (continued).76 Table CH.3: Neonatal tetanus protection .77 Table CH.4: Oral rehydration treatment .78 Table CH.5: Home management of diarrhoea .79 Table CH.6: Antibiotic treatment of pneumonia .80 Table CH.7A: Knowledge of the two danger signs of pneumonia.81 Table CH.8: Solid fuel use.82 Table EN.1: Use of improved water sources .83 Table EN.2: Household water treatment .84 Table EN.3: Time to source of water .85 Table EN.4: Person collecting water .86 Table EN.5: Use of sanitary means of excreta disposal .87 Table EN.6: Use of improved water sources and improved sanitation .88 Table FE.1: Current Fertility .89 Table FE.2: Fertility by background characteristics.89 Table RH.1: Use of contraception .90 Table RH.2: Unmet need for contraception .91 Table RH.3: Antenatal care provider .92 Table RH.4: Antenatal care .93 Table RH.5: Assistance during delivery .94 Table CD.1: Family support for learning.95 Table CD.2: Learning materials.96 Table CD.3: Children left alone or with other children .97 Table ED.1: Early childhood education.98 Table ED.2: Primary school entry (Basic Education) .99 Table ED.3: Primary school net attendance ratio (Basic Education).100 9 Table ED.4: Secondary school net attendance ratio (Basic Education) .101 Table ED.4w: Secondary school age children attending primary school (Basic Education) .102 Table ED.5: Children reaching grade 5 (Basic Education).103 Table ED.6: Primary school completion and transition to secondary education (Basic Education).104 Table ED.7: Education gender parity (Basic Education).105 Table ED.8: Adult literacy .106 Table ED.1A: Early childhood education (ISCED) .107 Table ED.2A: Primary school entry (ISCED).108 Table ED.3: Primary school net attendance ratio (ISCED).109 Table ED.4A: Secondary school net attendance ratio (ISCED) .110 Table ED.4Aw: Secondary school age children attending primary school (ISCED).111 Table ED.5A: Children reaching grade 5 (ISCED) .112 Table ED.6A: Primary school completion and transition to secondary education (ISCED) .113 Table ED.7A: Education gender parity (ISCED) .114 Table CP.2: Child labour.116 Table CP.3: Labourer students and student labourers .117 Table CP.5: Early marriage.119 Table CP.6: Spousal age difference.120 Table CP.7: Child disability.121 Table CP.8: Children's living arrangements and orphanhood.122 Table HA.1: Knowledge of preventing HIV transmission .123 Table HA.2: Identifying misconceptions about HIV and AIDS .124 Table HA.3: Comprehensive knowledge of HIV and AIDS transmission .125 Table HA.4: Knowledge of mother-to-child HIV transmission .126 Table HA.5: Attitudes toward people living with HIV and AIDS.127 Table HA.6: Knowledge of a facility for HIV testing .128 Table HA.7: HIV testing and counselling coverage during antenatal care .129 10 List of Figures Figure HH.1: Age and Sex Distribution of Household Population.22 Figure CM.1: Under 5 Mortality rates by background characteristics.26 Figure CM.2: Trends in under-5 mortality rates. .27 Figure NU.2 Percentage of mothers who started breastfeeding within one hour and within one day of birth. .28 Figure CH.1 Percentage of children age 12-23 months who received the recommended vaccinations by 12 months.32 Figure CH.2 Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus.34 Figure CH.3 Percentage of children age 0-59 months with diarrhoea who received oral rehydration treatment. .35 Figure CH.4 Percentage of children age 0-59 with diarrhoea who received ORT or increased fluids, AND continued feeding.36 Figure EN.1 Percentage distribution of household members by source of drinking water,.39 Yemen, 2006.39 Figure FE.1: Age-specific Fertility Rates by Urban-Rural Residence.43 Figure ED.2 Percent distribution of children attending school by age. .51 Figure HA.1 Percent of ever-married women who know 2 ways of transmission and women who reject misconceptions of HIV and AIDS transmission. .60 11 List of Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CSPro Census and Survey Processing System DPT Diphteria Pertussis Tetanus EPI Expanded Programme on Immunization FGM/C Female genital mutilation/cutting GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders ISCED International Standard Classification of Education ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoPH & P Ministry of Public Health & Population NAR Net Attendance Rate ORT Oral rehydration treatment PAPFAM Pan Arab Project for Family Health ppm Parts Per Million SPSS Statistical Package for Social Sciences UNAIDS United Nations Programme on HIV and AIDS UNESCO United Nations Educational, Scientific and Cultural Organisation UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV and AIDS UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization 12 Preface The betterment of health is the main causal factor behind the establishment of any health system. It is also the goal and aim of our health system represented by the Ministry of Public Health and Population. The realization of this goal is guided by the political leadership headed by the President of the Republic (may God preserve him) and by seeking to implement the goals of our right-guided government. While the betterment of health is the prime need, still, great strides have been made in primary health care and the resulting improvement in health indicators, particularly those related to combating infectious diseases such as malaria, bilharzias, tuberculosis, and diarrheal diseases. Further progress has been made through routine immunization coverage by way of linkage activities, reducing maternal, under-five child, and infant mortality rates, increasing the rate of usage of family planning methods, and raising the health awareness of families with a focus on pregnant mothers to promote safe deliveries. Within this framework, the Ministry of Public Health and Population has striven earnestly in cooperation with UNICEF and the Arab Family Health Project of the Arab League to implement the Multiple Indicator Cluster Survey aimed at monitoring the situation of mothers and children in our beloved Yemen. The objective of this MICS is to update its data and establish a health information database that would contribute to the planning process to revive the health standards of this segment of the population. The significance of this survey lies in the importance of the results which will facilitate the establishment of a database of updated health indicators. This database will help in analyzing the health, social, and educational situation of children and in comparing the results with data from the Family Health Survey of 2003. There is no doubt that the results of the MICS will greatly contribute to identifying the current situation of mother and child health (MCH). It will also help in the development of future remedies and plans based on a clear vision towards achieving the Millennium Development Goals and preparing the environment for national action and necessary programs that will revitalize MCH. On the occasion of the publication of the final MICS report covering the health situation of women and children in Yemen, the Ministry of Public Health and Population is pleased to offer its sincere appreciation and esteem for the United Nations Children’s Fund (UNICEF) and the Arab Family Health Project of the Arab League for their support and contribution in implementing this vital survey. Many thanks also go to all local agencies, contributing researchers, administrators, and staff who participated in the success of this survey. We have great hopes that the results of this survey will be a strong backdrop for the data and information necessary to enable us to make the appropriate decisions, formulate policies, prepare plans, and design health development programs that will have a resounding impact on improving the standard of mother and child health. Minister of Public Health and Population Dr. Abdul Karim Yahya Rasi’ 13 Foreword In 2006, Yemen conducted its first Multiple Indicator Cluster Survey (MICS) piloted by the Ministry of Public Health and Population. The survey received technical assistance from the Pan-Arab Project for Family Health (PAPFAM), with UNICEF providing technical and financial support. The genesis of the global MICS effort dates to 1995 when UNICEF supported governments around the world to assess progress in meeting the World Summit Goals for children at mid-decade. Data made available from these surveys provided fresh understanding of the situation of children and women in the countries that undertook them. The data served as baselines in the development of new programmes and interventions whilst also facilitating the monitoring of trends on the health, education and protection status of children. Since then, these surveys are becoming institutionalized by governments on a wide-scale. The second round of the multiple indicator cluster surveys were conducted in 2000 and the third round undertaken by countries during 2005 and 2006. The Republic of Yemen joined the effort with the third round of MICS in 2006 making good the opportunity to update key indicators presented in the Family Health Survey realized in 2003 by the Yemen Ministry of Public Health and Population, the Central Statistics Organisation and with support from the Pan-Arab Project for Family Health. This survey until recently constituted the single most important reference for a combination of indicators on maternal and child health. The 2006 Yemen MICS is an important contribution to this same strategy of addressing data gaps pertaining to the well-being of children using a standard methodology and producing internationally comparable estimates. The Yemen MICS is a commendable endeavour in data collection, analysis and presentation. From its findings, new disaggregated data is provided on mortality, birth registration, child health and development, reproductive health, primary school attendance, child discipline, child labour, early marriage, water and sanitation and other very important information. The results are thus helping to fill data gaps and facilitating measurement of progress in child-related goals as well as relevant Millennium Development Goals (MDGs). The available data sets will equally be useful in further disparity analysis based on urban/rural differentials, education, gender as well as socio-economic considerations. The MICS exercise has emerged as a credible tool in strengthening national capacity and systems for data production and utilization. Its worth is seen in the evidence produced on how the country is progressing in fulfilling and protecting the rights of children. This sets the premise for improving policy, programming and reporting on child survival, meeting education targets and on actions addressing vulnerable children. Now expected to be pursued every three years, the MICS will continue to support the Government of Yemen’s efforts and those of contributing national and international partners to fully utilize the data and knowledge created to ensure improved outcomes for children. UNICEF stands ready to support this process that will reinforce evidence gathering and its use for Yemeni children. We congratulate the Ministry of Public Health and Population and the internal and external partners who played such an important role in bringing Yemen MICS 2006 into fruition. Aboudou Karimou Adjibade Representative UNICEF Yemen 14 Executive Summary The Yemen Multiple Indicator Cluster Survey was conducted in 2006 with cooperation between the Ministry of Public Health and Population and UNICEF and the support of the Pan-Arab Project for Family Health in the League of Arab States. The MICS is a nationally representative survey of 3,586 households, 3,742 ever-married women age 15-49 and 3,783 mothers’ and caretakers of children age less than five. The primary objective of the MICS is to provide policy makers and planners with reliable and detailed information needed to monitor the situation of women and children in Yemen. Information on child mortality, nutrition, child health, child protection, water and sanitation, education, fertility, reproductive health, and knowledge of HIV and AIDS is included. Child Mortality ƒ In the five years preceding the survey infant mortality was estimated to be 69 deaths per 1,000 live births translating to approximately one in every 15 Yemeni children dying before they reach their first birthday. ƒ The under-five mortality rate was estimated to be 78 deaths per 1,000 live births. ƒ Both infant and under-5 mortality rates are higher for children coming from rural areas compared to their urban counterparts; the figures for under-five mortality in rural areas is about 51 percent higher than in urban areas. ƒ The probability of dying among children living in the poorest households is considerably higher than the national average. Immunisation • Thirty-eight percent of children age 12 -23 months had been fully vaccinated at the time of the survey; 18 percent of these children had received all their vaccinations before the age of one. • More than half of Yemeni children age 12-23 months had received each of the major vaccines by the age of one: 67 percent had received BCG, 60 percent had received all three doses of polio, a further 60 percent had received the third dose of DPT and 59 percent had received the measles vaccine. • A low proportion of children, just 19 percent, had received the hepatitis B vaccine before their first birthday. • Around one in ten Yemeni children age 12-23 months had not received a single vaccine. Diarrhea • Nationally 34 percent of children under the age of five had diarrhea at some time in the two weeks before the survey. • Almost nine out of ten of the children who had diarrhea were treated with some kind of oral rehydration therapy (ORT): 33 percent were treated with ORS (solution prepared from ORS packets) and the remainder of children were given home fluids recommended by the Ministry of Health. • Thirteen percent of children with diarrhea did not receive any type of treatment at all. • Home management of children with diarrhea was low with only 31 percent of mother’s or caretakers reporting that their child received more fluids AND continued eating somewhat less, the same or more food. Acute respiratory Infection (ARI) • Thirteen percent of children under age five showed symptoms of ARI in the two weeks before the survey. • Of the children who showed such symptoms of ARI only 38 percent received antibiotics. • Only a fifth of mothers and caretakers of under 5 children reported that fast and difficult breathing would be cause for taking their children immediately to a health facility. • The risk of acute respiratory illness is increased by the use of solid fuels used for cooking in Yemeni households; more than one third of households use solid fuels for cooking. Almost all of these households are in rural areas; 52 percent of rural households use solid fuels for cooking. 15 Breastfeeding • Three out of 10 children are breastfed within one hour of being born and 65 percent of children are breastfed within one day. • Women’s educational level appears to have a positive correlation with the early initiation of breastfeeding. Water and Sanitation • In Yemen, 59 percent of the population is using an improved source of drinking water – 74 percent in urban areas and 52 percent in rural areas. • Slightly less than three out of every ten households has water piped directly into their dwelling. • Only 5 percent of the household population uses an appropriate method to treat their water. • People living in households in urban settings or where the household head has received secondary or higher education or those living in the richest households, are significantly more likely to use an appropriate water treatment method than others. • On average for households where water is not on the premises, it takes just over one hour to go to the source of drinking water, collect the water, and then return to home. The time it takes to collect water is longer for households in rural areas but still takes 45 minutes in urban areas. • The burden of this job in over two thirds of households falls to a female adult. • A little over half of the Yemeni population uses a sanitary means of excreta disposal. • The difference between households in urban and rural areas is significant; 92 percent of the population in urban areas is using a sanitary form of excreta disposal compared to just 34 percent of the population living in rural areas. • Thirty-seven percent of the Yemeni population is using both an improved source of drinking water and a sanitary means of excreta disposal. • The gap between the rich and poor is striking when it comes to having use of both types of improved sources; the gap ranges from 2 percent for those living in the poorest households to 77 percent for those living in the richest. Fertility • The total fertility rate for Yemen is estimated at 5.2 births per woman. • Fertility rates are higher in rural areas than urban areas; the TFR in rural areas is 6 births per woman, while the TFR in urban areas is 4. The age specific fertility rates for women age 15-19 in rural areas is 56 percent higher than for women of the same age in urban areas. Contraception • Current use of contraception was reported by 28 percent of currently married Yemeni women. • Nineteen percent of currently married women were using modern methods of contraception. • The most popular method is the pill which is used by 9 percent of married women in Yemen. • Contraceptive prevalence in urban areas was double the prevalence found in rural areas. • The percentage of women using any method of contraception rises from 23 percent among those with no education to 34 percent among women with basic education, and to 42 percent among women with secondary or higher education. • Just under a quarter of currently married women in Yemen report an unmet need for contraception. Antenatal care • Forty-seven percent of mothers who had a live birth in the two years preceding the survey received antenatal care from a doctor, nurse or trained midwife. • Women living in urban areas are considerably more likely to receive antenatal care from skilled health personnel than their rural counterparts (68 percent versus 39 percent). • Women are most likely to see a medical doctor for their antenatal care. Assistance at delivery of births • Only 36 percent of births occurring in the year prior to the MICS survey were delivered by skilled health personnel; ranging from 26 percent in rural areas to 62 percent in urban areas. • Just under a quarter of births (24 percent) are delivered in a health facility. 16 • Socioeconomic status is positively correlated with the likelihood of giving birth in a health facility; only 9 percent of pregnant women from the poorest households delivered in a health facility compared to 51 percent of pregnant women from the richest households. • Half of all ever-married women who gave birth in the two years preceding the survey were assisted at delivery by a relative or friend. Child Development • In the 3 days prior to the survey, an adult engage in more than four activities that promote learning and school readiness for one quarter of under-5 children. • The average number of activities was 2.5. • Just under a third of fathers engage in such activities with their children. • In Yemen 59 percent of children live in households that own more than 3 non-adult books and 10 percent live in households with 3 or more children’s books. • A little under a fifth of under-5 children live in households where there are no play things. • Thirty-one percent of children age 0-59 months were left in the care of other children under the age of 10 in the week prior to the survey. • A tenth of children were left alone in the week prior to the survey. Education • Early childhood education is rare in Yemen and is attended by just 3 percent of Yemeni children age 3-5 years old. • Forty percent of children age 6 are currently attending the first grade of school with little differences between male and female children. In urban areas 51 percent of 6 year olds are attending school compared to 38 percent in rural areas. • Of all children of basic education age (6-14 years old), approximately 68 percent are attending primary school; 76 percent of boys are attending school compared to 60 percent of girls • Around eight out of ten children in urban areas are attending schools providing basic education compared to 6 out of ten children in rural areas. • Only 24 percent of secondary school age children (15-17 years old) are attending secondary education; 32 percent of boys are attending secondary school compared to 15 percent of girls. • A further 24 percent of secondary school age children are still attending basic education. • Over three quarters of students (79 percent) will eventually reach grade five; in urban areas 91 percent of children will reach grade 5 compared to 73 percent of children attending school in rural areas. The difference between male and female children reaching grade 5 is negligible. • Approximately two thirds of children who completed the last grade of basic education were found at the moment the survey to be attending the first grade of secondary school. • For every 10 boys who attend basic education, there are 8 girls. The gender parity index falls even more for secondary school education, with 6 girls attending for every 10 boys. Literacy • A little over a third (35 percent) of Yemeni ever-married women age 15-24 are literate. • The percentage of literate women in living in urban households is more than double the percentage for women living in rural households (59 percent versus 26 percent) Birth Registration • The births of just 22 percent of children under five years of age in Yemen have been registered • The most common reason for not registering the birth of a child was because the mother or caretaker did not know that the birth of their child had to be registered. Child Labour • It was reported that just over one fifth of children age 5 to 14 were involved in a form child labour (23 percent) • Of the 59 percent of children 5-14 years of age attending school, 23 percent are also involved in child labour activities. Out of the 23 percent of the children classified as child labourers, 60 percent of them are also attending school. 17 Child Discipline • In Yemen, 94 percent of children age 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. Child Disability • Mother’s or caretakers reported that a quarter of Yemeni children age 2-9 years had at least one disability. The disability most commonly reported was delay in sitting, standing or walking followed by being unable to understand instructions and unable to be understood. Early Marriage • 14 percent of women age 15-49 years were married by the time they were 15, the proportion increases to 52 percent by the time women are 18. • 19 percent of Yemeni women age 15-19 are currently married. In 16 percent of these marriages the husband is ten years older than the woman. HIV and AIDS1 • In Yemen, 61 percent of the interviewed women have heard of AIDS ranging from 50 percent in rural areas to 85 percent in urban areas. • Knowledge of the role condoms can play in preventing the transmission of HIV is low at 21 percent. • Twenty-two percent of ever-married women know that a healthy-looking person can have the AIDS virus. • Many ever-married women erroneously believe that AIDS can be transmitted by mosquito bites and by sharing food. • Just under half of the women know that HIV can be transmitted by sharing needles. • More than half of ever-married women know that HIV can be transmitted from mother to child; 32 percent knew all three ways of mother-to-child transmission. • An overwhelming 95 percent of ever-married women agreed with at least one discriminatory statement towards people living with HIV. The most widely held attitude was to not purchase food from a person with HIV and AIDS followed by the belief that a female teacher with HIV should not be allowed to work. • Just under one fifth of the women surveyed said that they would care for a family member who was sick with AIDS. • Only 12 percent of ever-married women know a place to be tested for HIV; ranging from 7 percent of women living in rural areas to 23 percent of women living in urban areas. • Only 1.9 percent of ever-married women have actually been tested and these women reside mainly in urban areas • Two percent of ever-married women who gave birth in the 2 years preceding the survey were provided information about HIV prevention during an antenatal care visit. 1 All HIV data is based on a sample of ever-married women only. 18 I. Introduction Background This report is based on the Yemen Multiple Indicator Cluster Survey, conducted in 2006 with cooperation between the Ministry of Public Health and Population and UNICEF and the support of the Pan-Arab Project for Family Health in the League of Arab States. The survey provides valuable information on the situation of children and women in Yemen, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children as well as declarations issued by the League of Arab States and related institutions and organizations concerned about child rights in Arab countries, and the Cairo Declaration “Towards an Arab World Fit for Children”, and the Second Arab Work Plan for Children (2004-2015) that was adopted at the Arab Summits. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” 19 The eight main goals that the Millennium Declaration focused on provided the basis for socio- economic planning priorities in Yemen. The five-year plans that followed aimed at raising citizens’ standard of living, improving income, and ensuring the best methods for making education available for boys and girls in both rural and urban areas. Special concern was given for health, environment, and women’s empowerment, among other issues. MICS will be an important resource to ensure that appropriate data are available for use in monitoring progress made towards achieving the Millennium Development Goals (MDGs). This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2006 Yemen Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Yemen; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Yemen and to strengthen technical expertise in the design, implementation, and analysis of such systems. 20 II. Sample and Survey Methodology Sample Design The Yemen MICS3 sample was designed to provide estimates of a large number of indicators on the situation of women and children at the national level and for urban and rural areas. The 2004 General Population Census was used as the basic frame for selecting the survey sample2. The selection process was prepared in two stages in each region; the first stage entailed the selection of 200 clusters as enumeration areas using the probability proportion to size (pps) sampling technique. In the second stage, a systematic sample of the primary sampling units (households) were selected. The Yemen MICS3 sample is a stratified weighted sample. A more detailed description of the sample design can be found in Appendix A. Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members, the household, and the dwelling; 2) a women’s questionnaire administered in each household to all ever-married women age 15-49 years; and 3) an under-5 questionnaire, administered to mothers or caretakers of all children under 5 living in the household. The questionnaires included the following modules: Household Questionnaire: • Household listing • Education • Water and Sanitation • Housing characteristics • Child labor • Child discipline • Disability Women’s Questionnaire: • Information panel • Marriage • Child mortality • Birth history • Tetanus Toxid • Maternal and newborn health • Contraception and unmet need • HIV and AIDS Under-Five Questionnaire: • Birth registration and early education • Child development • Care for illness • Immunization 2 The residents of the Yemeni islands and the nomadic population are excluded from the survey coverage. 21 The questionnaires are based on the MICS3 model questionnaire3. From the MICS3 model Arabic version, the questionnaires were pre-tested and based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Yemen MICS questionnaires is provided in Appendix F. Training and Fieldwork Training for the fieldwork was conducted for 2 weeks in August 2006. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. The data were collected by 16 teams; each team was comprised of 4 female interviewers, one driver, one male editor and a male supervisor. Fieldwork took place over one month in September 2006. Data Processing Data were entered using the CSPro software. The data was carried out by 11 data entry operators and 1 data entry supervisor. In order to ensure quality control, and internal consistency checks were performed. Procedures and standard programs developed under the global MICS3 project and adapted to the Yemen questionnaire were used throughout. Data processing began after data collection had been conducted in Octave 2006 and was completed in December 2006. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 14, and the model syntax and tabulation plans developed by UNICEF this purpose. 3 The model MICS3 questionnaire can be found at www.childinfo.org, or in UNICEF, 2006. 22 8 6 4 2 0 2 4 6 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+ Percent Males Females III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 3979 households selected for the sample, 3972 were found to be occupied. Of these, 3586 were successfully interviewed for a household response rate of 90.3 percent. In the interviewed households, 3912 ever-married women (age 15-49) were identified. Of these, 3742 were successfully interviewed, yielding a response rate of 95.7 percent. In addition, 3918 children under age five were listed in the household questionnaire. Questionnaires were completed for 3783 of these children, which corresponds to a response rate of 96.6 percent. Overall response rates of 86.4 and 87.2 are calculated for the women’s and under-5’s interviews respectively (Table HH.1). Response rates were similar across urban and rural areas. Characteristics of Households The age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 3586 households successfully interviewed in the survey, 26,088 household members were listed. Of these, 12,951 (49.6 percent) were males, and 13,137 (50.4 percent) were females. These figures indicate that the average household size is 7.3. Table HH.2 indicates that Yemen is characterised by a young population with high fertility; 15 percent of the population is under 5 years of age, 44.4 percent is under 15 years of age and over half of the population is under 18 (52.2 percent). The potentially economically active population age 15-64 makes up 52.3 percent of the population and just 3.1 percent of the population is 65 years or older. Due to the large under-15 population, the dependency ratio is extremely high with 9 dependents for every 10 persons age 15-64. Figure HH.1: Age and Sex Distribution of Household Population, Yemen, 2006 Table HH.3 provides basic background information on the households. Within households, the sex of the household head, urban/rural status and number of household members. These 23 background characteristics are also used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households where at least one child under 18, at least one child under 5, and at least one eligible woman age 15-49 were found. The figures in table HH.3 indicate that just over nine out of every ten Yemen households are headed by a male household member; female headed households accounted for just 8.7 of all households in the survey. The table also shows that slightly more than two thirds of households in Yemen can be found in rural areas (68.4 percent). Yemen households are typically large with almost a quarter of all households containing 6-7 members (24.4 percent) and over a fifth of households containing 10 or more members (22.8). Just one third of households in Yemen (33.3. percent) contain 5 member or less. In almost nine out of every ten households (87.9 percent) there is at least one child age less than 18 years old and in 62.4 percent of households there is at least one child age less than 5. Also in almost nine out of every ten households (87.3 percent) there lives at least one woman of reproductive age (15-49). Characteristics of Respondents Tables HH.4 and HH.5 provide information on the background characteristics of ever-married female respondents 15-49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of ever-married female respondents 15-49 years of age. The table includes information on the distribution of women according to urban-rural residence, age, marital status, motherhood status, education4 and wealth index quintiles5. Approximately one third of ever-married women in Yemen reside in urban areas and two thirds reside in the rural areas (31.3 and 68.7 percent respectively). One in ten in ever-married women were found in the oldest age group 45-49 (10.8 percent); due to population growth the proportion of women found in each successive younger age group increases and peaks at 25-29 (21.8 percent) before falling to 18.6 percent for women age 20-24 and 8.5 percent for women age 15-19. 4 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 5 Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each household asset, and obtain wealth scores for each household in the sample (The assets used in these calculations were as follows: Electricity, A radio, A television, A mobile telephone, A non-mobile telephone, A refrigerator, a satellite dish, A bicycle, A motorcycle or scooter, An animal-drawn cart, A car or truck, A boat with a motor, agricultural land, a workshop/factory, real estate/land, and a shop orcompany. Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels, and the wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 2001. 24 The reason for the small proportion of women in the youngest age group may be due to the number of women age 15-19 who are not married. The majority of the ever-married sample was currently married; just 6.1 percent of women reported that they were formerly married but are not married now. Nine out of every ten women had given birth. Two thirds of the women had never received any form of formal or non standard education (66 percent). Of the remaining women who had attended school at some point in their lives, a quarter had attended just basic (primary) education and just nine percent had received secondary or higher education. Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by several attributes: sex, area of residence, age in months, mother’s or caretaker’s education and wealth. As to be expected, the proportion of male and female children under the age of five is approximately equal (50.9 percent female and 49.1 percent male). Just less than three quarters of these children reside in rural areas (73 percent) and one quarter reside in households in urban areas (27 percent). When disaggregated by single year age, the largest proportion of children were age 0-11 months (22.5 percent) however the proportion of children in each yearly age group is approximately equal at around 20 percent in each year. Slightly fewer children were observed in the age group 48-59 months (18.3) percent. Almost two thirds of children less than five years of age have mothers or primary caretakers who have received no formal or non standard education6 (65.6 percent). One quarter of children have mothers or primary caretakers who have received only basic education and just 8.4 percent of mothers or caretakers are educated to secondary level or higher. Children less than 5 years of age are more likely to be living in poorer households. As the wealth of the households increase the proportion of children living in these households decreased; 23.2 percent of children were living in the poorest households and 15.8 percent were living in the richest. 6 Non standard curriculum includes courses primarily run by non governmental organisations such as literacy classes and may include education that has been received overseas. 25 IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction of under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. The mortality rates presented in this chapter are computed from information gathered from the birth history of the Women’s Questionnaire. Women in the age-group 15-49 were asked whether they had ever given birth, and if they had, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died. In addition, they were asked to provide a detailed birth history of their children in chronological order starting with the first child. Woman were asked whether a birth was single or multiple; the sex of the child; the date of birth (month and year); survival status; age of the child on the date of the interview if alive; and if not alive; the age at death of each live birth. Since the primary causes of childhood mortality change as children age, mostly biological factors to environmental factors, childhood mortality rates are expressed by age categories and are customarily defined as follows; • Neonatal mortality (NN): the probability of dying within the first month of life • Postneonatal mortality (PNN): the difference between infant and neonatal mortality • Infant mortality (1q0): the probability of dying between birth and the first birthday • Child mortality (4q1): the probability of dying between exact ages one and five • Under-five mortality (5q0): the probability of dying between birth and the fifth birthday The rates of childhood mortality are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age one. Levels and Trends in Infant and Child Mortality Table CM.1 presents neonatal, post neonatal, infant, child and under-five mortality rates for the three recent five year periods before the survey while CM.2 provides estimates of child mortality by various background characteristics. Neonatal mortality in the most recent period is 37 per 1000 live births. This rate is slightly higher than post neonatal deaths (31 per 1000 live births) during the same period; that is, the risk of dying for a child in the first month of life is slightly greater but approximately similar as in the remaining 11 months of the first year of life. Thus just over 50 percent of infant deaths in Yemen occur during the first month of life. The infant mortality rate in the five years preceding the survey is 69 per 1,000 live births and under-five mortality is 78 deaths per 1,000 live births for the same period. This means that one in every 15 Yemeni children dies before reaching age one, while one in every 13 does not survive to the fifth birthday. Male children experience slightly higher probabilities of dying than females. Both infant and under-5 mortality rates are higher for children coming from rural areas compared to their urban counterparts; the figures for under-five mortality in rural areas is about 51 percent higher than in urban areas. There are also significant differences in mortality in terms of the women’s socioeconomic status. In particular, the probabilities of dying among children living 26 in the richest households are considerably lower than the national average. Differentials in under-5 mortality rates by background characteristics are shown in Figure CM.1. Figure CM.1: Under 5 Mortality rates by background characteristics, Yemen 2006 57 86 81 75 118 81 76 61 37 78 0 20 40 60 80 100 120 Residence Urban Rural Sex Male Female Wealth Qunitile Poorest Second Middle Fourth Richest Yemen Per 1000 Mortality trends can be examined in two ways: by comparing mortality rates for five year periods preceding a single survey and by comparing mortality estimates obtained from various surveys. However, these comparisons should be interpreted with caution because quality of data, time references and sample coverage varies. In particular, sampling errors associated with mortality estimates are large and should be taken into account when examining trends between surveys. Figure CM.2 compares the trends in under five mortality rates from previous household surveys in Yemen. All surveys indicate a downward trend in mortality. The most recent MICS under five mortality estimate is about 23 percent lower than the PAPFAM 2003 survey estimate (102 per 1000). 27 Figure CM.2: Trends in under-5 mortality rates, Yemen 2006 0 50 100 150 200 250 300 1970 1975 1980 1985 1990 1995 2000 2005 2010 Year MICS 2006 (Direct method) PAPFAM 2003 (Direct method) DHS 1997 (Indirect method) DHS 1997(Direct method) PAPCHILD/DHS 1991-1992 (Indirect method) Per 1,000 live births 28 71.0 62.9 61.2 70.7 75.2 65.1 31.7 28.8 28.9 29.8 32.3 29.6 0 10 20 30 40 50 60 70 80 Ur ba n Ru ral No Ed uc ati on Ba sic Se co nd ary + Ye me n Pe rc en t Within one day Within one hour V. Nutrition Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. Table NU.1 provides the proportion of ever-married women with a birth in the two years preceding the survey who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which includes those who started within one hour). Almost thirty percent (29.6 percent) of ever-married women who had given birth in the 2 years preceding the survey started breastfeeding within one hour of birth and 65.1 percent began to breastfeed within one day. Women living in urban households were slightly more likely to start breastfeeding within an hour of birth compared to their rural counterparts (31.7 percent versus 28.8 percent) and were also more likely than women in rural households to start breastfeeding within one day of birth (71 percent versus 62.9 percent). Women’s educational level appears to have a positive correlation with the early initiation of breastfeeding as shown in figure NU.2. Figure NU.2 Percentage of mothers who started breastfeeding within one hour and within one day of birth, Yemen, 2006 29 Vitamin A Supplements Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly's Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under-five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother's stores of vitamin A, which are depleted during pregnancy and lactation. It is recommended that mothers take a Vitamin A supplement within eight weeks of giving birth due to increased Vitamin A requirements during pregnancy and lactation. The percentage of ever-married women who had a birth in the two years preceding the survey and received a high dose vitamin A supplement before the infant was 8 weeks old was 15.9 percent (Table NU.2). This percentage was higher for women living in urban households compared to their rural counterparts (19.4 percent versus 14.7 percent). Women from wealthier households are also more likely to have received vitamin A; just 12.9 percent of women from the poorest household had taken the supplement increasing to 15.9 percent for women in the middle income households and 21.9 percent for women residing in the richest households. Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, 30 diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births (for example in Yemen and as will be discussed in chapter IX only 23.5 percent of births are delivered in a health facility). Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth7 . However, this adjustment and calculation method has to be used with caution in settings where the proportion of infants weighed at birth is very small. As mentioned earlier, infants weighed at birth are a biased sample of all births and this bias becomes stronger the smaller the percentage weighed at birth. Therefore, this procedure should be used with caution for countries with very few infants weighed at birth. Unfortunately Yemen is an example of this and it is not possible from the data to calculate low birth weight prevalence. As Table NU.3 shows, only 7.8 percent of infants born in the two years before the survey were weighed at bir3th. Infants born to women living in urban areas were considerably more likely to be weighed than those in rural areas (19.5 versus 3.6 percent respectively) as were infants born to mothers with higher socioeconomic status. It is interesting to note that even among those few infants that were weighed at birth approximately 27 percent weighed less than 2.5Kg (it should be emphasized once again however that this cannot be taken as a national estimate for low birth weight, but does provide some indication of the extent of the problem). Table NU.3 also indicates that under half of all women who gave birth in the two years preceding the survey estimated that their child was of average size (43.5 percent). Of the remaining infants women were more likely to report that their child was ‘smaller than average’ or ‘very small’ compared to above average. Almost a quarter of women reported that their child was ‘very small’ at birth, in particular women from the poorest households were likely to report that their baby was very small (32.8 percent) compared to women living in the richest households (16 percent). 7 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. 31 VI. Child Health Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. In Yemen, prior to March 2005, DPT was administered as a separate vaccination; since March 2005 the Pentavalent8 vaccination was introduced. The table on the right provides the current vaccination schedule in Yemen. The survey however was conducted just 6 months after the Pentavalent vaccine was introduced and therefore some children would still have received the single doses of DPT. The coverage for each vaccination is shown separately in the tables. The Mothers/caretakers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Overall, 48.3 percent of children had health cards (Table CH.2). If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times. The percentage of children age 12 to 23 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children age 12-23 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. Approximately 67.2 percent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 76.9 percent. The percentage declines for subsequent doses of DPT to 59.7 percent for the second dose, and 28.5 percent for the third dose 8 The Pentavalent vaccine is a combined vaccine which protects against diphtheria, tetanus, pertussis, Hepatitis B and Haemophilus Influenzae Type b (Hib). Vaccination schedule for children less than 24 month in Yemen Vaccination Required age given to child BCG At birth Polio 0 At birth Polio 1 1.5 months Polio 2 2.5 months Polio 3 3.5 months Pentavalent 1 1.5 months Pentavalent 2 2.5 months Pentavalent 3 3.5 months Measles 1 9 months Measles 2 18 months 32 (Figure CH.1). Similarly, 78.9 percent of children received Polio 1 by age 12 months and this declines to 60.2 percent by the third dose. The coverage for measles vaccine by 12 months is lower than for the other vaccines at 59.2 percent; although 65.1 percent of children received the vaccine, only 59.2 percent received it by their first birthday. The percentage of children who had all the recommended vaccinations by their first birthday is low at only 17.9 percent. Just over one in every ten children had not received any of the vaccinations by 23 months (11.6 percent). Figure CH.1 Percentage of children age 12-23 months who received the recommended vaccinations by 12 months, Yemen, 2006 67.2 76.9 70.1 59.7 78.9 72.3 60.2 59.2 17.9 0 10 20 30 40 50 60 70 80 90 BCG DPT1 DPT2 DPT3 Polio1Polio2Polio3 Measles All Pe rc en t In Yemen, Hepatitis B and Haemophilus Influenzae Type b (Hib) are also recommended as part of the immunization schedule and are 2 of the antigens included in the Pentavalent vaccine. Prior to March 2005 the Hepatitis B vaccine was administered as a single vaccine. Table CH.1c reveals that one quarter of children (25.5 percent) had received the first Hepatitis B vaccine by 12 months of age, this proportion fell slightly for subsequent vaccines to 23.4 percent for HepB2 and 18.6 percent for HepB3. Tables CH.2 and CH.2c show vaccination coverage rates among children 12-23 months by background characteristics. The figures reflect children that have received the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. From the table it is evident that there are no notable differences between the percentages of male and female with respect to receiving any of the vaccinations. However where the child lives, the education of the mother or caretaker and the wealth of the household appears to have a strong association with the risk of being vaccinated. Children living in urban households were more likely to have received each of the vaccinations compared to children living in rural households; for example 89.6 percent of children in urban areas received the BCG vaccination compared to 60.5 percent of their rural counterparts. Children born to mothers or caretakers who had received even just basic education were still more likely to receive each of the vaccinations compared to children with mothers who had never received any education. The differentials among the wealth quintiles however are the most 33 striking; just over half of the children living in the poorest households had received the measles vaccination (52.4) compared to 85.5 percent of children living in the richest households. Almost three quarters of children living in the richest households had received all of the vaccinations (72.5 percent) compared to under one fifth (17.8 percent) of children living in the poorest households. Tetanus Toxoid One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected if the following conditions are met: • Received at least two doses of tetanus toxoid vaccine, the last within the prior 3 years; • Received at least 3 doses, the last within the prior 5 years; • Received at least 4 doses, the last within 10 years; • Received at least 5 doses during lifetime. Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 24 months. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. Thirty-one percent (30.8 percent) of all mothers who had give birth in the last 24 months were protected against tetanus; however protection varied considerably depending on whether the mother lived in an urban or rural household, her age and wealth of her household. Women residing in urban households were more likely to be protected against tetanus compared to their rural counterparts (40.5 percent versus 27.3 percent). Of women coming from the richest households 46.2 percent were protected against tetanus compared to just 22.1 percent of women living in the poorest households. Over half of women with secondary or higher education were protected against tetanus (51.8 percent) compared to just a quarter of women with no education and 36.3 percent of women with basic education. 34 41 27 25 36 52 31 0 10 20 30 40 50 60 Area Urban Rural Mother's Education No education Basic Secondary + Yemen Percent Figure CH.2 Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus Yemen, 2006 Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • (ORT or increased fluids) AND continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 33.5 percent of under five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence was higher in rural areas compared to urban areas (35.2 percent and 29.2 percent respectively). The peak of diarrhoea prevalence occurs in the first year of life (46.6 percent). 35 90 86 86 87 90 87 75 80 85 90 95 100 Urban Rural None Basic Secondary + Country Pe rc en t The Ministry of Health and Population in Yemen recommends that children with diarrhoea be given one or more of the following liquids: good drinking water, rice water, vegetable soup or fruit juice. Table CH.4 shows the percentage of children receiving these various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. Just under one third of children (32.7 percent) received fluids from ORS packets; the highest proportion of children with diarrhoea received good drinking water (73.9 percent) , 31.1 percent received fruit juice, one fifth of children received rice water (21.1 percent) and 10.8 percent received vegetable soup. Almost nine in ten children (86.7 percent) with diarrhoea received one or more of the recommended home treatments, while 13.3 percent received no treatment. As can be seen in figure CH.3, the differentials between the background variables are minimal. Figure CH.3 Percentage of children age 0-59 months with diarrhoea who received oral rehydration treatment, Yemen, 2006 Of the under five children who had diarrhoea in the 2 weeks previous to the survey 59.9 percent drank more than usual while 38.8 percent drank the same or less (Table CH.5). Just over half (50.6 percent) ate somewhat less, same or more (continued feeding), but 47.8 percent ate much less or ate almost none. Given these figures, 30.7 percent children received increased fluids and at the same time continued feeding. Combining the information in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that 47.6 percent of children either received ORT or fluid intake was increased, and at the same time, feeding was continued, as is the recommendation. There are little differences in the home management of diarrhoea by background characteristics sex and urban-rural residence. However mother’s education and socioeconomic wealth display a positive correlation with home management of diarrhoea as presented in figure CH.4. 36 41 50 45 51 54 46 48 56 48 0 10 20 30 40 50 60 Wealth Quintile Poorest Second Middle Fourth Richest Mother's Education No education Primary Secondary + Yemen Percent Figure CH.4 Percentage of children age 0-59 with diarrhoea who received ORT or increased fluids, AND continued feeding Yemen, 2006 Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one- third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest and a blocked nose. The indicators are: • Prevalence of suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia Table CH.6 presents the prevalence of suspected pneumonia and the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, residence, and socioeconomic factors. Over one in ten under-5 children in Yemen had suspected pneumonia in the two weeks prior to the survey; of these children 37.9 percent had received an antibiotic during the two weeks prior to the survey (12.9 percent). The percentage was considerably higher for children living in urban households compared to their rural counterparts (48.6 percent versus 34.4 percent). The table also shows that antibiotic treatment of suspected pneumonia is lower among the poorest households and among children whose mothers/caretakers who have not received any education. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.7A. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 19.6 percent of women reported that they would immediately take their 37 children to a health facility if they were suffering from the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is when the child develops fever (72.5 percent). One quarter of mothers or caretakers (24.7 percent) identified fast breathing and 29.2 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. Mother’s and caretakers living in urban households were almost twice as likely to recognise the two danger signs of pneumonia. Increased household wealth was also positively related to mothers or caretakers being able to recognise the two danger signs of pneumonia. Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Overall, more than a third (36.2 percent) of all households in Yemen are using solid fuels for cooking. Almost all of these households are in rural areas (52.4 percent); use of solid fuels is very low in urban areas (1 percent), but over half of all households in rural areas (52.4 percent) are using solid fuels. Differentials with respect to household wealth and the educational level of the household head are also significant. The findings show that use of solid fuels is very uncommon among households in the two richest wealth quintiles but almost universal in the poorest households (93.7 percent). Solid fuel use alone however is a poor proxy for indoor air pollution, since the concentration of the pollutants is different when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. Unfortunately questions on stoves and fires were excluded from this survey; however the high use of solid fuels particularly in poor households warrants the need for further investigation into the practices of burning solid fuels within the home. 38 VII. Environment Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS are as follows : Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation facilities • Sanitary disposal of child’s faeces The distribution of the population by source of drinking water is shown in Table EN.1 and Figure EN.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, tubewell/borehole, protected well, protected spring, rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as hand-washing and cooking. In Yemen, 58.9 percent of the population is using an improved source of drinking water – 73.8 percent in urban areas and 52.2 percent in rural areas. Use of improved drinking sources varies considerably by the socioeconomic status of the household ranging from 28.2 in the poorest households and rising to 81.7 percent in the richest. 39 Public tap/standpipe 2% Tubewell/borehol e 5% Protected well or spring 9% Rain water 3% Bottled water 8% Unprotected well or spring 22% Tanker truck/cart 11% Surface water 4% Other unimproved 2% Piped into dwelling, yard or plot 34% Figure EN.1 Percentage distribution of household members by source of drinking water, Yemen, 2006 The source of drinking water for the population varies considerable depending if the household is in an urban or rural area (Table EN.1). In urban households, 49 percent of members use drinking water that is piped into their dwelling or into their yard or plot. By contrast, 19.1 percent of household members living in rural areas use piped water; a further 20.1 percent use water from an unprotected well. Over a quarter of the household population living in the two lowest wealth quintiles obtain their water from unprotected wells and 22 percent obtain water from unprotected springs. Use of in-house water treatment is presented in Table EN.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and using solar disinfection were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. The majority of the household population does not use any method to treat drinking water (92.4 percent) and just 4.6 percent of the household population uses an appropriate water treatment method9. The most common methods are boiling the water (3 percent) and straining water through a cloth (2.7 percent). Household members with access to improved water sources are slightly more likely to use an appropriate water treatment method compared to household members obtaining drinking water from unimproved sources (5.2 percent versus 3.8 percent). The urban household population are more likely to treat their drinking water compared to the rural population (7.8 percent versus 3.6 percent); 3.5 percent of the urban population uses a water filter. Household members living in households where the head has received secondary school education are more than twice as likely to use an appropriate water treatment method compared to households where the head has no education (9.6 percent versus 4 percent). 9 Appropriate water treatment method includes boiling water, adding bleach or chlorine, or using a water filter. 40 The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually collected the water in Table EN.4. Note that these results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table EN.3 shows that for 49.3 percent of households, the drinking water source is on the premises. For over a quarter of all households, it takes more than one hour to get to the water source and bring water (26.8 percent), and one in ten households spend 30 minutes to 1 hour for this purpose. Excluding those households with water on the premises, the average time to the source of drinking water is just over one hour at 64 minutes. As to be expected the time spent in rural areas in collecting water is higher than in urban areas (65 minutes versus 45 minutes). The higher the education level of the household head the closer the water source is to the household. Similarly the wealthier the household the less time is spent on water collection; one striking finding however is the high average time spent by those in the richest households in collecting water when water is not available on the premises (66 minutes), however this result should be interpreted with caution due to the small number of rich households in this category without water on premises. Table EN.4 shows that for the majority of households, an adult female is the person collecting the water, when the source of drinking water is not on the premises (68.2 percent). Adult men collect water in only 11.4 percent of cases. For the rest of the households however, female or male children under age 15 collect water (15.9 percent), female children are more likely than male children to perform this task (10.9 percent versus 5 percent). Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit latrine, pit latrine with slab, and composting toilet. As shown in Table EN.5 more than half of the population of Yemen is living in households using improved sanitation facilities (51.7 percent). The population using improved sanitation facilities are those using any of the following: flush/pour flush to a piped sewer system or to somewhere else, a septic tank or a ventilated or unventilated pit latrine with or without a slab. The difference by residence is striking; in urban areas 92.3 of the population is using an improved sanitary means of excreta disposal compared to 33.6 percent in rural areas. In rural areas, the population is mostly using pit latrines without slabs, or people simply have no facilities, whereas the most common facilities in urban areas are pit latrines and a flush/pour flush to a piped sewer system. Residents living in households in which the household head has not received any education are less likely than others to use improved facilities. The table also indicates that use of improved sanitation facilities is strongly correlated with socioeconomic status. Only 3.2 of residents living in the poorest households are using improved sanitation facilities, a staggering three quarters of these residents do not use any facilities at all. An overview of the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.6. Combining these two indicators the table reveals that 36.9 percent of the household population are using both improved sources of drinking water and sanitary means of excreta disposal. The strong correlation between use of improved facilities and the background variables follow the same patterns as described elsewhere in this chapter. For example those living in urban areas are three times as likely to use both improved sources of drinking water and sanitary means of excreta disposal, compared to the household population living in rural areas. Most striking is the gap 41 between the rich and poor when it comes to having access to both types of improved sources; the gap ranges from 1.7 percent for those living in the poorest households to 77.1 percent for those living in the richest. 42 VIII. Fertility Population size may play a critical role in achieving the MDGs. At both the household and national levels, larger families and rapidly growing populations obstruct development and prolong poverty. Children born into large, poor families face increased competition for limited resources, including food, clothing, health and education. At the national level, rapid population growth in poor countries stretches the demand for services, including health care and education, faster than the capacity to satisfy it. Monitoring levels of fertility is one of the three components of population dynamics needed to determine the future size and structure of the population. This chapter presents the Yemen 2006 MICS results on the levels and trends in fertility. The analysis is based on birth history information collected from ever-married women age 15-49 interviewed during the survey. Each eligible woman was asked a series of questions on the number of sons and daughters who were living with her, the number living elsewhere, and the number who had died, in order to obtain the total number of live births she had had in her lifetime. For each live birth, information was also collected on the name sex, age and survival status of the child. For dead children, age at death was recorded. Information from the birth history is then used to assess current levels and trends in fertility. Current Fertility Measures of current fertility are presented in Table FE.1 for the three year period preceding the survey, corresponding to the calendar period 2003-2006. A three-year period was chosen because it reflects the most current information, while also allowing the rates to be calculated on a sufficient number of cases so as not to compromise the statistical precision of the estimates. Two measures of current fertility are shown. Age-specific fertility rates (ASFRs), expressed as the number of births per thousand women in a specified age group, are calculated by dividing the number of live births to women in a specific age group by the number of woman-years lived in that age-group. Although information on fertility was obtained only for ever-married women, the age-specific rates are presented for all women regardless of marital status. Data obtained from the household questionnaire on the age structure of the population of never-married women were used to calculate the all women-rates. This procedure assumes that women who have never been married have had no children. The total fertility rate (TFR) is a useful measure for examining the overall level of fertility. It can be defined as the average number of babies born to a woman during her reproductive years if she were to pass through those years bearing children at the currently observed age-specific fertility rates. Table FE.1 shows the current fertility rates for Yemen as a whole and for urban and rural areas. The total fertility rate for Yemen is estimated at 5.2 births per woman. Such high fertility is a strong indication of the huge population growth that Yemen will experience. Childbearing begins early in Yemen as reflected by the overall age pattern of fertility shown in the ASFRs. Fertility is low among adolescents and increases to a peak of 247 births per 1,000 among woman age 25-29 and declines thereafter (Table FE.1). Fertility rates are higher in rural areas than urban areas; the TFR in rural areas is 6 births per woman, while the TFR in urban areas is 4. The ASFR for women age 15-19 in rural areas is 56 percent higher than for women of the same age in urban areas (Figure FE.1). 43 Figure FE.1: Age-specific Fertility Rates by Urban-Rural Residence, Yemen, 2006 0 50 100 150 200 250 300 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age B ir th s pe r 1, 00 0 w om en Urban Rural Total Fertility Differentials Table FE.2 present differentials in the total fertility rates over the 3 years preceding the survey by urban-rural residence, education and wealth quintiles. Education has been dichotomised into women with no education and women with any education due to the small number of women with secondary or higher education which cannot be presented separately. The total fertility rate for women who have not received any education is slightly higher than the national average at 5.8 births per woman in the most recent 3 year period. Women who have received some level of formal or son standard education experience slightly lower fertility at 4.7 births per woman. In the 3 year period before the survey women in the poorest households were, on average, likely to have twice the number of births than women from the richest households (6.6 births versus 3.4 births per woman). Fertility Trends In addition to estimating levels and patterns of current fertility, retrospective data from birth histories can also be used to assess trends in fertility over time. Table FE.3 compares age-specific fertility for successive three-year periods preceding the survey. The numerators of the rates are classified by three-year segments of time preceding the survey and the mother’s age at the time of survey. Women 50 years and over were not interviewed in the survey, therefore rates for older age groups of women become progressively more truncated for periods more distant from the survey date. Table FE.3 shows an interesting pattern of fertility in Yemen over the last fifteen years. Fertility seems to have peaked during the 6-8 year period preceding the survey. Rates prior to this period appear to be lower in all age groups. Although the results indicate that fertility has declined in the last 6 years, the fertility rates for the most recent period (0-2 years) are higher in every age group compared to rates from 3-5 years ago (other than for women age 15-19). 44 IX. Reproductive Health Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. A World Fit for Children goal is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. Current use of contraception was reported by 27.7 percent of currently married women (Table RH.1); this includes both modern and traditional methods. The use of modern methods, which includes female sterilisation, the pill, IUD, injections and condoms were reported by 19.2 percent of women. Use of traditional methods, which include the lactational amenorrhea method (LAM), periodic abstinence and withdrawal was reported by 8.4 percent of women. The most popular method is the pill which is used by 9 percent of married women in Yemen. The next most popular method is LAM, which accounts for 5.8 percent of married women. Between 2-4 percent of women reported use of the IUD, injectables and female sterilisation. One percent or less reported use of periodic abstinence, withdrawal and the condom. Current use of contraception in urban areas was double the prevalence found in rural areas (42.3 percent versus 21.1 percent). Adolescents are far less likely to use contraception than older women. Only one in ten married women age 15-19 currently use a method of contraception compared to a quarter of 20-24 year olds and 35 percent of married women age 35-39 years. Women’s education level is strongly associated with contraceptive use; the percentage of currently married women using any method of contraception rises from 23.1 percent among those with no education to 34.2 percent among women with primary education, and to 42.1 percent among women with secondary or higher education. Wealth quintiles show a strong association with contraceptive prevalence; the percentage of women using any method of contraception is 14.7 percent in the poorest households increasing to 27.1 percent in the middle income households and 43.7 percent in the richest households. Unmet Need Unmet need10 for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women in unmet need for spacing includes women who are currently married, fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have another child, but want to have the child at least two years later. 10 Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the Demographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenorrhoea, and sexual activity. Results from the two types of surveys are strictly not comparable. 45 Women in unmet need for limiting are those women who are currently married, fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to limit their births. The latter group includes women who are currently pregnant but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have another child. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. Percentage of demand for contraception satisfied is defined as the proportion of currently married women who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. Thirteen percent of currently married women age 15-49 years old have an unmet need for spacing and 10.6 percent have an unmet need for limiting. These two indicators combined reveal that just under a quarter (23.6 percent) of currently married women in Yemen report an unmet need for contraception. Unmet need is higher for women living in rural areas compared to urban areas (28 percent versus 13.8 percent) and for women living in poorer households compared to their richer counterparts. The table also shows that as education of the women increases their need for contraception is more likely to be satisfied. Over 54 percent of currently married women reported that their demand for contraception was is satisfied. Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother's health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women's nutritional status and prevent infections (e.g., malaria and STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: • Blood pressure measurement • Urine testing for bateriuria and proteinuria • Blood testing to detect syphilis and severe anemia • Weight/height measurement (optional) 46 Coverage of antenatal care (by a doctor, nurse or midwife) is relatively low in Yemen with 47 percent of women receiving antenatal care at least once during the pregnancy. Women living in urban areas are considerably more likely to receive antenatal care than their rural counterparts (68.2 percent versus 39.3 percent). The lowest level of antenatal care is found among older women age 45-49 (24.9 percent) but is relatively equal among women in all other age groups (ranging from 41.9 to 50 percent). Antenatal care coverage is some 47 percent more in the richest households compared to the poorest ones. The type of personnel providing antenatal care to women age 15-49 years who gave birth in the two years preceding is presented in Table RH.3. While over half of the women who gave birth in the previous 2 years did not receive any antenatal care, those that did were most likely to see a medical doctor for their antenatal care (39.5 percent); just 4.6 percent of women saw a nurse and 2.8 percent were seen by midwife. This pattern does not vary among the background variables. The types of services pregnant women received as part of their antenatal care are shown in table RH.4. Thirty-seven percent of women reported that they were given a blood test, 40.4 percent reported that their blood pressure was measured, 34 percent had a urine specimen taken and 26.8 percent were weighed. Women living in urban areas were more likely to receive all of the aforementioned services compared to women living in rural areas indicating the differences in the quality of antenatal care services between urban and rural settings. The table also reveals a positive relationship between women’s educational level and the chance of receiving the recommended antenatal care services. Also, perhaps to be expected, the higher the socioeconomic status of the household from which the women lives in the more likely she will receive all of the specific antenatal care services. Assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse or midwife. Only 35.7 percent of births occurring in the 2 years prior to the MICS survey were delivered by skilled health personnel (Table RH.5). The percentage ranges from 26.3 percent in rural areas to 61.7 percent in urban areas. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled attendant. Births delivered by skilled attendants occurred mainly among women in urban areas and to women living in households in the two richest wealth quintiles. One fifth of the births (20.9 percent) in the 2 years prior to the MICS survey were delivered with assistance by a medical doctor. Midwifes assisted with the delivery of 8.8 percent of births and nurses assisted with 6 percent. A traditional birth attendant delivered 8 percent of all births. Alarmingly half of all women who gave birth in the two years preceding the survey were assisted at delivery by a relative or friend. 47 A little under a quarter of births (23.5 percent) were delivered in a health facility. Household wealth is positively associated with the likelihood of giving birth in a health facility; only 8.7 percent of pregnant women from the poorest households delivered in a health facility compared to 51 percent of pregnant women from the richest households. 48 X. Child Development It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, presence of books in the home, for the child, and the conditions of care are important indicators of quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. For just one quarter of under-five children (25.5 percent), an adult engage in more than four activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.1). The average number of activities that adults engage with children was 2.5. The table also indicates that the father’s involvement in such activities was somewhat limited. Father’s involvement with one or more activities was only 32.2 percent. Only 7.8 percent of children were living in a household without their fathers. There are no gender differentials in terms of adult activities with children; however, a larger proportion of fathers engage in activities with male children (34.1 percent) than with female children (30.2 percent). Larger proportions of adults engage in learning and school readiness activities with children in urban areas (38.5 percent) than in rural areas (20.7 percent). Strong differentials by mother’s and father’s education and socio-economic status are also observed: Just under half of mothers with secondary or higher education engage in activities with children (46 percent) compared to 19.3 percent of mother’s with no education at all. Adult engagement in activities with children was greatest in the richest households (44.6 percent), as opposed to those living in the poorest households (13.5 percent). Father’s involvement showed a similar pattern in terms of adults’ engagement in such activities. Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. In Yemen, 58.6 percent of children are living in households where at least 3 non-children’s books are present (Table CD.2). However, only one in ten children age 0-59 months are living in households that have children’s books (10.3 percent). While no gender or age differentials are observed, urban children appear to have considerably more access to both types of books than those living in rural households. The proportion of under-5 children who have 3 or more non- children’s books is 73.1 percent in urban areas, compared to 57.7 percent in rural areas. A fifth of under-5 children living in urban areas live in households with more than 3 children’s books (21.3 percent), while the figure is 6.3 percent in rural households. The presence of both non-children’s and children’s books is positively correlated with the education of the mother and household wealth. 49 Table CD.2 also shows that 18 percent of children age 0-59 months had 3 or more playthings to play with in their homes, while just under one fifth of children (19.2 percent) had none of the playthings asked to the mothers/caretakers (Table CD.2). The playthings in MICS included household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that 49.2 percent of children play with objects and materials found outside the home and 44.3 percent play with toys that came from a store and 43.1 percent play with household objects. The proportion of children who have 3 or more playthings to play with is 19.4 percent among male children and 16.5 percent among female children. Small urban-rural differentials are also observed in this respect. Larger differences are observed in terms of mother’s education – 28 percent of children whose mother’s are educated to secondary or higher level have 3 or more playthings, while the proportion is 16.4 percent for children whose mother’s have only basic education. Differentials also exist by socioeconomic status of the household; just one in ten children living in the poorest households have 3 or more playthings but this is more than double for children living in the richest households (23.5 percent). The age of the child also has a strong correlation with the number of playthings children have available to them, a somewhat expected result. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, two questions were asked to find out whether children age 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows that 30.7 percent of children age 0-59 months were left in the care of other children, while a tenth of children were left alone during the week preceding the interview (9.8 percent). Combining the two care indicators, it is calculated that 34.1 percent of children were left with inadequate care during the week preceding the survey. Only small differences were observed by the sex of the child, however if a child resides in an urban or rural household strongly affects the risk of he or she being left with inadequate care. In rural areas 35.2 percent of children were left in the care of other children and 11.8 percent were left alone, this compares to 18.6 percent and 4.6 percent in urban areas respectively. Inadequate care was more prevalent among children whose mothers have not received any education (37.6 percent), as opposed to children whose mothers had received secondary or higher education (21.9 percent). Children aged 24-59 months were more likely to be left in inadequate care than those children age 0-23 months (37.5 percent versus 29.4 percent). There is a negative association between inadequate care and wealth of the household; in the two poorest wealth quintiles at least 40 percent of children were left with inadequate care compared to less than 30 percent in the middle, fourth and richest households. 50 XI. Education Pre-School Attendance and School Readiness Attendance to pre-school education in an organized learning or child education program is important for the readiness of children to school. One of the World Fit for Children goals is the promotion of early childhood education. Only 2.6 percent of children age 36-59 months are attending pre-school (Table ED.1). The figure rises to 5.3 percent in urban areas, compared to 1.6 percent in rural areas. No gender differential exists, but differentials by socioeconomic status are evident. Of children living in the richest households 8.4 percent attend pre-school, while no children living in the poorest households were reported to be attending pre-school. School Participation Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. The indicators for school attendance included in this report include: • Net intake rate in primary education (basic education) • Net primary school attendance rate (basic education) • Net secondary school attendance rate • Net basic education school attendance rate of children of secondary school age • Female to male education ratio (or gender parity index - GPI) The indicators of school progression include: • Survival rate to grade five • Transition rate to secondary school • Net basic education completion rate The education indicators presented in this chapter are based on the basic education system in Yemen; under this school system children are required to attend level one and two of basic education from 6 to 14 years old which covers grades 1 to 9. Secondary education is from 15 to 17 years and covers grades 10-12. The ages at which children attend school under the basic education system is different from the primary and secondary school age ranges which follow the UNESCO International Standard Classification of Education (ISCED). Tables presenting indicators based on primary and secondary school age ranges following the ISCED classification can be found after the basic education tables in the table section of this report. The Yemen MICS was conducted at the end of the academic school year in which many children would have turned one year older than at the start of the school year. During the data analyses Yemen Education System UNESCO ISCED System Grades Age (yrs) Grades Age(yrs) Basic Education Primary Education 1 - 9 6 – 14 1 -6 6 – 11 Secondary Education Secondary Education 10 - 12 15 – 17 7 – 12 12-17 51 children were rejuvenated by one year so that children whose ages at the time of survey would no longer fall in the age range for the different educational levels would still be included in the respective net attendance ratios. Of Yemeni children who are of school entry age (age 6), 39.7 percent are attending the first grade (ED.2). Sex differentials are small; 41.7 percent of 6 year old boys are attending the first grade of school compared to 37.5 percent of 6 year old girls. Larger differentials are evident by urban- rural residence; in urban areas the value of the indicator reaches 50.8 percent, while it is 35.7 percent in rural areas. A positive correlation with mother’s education and socioeconomic status is observed; for children age 6 whose mothers have at least basic school education, 54.1 percent were attending the first grade compared to 33.9 percent of children whose mothers have received no education. In rich households, the proportion is 51.7 percent, while it is 25.5 percent among children living in the poorest households. Table ED.3 provides the percentage of children of school age (6 to 14 years) that are attending school. Over two thirds of children are attending school (68.4 percent) which means that 31.6 percent of the children are out of school when they are expected to be participating in school. Male children of basic education age are more likely to be attending school than their female counterparts (76.1 percent versus 60.6 percent). Wider differentials exist between urban-rural residence, levels of mother’s education and socioeconomic status; the indicator is as high as 90.5 percent for children whose mothers who have attended secondary school compared to 64.7 percent for children whose mother’s do not have any education. Figure ED.1 presents the proportion of children in school by age; from the ages of 6 to 10 the percentage of children attending school increases however after the age of 10 the proportion of children in school begins to fall. Figure ED.2 Percent distribution of children attending school by age, Yemen, 2006 45 69 82 85 87 88 86 76 73 40 58 72 70 77 74 65 56 41 0 10 20 30 40 50 60 70 80 90 100 6 7 8 9 10 11 12 13 14 Age Pe rc en t Male Female The secondary net attendance ratio is presented in Table ED.4. More dramatic than for children in the age range for basic education, where 32 percent of the children are not attending school at all, is the fact that only 23.9 percent of children age 15 to 17 years are attending secondary school. Girls in particular are less likely to attend secondary school compared to boys (18.1 percent verses 29.9 percent). Urban-rural residence also appears to be a significant factor in whether 15 to 52 17 year olds attend secondary school; in rural areas only 17.1 percent of children are attending falling to 8.4 percent for females living in rural areas. However it is interesting to note that in urban areas a slightly higher proportion of girls were found to be attending secondary school compared to boys (38.9 percent versus 36.3) indicating no comparative advantage for boys in urban areas. The differentials among mother’s education and socioeconomic wealth reveal a strong positive correlation with secondary school attendance. The net attendance ratio of children age 15-17 attending basic education is presented in Table ED.4w. Just under a quarter (23.5 percent) of 15-17 year olds are attending basic education when they should be attending secondary school. The remaining 52.6 percent of 15-17 year olds are not attending school at all, they are children out of school since we already indicated that 23.9 percent of them were attending upper secondary education. The differentials between urban- rural residence, mother’s education and socioeconomic status when it comes to older children attending basic education are not large. However the majority of 15 to 17 years old attending basic education are 15 (34.1 percent); the proportion of 16 and 17 year olds attending basic education are 23.8 percent and 14 percent respectively. The percentage of children entering first grade of basic education who eventually reach grade 5 is presented in Table ED.5. This MDG indicator is calculated using data by grade for two consecutive years in a procedure called the reconstructed cohort method. The method makes 3 assumptions: drop outs never return to school; promotion, repetition and dropout rates remain constant over the entire period in which the cohort is enrolled in school; and the same rates apply to all pupils enrolled in a given grade, regardless of whether they previously repeated a grade. As the table shows of all children starting grade one, over three quarters of them (78.9 percent) will eventually reach grade five. The ability to retain students is higher in urban areas than rural areas: in urban areas 91.1 percent of children will reach grade 5 compared to 73.1 percent of children attending school in rural areas. Children from richer households are also more likely to reach grade 5 compared to children from poorer households. The net school completion rate (grade 9) and transition rate to upper secondary education is presented in Table ED.6. At the moment of the survey, only 18.4 percent of the children of basic education school completion age (14 years) were attending the last grade (grade 9). This value should be distinguished from the gross completion ratio which includes children of any age attending the last grade of basic education. Over a third of 14 year olds from the richest households (37.3 percent) were attending the last grade of basic education compared to just 7.4 percent of 14 year olds living in the poorest households. A little under two thirds of the children (65.8 percent) that successfully completed the last grade of the second stage of the basic education system were found at the moment the survey to be attending the first grade of secondary school. A positive correlation between socioeconomic status and transition to secondary school is observed; however due to the overall small number of children transitioning to upper secondary school these figures should be used with caution. The ratio of girls to boys attending basic education or secondary school is provided in Table ED.7. These ratios are better known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios; the latter ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-age children attending early basic education tend to be boys. The table shows that gender parity for basic education is 0.80, indicating that for every 10 boys attending, there are 8 girls. The gender parity drops to 0.60 for secondary school. The disadvantage of girls is particularly pronounced in rural areas, as well as among children living in the poorest households; in rural areas there are 7 girls for every 10 boys in basic education and this falls to 5 girls for every 10 boys among those children living in the poorest households. The only instance 53 when girls appear to be at a slight advantage over boys is for secondary school attendance in urban areas (GPI 1.07). Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was administered, the results are based only on ever-married females age 15-2411. Literacy was assessed on the ability of women to read a short simple statement or was based on school attendance at secondary or higher levels. The percent literate is presented in Table ED.8. Slightly over one third of ever-married women (35.2 percent) in Yemen are literate. The percentage of literate women in living in urban households is more than double the percentage for women living in rural households (59 percent versus 26.3 percent). A strong correlation can also be observed between socioeconomic wealth and literacy. The literacy rates for ever-married women age 15-19 and for ever-married women age 20-24 were the same. An interesting finding was that for women who had received basic education only 59.4 percent could actually read, perhaps reflecting the quality and length of the basic education they had received. 11 The MDG indicator measures ‘all’ women age 15-24 therefore this indicator cannot be calculated from the Yemen ever-married women sample. 54 XII. Child Protection Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. The births of just 22.3 percent of children under five years of age in Yemen have been registered (Table CP.1). There is no variation in birth registration between male and female children. Children living in the rural households however are less likely to have their births registered than children living in rural areas (16.4 percent versus 38.2 percent). There is a positive correlation between the education of the mother/caretaker and birth registration, only 15.8 percent of mothers or caretakers with no education, registered the birth or their child compared to 41.4 of mothers or caretakers with secondary or higher education. Children born into wealthier households are also more likely to have their births registered; birth registration took place in only 5 percent of the poorest households compared to 50.4 percent in the richest households. Mothers and caretakers were asked to provide the reasons why the births of their children were not registered (Table CP.1). Just under half of the mothers or caretakers reported that they didn’t know the birth had to be registered (47.9 percent). The second most common reason cited was that they didn’t want to have to travel so far (17.6 percent); this reason was more common in the rural areas (20.8 percent) than urban areas (6 percent). Child Labour Article 32 of the Convention on the Rights of the Child states: "States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development." The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions were asked to measure the level and type of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: • Ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. • Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiation between child labour and child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained 55 above. Table CP.2 presents the results of child labour by the type of work. Percentages do not add up to the total child labour as children may be involved in more than one type of work. It was reported that just over one fifth of children age 5 to 14 were involved in a form child labour (22.7 percent). There was no large variation between male and female children; female children however were much more likely to be engage in conducting household chores for more than 28 hours a week compared to their male counterparts (14.1 percent versus 7.5 percent). A third of children age 12-14 were involved in a form of child labour (33.1 percent) compared to 18.6 percent of children age 5-11 years. Children living in rural households are considerably more likely to be involved in child labour compared to children living in urban households (28.6 percent verses 8.1 percent). The proportion of children living in poorer households and who were engage in child labour was also significantly higher than children living in wealthier households. Table CP.3 presents the percentage of children classified as student labourers or as labourer students. Student labourers are the children attending school that were involved in child labour activities at the moment of the survey; of the 58.5 percent of children 5-14 years of age attending school, 23.4 percent are also involved in child labour activities. While there is no difference between male and female children, children attending school from urban areas are less likely to be participating in child labour compared to their rural counterpart (8.5 percent versus 31.2 percent). Labourer students are the children who are involved in child labour activities but were also attending school at the time of the survey; out of the 22.7 percent of the children classified as child labourers, 60.2 percent of them are also attending school. Male children that are involved in child labour activities are more likely than female children, also involved in labour activities, to be attending school (69.8 percent versus 51.6 percent). Children from urban areas that participate in child labour also appear to have a greater chance to be attending school compared to children working in rural areas (74.2 percent versus 58.6 percent). For children that participate in child labour the opportunity to also be attending school is positively correlated with mother’s education and socioeconomic status. Child Discipline As stated in A World Fit for Children, “children must be protected against any acts of violence …” and the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the Yemen MICS survey, mothers/caretakers of children age 2-14 years were asked a series of questions on the ways parents tend to use to discipline their children when they misbehave. Note that for the child discipline module, one child age 2-14 per household was selected randomly during fieldwork. Out of these questions, the two indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of parents/caretakers of children 2-14 years of age that believe that in order to raise their children properly, they need to physically punish them. In Yemen, proportion of children age 2-14 subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household member is extremely high at 94 percent. Alarmingly, 4 out of every 10 children age 2-14 years (41.2 percent) were subjected to severe physical punishment and 8 out of 10 (82.8 percent) were subjected to minor physical punishment. The proportion of children experiencing minor physical punishment was higher than the proportion of mothers/caretakers that believe that children should be physically punished (43.9 percent), which perhaps suggests that other household members are inflicting such punishment on children. 56 Male children were subjected more to both minor and severe physical discipline than female children (84 and 44.2 percent for boys versus 81.6 and 38.2 percent for girls). It is interesting to note that only small differences exist among the other background variables such as the age of child, mother’s education and household wealth. A staggering 91.7 percent of children were subjected to psychological punishment; this did not vary across the background variables. Early Marriage According to UNICEF's worldwide estimates, over 60 million women age 20-24 were married/in union before the age of 18. Factors that influence child marriage rates include: the state of the country's civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. The right to 'free and full' consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be 'free and full' when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in article 16, which states: "The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices - and is frequently addressed by the Committee on the Rights of the Child. Currently in Yemen, there is no legal minimum age for marriage; the law only stipulates that girls should not marry unless they have reached sexual maturity, yet even then there is no punishment for those families who allow their daughters to marry before this time. Research suggests that many factors interact to place a child at risk of marriage. Poverty and financial burden are factors which push families to get rid of their daughters’ burden at early ages. Traditional values add to the belief that early marriage will protect girls from deviation and consequently will protect the family honour. Very often in Yemen it is the fathers, elder brothers and other male patrons who make the marriage decisions without the girl’s consent. Evidence shows that women who are married at younger ages are more likely to believe that it is sometimes acceptable for a husband to beat his wife and are more likely to experience domestic violence themselves. The age gap between partners is thought to contribute to these abusive power dynamics and to increase the risk of untimely widowhood. Recently in Yemen the phenomenon of ‘tourist marriage’ has also emerged whereby gulf tourists come to Yemen, usually for the summer months and marry much younger girls for large dowries. After the summer the tourists return to their countries in many cases leaving children behind without fathers. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to 57 marry older men which puts them at increased risk of HIV infection. Men often seek younger women as wives as a means to avoid choosing a wife who might already be infected. The demand for this young wife to reproduce and the power imbalance resulting from the age differential leads to very low condom use among such couples. The percentage of women married at various ages is provided in Table CP.5. The table shows that 14 percent of women aged 15-49 married before age 15, 32 percent of women aged 20-24 married before age 18. These proportions seem to be declining rapidly during the last 3-4 decades. Nineteen (19) percent of women aged 15-19 are currently married. Differentials seem meaningful, particularly by wealth and education and slightly less so by urban-rural, although still significant for marriage before age 18. Another component is the spousal age difference with an indicator being the percentage of married women with a difference of 10 or more years younger than their current spouse. Table CP.6 presents the results of the age difference between husbands and wives. Among currently married women age 15-19 years, 15.8 percent are married to men who are at least 10 years older than them. Among currently married women age 20-24 years, 17.9 percent have husbands who are 10 or more years older. Women living in urban households are more likely to be in marriages with a large spousal age difference; 23.1 percent of currently married women age 20-24 from urban areas are married to spouses who are at least ten years older compared to 15.9 percent of women living in rural areas. The correlation between large spousal age gaps and the women’s educational level is unclear, however from the data is would appear that women with basic education are more likely to have husbands who are at least ten years older compared to women who either have no education at all or have secondary or higher education. Child Disability One of the World Fit for Children goals is to protect children against abuse, exploitation, and violence, including the elimination of discrimination against children with disabilities. For children age 2 through 9 years, a series of questions were asked to assess a number of disabilities/impairments, such as sight impairment, deafness, and difficulties with speech. This approach rests in the concept of functional disability developed by WHO and aims to identify the implications of any impairment or disability for the development of the child (e.g. health, nutrition, education, etc.). It should be noted that the mothers/caretakers reports of disability are not verified by a clinical diagnosis therefore the percentages presented here can only be taken as a proxy of disability within the country. It was reported that a quarter (24.5 percent) of children age 2-9 years had at least one disability (Table CP.7). The disability most commonly reported was delay in sitting, standing or walking (9.3 percent) followed by being unable to understand instructions (6 percent) and unable to be understood (6 percent). There were no major differences found between children living in urban or rural households. Mother’s or caretakers in poorer households reported higher levels of child disability. In the poorest households it was estimated that 29.4 percent of children had at least one disability compared to less than 20 percent in the two richest wealth quintiles. Among children age 3-9 it was reported that 7.4 percent did not have normal speech with little variation among the background variables. A quarter of mother or caretakers with a 2 year old reported that their child cannot name at least one object. Children’s Living Arrangements Children who are orphaned may be at increased risk of neglect or exploitation if the parents are not available to assist them. The frequency of children (0 to 17 years) living with neither parent, 58 mother only or father only is presented in Table CP.8. The table reveals that the majority of children in Yemen are living with both biological parents (85.8 percent); a very small number of children are living in households with neither of their biological parents (1.7 percent). Five percent of Yemeni children have lost either one or both of their biological parents. The definition of orphans in Yemen however, only takes into account children that have lost their biological father which was the case for 2.9 percent of children. Children living in households that had lost both biological parents (double orphans) was reported for 0.2 percent of children, however according to the 2006 National Report on Children in Yemen, it is believed that a great many more double orphans are living in government and private institutions. 59 XIII. HIV and AIDS Knowledge of HIV Transmission One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV and AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further transmission of the disease. The HIV module was administered to ever married women 15-49 years of age12. Ever-married women were asked whether they knew of two13 of the main ways of HIV prevention– using a condom and abstaining from sex. The results are presented in Table HA.1. In Yemen, 60.6 percent of the interviewed women have heard of AIDS ranging from 49.8 percent in rural areas to 84.5 percent in urban areas. However, the percentage of women who know both ways of preventing HIV transmission is only 13.7 percent. One fifth of women know of using a condom every time (20.8 percent), and 29 percent know of abstaining from sex as main ways of preventing HIV transmission. While 36.1 percent of women know at least one way, a high proportion of women (63.9 percent) do not know either of the two ways. Table HA.2 presents the percent of ever-married women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Yemen, that HIV can be transmitted by sharing food and mosquito bites. The table also provides information on whether women know that HIV cannot be transmitted by supernatural means and that HIV can be transmitted by sharing needles. Of the interviewed women, 6.9 percent reject the two most common misconceptions and know that a healthy- looking person can be infected. Twenty four percent of women know that HIV cannot be transmitted by sharing food and 27.8 percent of women know that HIV cannot be transmitted by mosquito bites, while 22 percent of women know that a healthy-looking person can be infected. Ever-married women in urban areas are more than 4 times as likely to reject the two most common misconceptions and know that a healthy-looking person can be infected compared to their rural counterparts (14.7 percent versus 3.3 percent). Three quarters of women in urban areas are aware that HIV can be transmitted by sharing needles (75.4 percent) compared to 41.7 percent of women living in rural areas. There is also a positive relationship between household wealth and the ability to reject the two most common misconceptions and know that a healthy- looking person can be infected ranging from 0.7 percent in the poorest households to 4.7 percent in the middle income households to 16.9 percent in the richest households. 12 The MDG indicators on HIV are based on all women which cannot be calculated from the Yemen MICS which was an ever-married sample. 13 The third main way of preventing HIV transmission ‘having only one faithful uninfected partner’ was deemed culturally inappropriate to be asked to women in Yemen. Therefore the MDG indicator 19B and MICS indicator 82 and also comprehensive knowledge indicators cannot be constructed from the survey data. 60 Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of ever-married women who know the 2 ways of preventing HIV transmission that were asked in the survey and reject three common misconceptions. Overall, 1.3 percent of women were found to know both modes of HIV transmission, this was higher in urban areas (2.6 percent) compared to rural (0.7 percent). As expected, there is a positive correlation between HIV knowledge and woman’s education level (Figure HA.1). Figure HA.1 Percent of ever-married women who know 2 ways of transmission and women who reject misconceptions of HIV and AIDS transmission, Yemen, 2006 Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among ever-married women age 15-49 years concerning mother-to-child transmission is presented in Table HA.4. Overall, more than half (51.2 percent) of ever-married women know that HIV can be transmitted from mother to child. The percentage of ever-married women who know all three ways of mother-to-child transmission is 32.4 percent, while 9.4 percent of women did not know of any specific way. There appeared to be little difference in knowledge among women of different age groups, however residence, education and socioeconomic status indicate strong associations with knowledge of mother to child HIV transmission. Of ever-married women living in urban areas, 45.4 percent knew of all three ways of transmission compared to 26.5 percent of women in rural areas. Women living in the richest households were almost 3 times as likely to know of all three ways compared to women living in the poorest households (44.3 percent versus 15.3 percent). The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. Table HA.5 presents the attitudes of women towards people living with HIV and AIDS. 15 29 42 21 23 39 49 29 3 11 26 7 0 10 20 30 40 50 60 No Education Basic Secondary + Yemen Knows condom use can prevent HIV transmission Knows abstinence can prevent HIV transmission Reject 3 misconceptions Percent Women's Educational Level 61 An overwhelming 94.8 percent of women agreed with at least one of the discriminatory statements listed above. The most widely held attitude was to not purchase food from a person with HIV and AIDS (82.6 percent) followed by the belief that a female teacher with HIV should not be allowed to work (71.9 percent). Over half of the ever-married women reported that if a family member had HIV they would want to keep it a secret (52.2 percent) and just under a fifth of women reported that they would not care for a family member who was sick with AIDS (19 percent). There is little variation in attitudes toward people living with HIV among any of the background variables. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Only 12.4 percent of women know where to be tested, this ranged from 7.4 percent of women living in rural areas to 23.3 percent of women living in urban areas. Women with any education were much more likely to know of a place to be tested compared to women with no education. Over 16 percent of women living in households in the two richest wealth quintiles knew of a place to be tested compared to less than 10 percent of women living in household in the poorest, second and middle wealth index quintiles. Table HA.6 also shows that only 1.9 percent of ever-married women have actually been tested and these women reside mainly in urban areas. Of this small number of women who have been tested 51.6 percent has been told the result (88 percent)14. Among women who had given birth within the two years preceding the survey, the percent who received counselling and HIV testing during antenatal care is presented in Table HA.7. As discussed in chapter IX less than half of the women received antenatal care from a health care professional (47 percent) thus presenting a particular challenge for the roll out of the prevention of mother to child transmission (PMTCT) services. Of women who received antenatal care just 2.1 percent of women were provided information about HIV prevention during their visit with very little variation among any of the background variables. Less than 1 percent of women recalled that they had been tested for HIV at an antenatal care visit (0.7 percent) and of these women only half a percent received the results. However these figures are extremely limited and should be used with caution due to the small number of women that the percentages are based upon. 14 The disaggregation by background characteristics is not shown in table HA.6 due to the national figure being based on a small number of unweighted cases. 62 List of References Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Blanc, A. and Wardlaw, T. 2005. "Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure". WHO Bulletin, 83 (3), 178-185. Filmer, D. and Pritchett, L., 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN WHO and UNICEF, 1997. The Sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users, Geneva. www.Childinfo.org. 63 Tables 64 Table HH.1: Results of household and individual interviews Number of households, women, and children under 5 by results of the household, women's and under-five's interviews, and household, women's and under-five's response rates, Yemen, 2006 Residence Urban Rural Total Number of households Sampled 1159 2820 3979 Occupied 1157 2815 3972 Interviewed 1055 2531 3586 Response rate 91.2 89.9 90.3 Number of women Eligible 1136 2776 3912 Interviewed 1095 2647 3742 Response rate 96.4 95.4 95.7 Overall response rate 87.9 85.7 86.4 Number of children under 5 Eligible 986 2932 3918 Mother/Caretaker interviewed 956 2827 3783 Response rate 97.0 96.4 96.6 Overall response rate 88.4 86.7 87.2 65 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children age 0-17 years, by sex, Yemen, 2006 Males Females Total Number Percent Number Percent Number Percent Age 0-4 2024 15.6 1951 14.8 3975 15.2 5-9 2006 15.5 1934 14.7 3940 15.1 10-14 1868 14.4 1810 13.8 3678 14.1 15-19 1631 12.6 1749 13.3 3381 13.0 20-24 1207 9.3 1299 9.9 2506 9.6 25-29 881 6.8 1081 8.2 1962 7.5 30-34 637 4.9 653 5.0 1290 4.9 35-39 492 3.8 583 4.4 1075 4.1 40-44 473 3.7 444 3.4 917 3.5 45-49 377 2.9 425 3.2 803 3.1 50-54 364 2.8 409 3.1 773 3.0 55-59 231 1.8 253 1.9 484 1.9 60-64 284 2.2 182 1.4 466 1.8 65-69 104 0.8 101 0.8 205 0.8 70+ 363 2.8 248 1.9 611 2.3 Missing/DK 10 0.1 14 0.1 23 0.1 Dependency age groups < 15 5899 45.5 5695 43.3 11593 44.4 15-64 6576 50.8 7080 53.9 13656 52.3 65 + 467 3.6 349 2.7 816 3.1 Missing/DK 10 0.1 14 0.1 23 0.1 Children age 0-17 6869 53.0 6758 51.4 13627 52.2 Adults 18+/Missing/ DK 6082 47.0 6379 48.6 12461 47.8 Total 12951 100 13137 100 26088 100 66 Table HH.3: Household composition Percent distribution of households by selected characteristics, Yemen, 2006 Number of households Weighted percent Weighted Unweighted Sex of household head Male 91.3 3276 3274 Female 8.7 311 312 Residence Urban 31.6 1132 1055 Rural 68.4 2454 2531 Number of household members 1 2.1 74 77 2-3 12.7 457 467 4-5 18.5 665 661 6-7 24.4 873 861 8-9 19.5 699 681 10+ 22.8 818 839 Total 100.0 3586 3586 At least one child age < 18 years 87.9 3586 3586 At least one child age < 5 years 62.4 3586 3586 At least one woman age 15-49 years 87.3 3586 3586 67 Table HH.4: Women's background characteristics Percent distribution of ever-married women age 15-49 years by background characteristics, Yemen, 2006 Number of women Weighted percent Weighted Unweighted Residence Urban 31.3 1170 1095 Rural 68.7 2572 2647 Age 15-19 8.5 318 307 20-24 18.6 697 691 25-29 21.8 815 802 30-34 14.8 553 571 35-39 14.3 536 535 40-44 11.3 421 433 45-49 10.8 402 403 Marital status Currently married 93.9 3514 3519 Formerly married 6.1 228 223 Motherhood status Ever gave birth 88.6 3315 3308 Never gave birth 11.4 427 434 Education None 66.0 2469 2452 Basic 24.6 922 950 Secondary + 9.2 344 334 Missing (*) 7 6 Wealth index quintiles Poorest 19.9 745 686 Second 19.6 735 724 Middle 19.5 731 791 Fourth 19.8 740 773 Richest 21.1 791 768 Total 100.0 3742 3742 (*) Percentage based on less than 25 unweighted cases 68 Table HH.5: Children's background characteristics Percent distribution of children under five years of age by background characteristics, Yemen, 2006 Number of under-5 children Weighted percent Weighted Unweighted Sex Male 50.9 1925 1930 Female 49.1 1858 1853 Residence Urban 27.0 1021 956 Rural 73.0 2762 2827 Age < 6 months 11.1 421 408 6-11 months 11.4 432 443 12-23 months 19.1 721 715 24-35 months 19.6 741 750 36-47 months 20.5 774 781 48-59 months 18.3 691 682 Mother’s education None 65.6 2483 2453 Basic 24.9 941 971 Secondary + 8.4 316 310 Non Standard Curriculum (1.1) 41 48 Missing (*) 1 1 Wealth index quintiles Poorest 23.2 878 810 Second 21.4 810 798 Middle 20.1 759 831 Fourth 19.5 738 768 Richest 15.8 598 576 Total 100.0 3783 3783 (*) Percentage based on less than 25 unweighted cases Percentages in parenthesis based on less than 50 unweighted cases 69 Table CM.1: Childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods precedining the survey, Yemen 2006 Years precedining the survey Neonatal mortality (NN) Postneonatal mortality (PNN) Infant mortality (1q0) * Child mortality (4q1) Under five mortality (5q0)** 0-4 37.3 31.1 68.5 10.5 78.2 5-9 38.8 37.0 75.8 19.5 93.8 10-14 38.7 48.2 86.9 23.4 108.3 15-19 46.2 57.1 103.2 25.9 126.5 20-24 52.2 68.5 120.7 38.8 154.8 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 Table CM.2: Child mortality by sex and residence characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the five-year periods preceding the survey, by background characteristics Yemen, 2006 Neonatal mortality (NN) Postneonatal mortality (PNN) Infant mortality (1q0) Child mortality (4q1) Under five mortality (5q0) Sex Male 40.3 31.6 71.9 9.9 81.1 Female 34.2 30.5 64.7 11.2 75.2 Residence Urban 29.1 26.2 55.3 1.6 56.7 Rural 40.3 32.9 73.3 13.8 86.1 Wealth index quintiles Poorest 43.9 50.0 93.9 26.6 118.0 Second 42.5 26.7 69.2 12.6 80.9 Middle 42.8 28.6 71.4 4.5 75.5 Fourth 28.6 29.7 58.4 3.0 61.2 Richest 23.5 12.6 36.0 1.4 37.4 Total 37.3 31.1 68.5 10.5 78.2 70 Table NU.1: Initial breastfeeding Percentage of women age 15-49 years with a birth in the two years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Yemen, 2006 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with a live birth in the two years preceding the survey Residence Urban 31.7 71.0 429 Rural 28.8 62.9 1181 Mother’s education None 28.9 61.2 1035 Basic 29.8 70.7 412 Secondary + 32.3 75.2 162 Wealth index quintiles Poorest 35.7 61.8 378 Second 25.7 59.2 352 Middle 30.3 63.1 322 Fourth 26.0 69.2 307 Richest 29.2 75.8 251 Total 29.6 65.1 1610 * MICS indicator 45 Total includes 1 child missing information on mother’s education who is not shown separately. 71 Table NU.2: Post-partum mothers' vitamin A supplementation Percentage of women age 15-49 years with a live birth in the 2 years preceding the survey by whether they received a high dose vitamin A supplement before the infant was 8 weeks old, Yemen, 2006 Received vitamin A supplement* Not sure if received vitamin A Number of women age 15-49 years Residence Urban 19.4 4.8 429 Rural 14.7 3.4 1181 Education None 14.2 2.9 1035 Basic 18.4 5.5 412 Secondary + 21.2 4.8 162 Wealth index quintiles Poorest 12.9 3.1 378 Second 15.7 3.4 352 Middle 15.9 4.0 322 Fourth 15.0 2.9 307 Richest 21.9 6.0 251 Total 15.9 3.8 1610 *MICS indicator 43 Total includes 1 child missing information on mother’s education who is not shown separately. 72 Table NU.3: Child size at birth Percentage of live births in the 2 years preceding the survey by mother's estimate of baby size at birth, Yemen, 2006 Size of child at birth as estimated by the mother Weighed at birth* Very large Larger than average Average Smaller than average Very small Don't know/ missing Total Number of births Residence Urban 19.5 2.3 11.5 47.7 16.3 22.1 0.0 100.0 429 Rural 3.6 2.5 10.5 42.0 19.2 25.2 0.5 100.0 1181 Education None 3.6 1.9 9.9 41.8 18.8 27.3 0.3 100.0 1035 Basic 11.9 3.9 12.4 45.3 17.8 19.9 0.7 100.0 412 Secondary + 23.9 2.9 12.2 49.9 17.8 17.1 0.0 100.0 162 Wealth index quintiles Poorest 1.2 2.8 3.4 37.6 22.4 32.8 1.0 100.0 378 Second 3.0 1.2 12.9 45.7 16.9 22.9 0.3 100.0 352 Middle 5.3 3.6 12.6 42.7 18.4 22.8 0.0 100.0 322 Fourth 12.1 2.2 13.0 44.1 16.3 24.3 0.1 100.0 307 Richest 22.3 2.7 13.9 49.9 17.1 16.0 0.4 100.0 251 Total 7.8 2.5 10.8 43.5 18.4 24.4 0.4 100.0 1610 ** MICS indicator 10 Total includes 2 births missing information on mother’s education that are not shown separately. 73 Table CH.1: Vaccinations in first year of life Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Yemen, 2006 Percentage of children who received: BCG* DPT1 DPT2 DPT3** Polio0 Polio1 Polio2 Polio3*** Measles**** All***** None Number of children age 12-23 months Vaccinated at any time before the survey According to: Vaccination card 37.9 46.8 43.4 39.2 20.0 45.2 40.7 36.5 30.8 25.1 0.0 721 Mother’s report 31.1 31.6 27.5 21.7 10.0 36.1 32.8 26.6 34.3 12.4 11.6 721 Either 69.0 78.4 70.9 61.0 30.0 81.2 73.5 63.0 65.1 37.5 11.6 721 Vaccinated by 12 months of age 67.2 76.9 70.1 59.7 28.5 78.9 72.3 60.2 59.2 17.9 11.6 721 * MICS indicator 25 ** MICS indicator 27 *** MICS indicator 26 **** MICS indicator 28; MDG indicator 15 Since March 2005 DPT is typically administered as part of the Pentavalent vaccination 74 Table CH.1c: Vaccinations in first year of life (continued) Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Yemen, 2006 Percentage of children who received: HepB1 HepB2 HepB3* Hib1 Hib2 Hib3 Number of children age 12-23 months Vaccinated at any time before the survey According to: Vaccination card 11.8 11.0 8.7 32.8 30.2 26.7 721 Mother’s report 16.3 13.0 10.7 25.8 20.9 15.9 721 Either 28.1 24.0 19.4 58.6 51.1 42.6 721 Vaccinated by 12 months of age 25.5 23.4 18.6 56.9 49.8 40.0 721 * MICS indicator 29 Hib typically received as part of the Pentavalent vaccine 75 Table CH.2: Vaccinations by background characteristics Percentage of children age 12-23 months currently vaccinated against childhood diseases, Yemen, 2006 Percentage of children who received: BCG DPT1 DPT2 DPT3 Polio0 Polio1 Polio2 Polio3 Measles All None Percent with health card Number of children age 12-23 months Sex Male 68.8 76.2 70.2 61.7 31.8 81.2 73.2 63.2 65.7 36.4 11.8 49.7 360 Female 69.1 80.5 71.7 60.2 28.1 81.2 73.8 62.9 64.5 38.6 11.5 47.0 361 Residence Urban 89.6 91.9 85.5 79.5 43.4 87.4 80.6 72.9 80.3 57.7 6.4 51.2 210 Rural 60.5 72.7 64.8 53.2 24.5 78.7 70.6 59.1 58.8 29.3 13.8 47.2 511 Mother’s education None 61.0 71.2 63.0 51.9 24.5 77.1 68.9 58.8 59.5 29.0 14.4 44.4 454 Basic 81.4 89.4 82.0 71.3 39.0 87.6 78.5 67.4 72.2 47.4 7.8 55.9 175 Secondary + 86.4 92.0 87.3 83.9 39.5 88.4 85.6 73.6 80.7 60.1 5.5 53.8 82 Non Standard Curriculum (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 11 Wealth index quintiles Poorest 53.3 63.7 52.6 40.3 21.4 76.5 64.0 51.8 52.4 17.8 14.3 43.9 153 Second 53.8 70.8 60.2 50.0 24.0 76.4 65.9 56.1 57.2 26.4 14.0 39.2 161 Middle 70.7 79.2 72.1 60.5 24.7 80.4 72.5 62.5 60.2 38.1 15.5 44.0 139 Fourth 76.0 83.7 77.6 65.5 39.3 79.8 76.0 63.9 74.5 40.2 12.0 55.3 141 Richest 97.9 98.4 97.2 94.6 43.6 95.9 93.2 85.6 85.5 72.5 0.8 62.3 127 Total 69.0 78.4 70.9 61.0 30.0 81.2 73.5 63.0 65.1 37.5 11.6 48.3 721 (*) Percentage based on less than 25 unweighted cases 76 Table CH.2c: Vaccinations by background characteristics (continued) Percentage of children age 12-23 months currently vaccinated against childhood diseases, Yemen, 2006 Percentage of children who received: HepB1 HepB2 HepB3 Hib1 Hib2 Hib3 Percent with health card Number of children age 12-23 months Sex Male 30.0 26.4 21.5 55.8 49.1 42.3 49.7 360 Female 31.3 26.0 20.9 64.8 56.1 45.4 47.0 361 Residence Urban 40.3 36.0 30.9 68.5 61.4 56.6 51.2 210 Rural 26.8 22.3 17.3 57.0 49.0 38.7 47.2 511 Mother’s education None 24.9 21.1 17.0 57.7 49.0 39.4 44.4 454 Basic 39.7 33.5 27.5 63.6 54.7 46.4 55.9 175 Secondary + 38.9 34.7 29.1 68.1 67.2 61.4 53.8 82 Non Standard Curriculum (*) (*) (*) (*) (*) (*) (*) 11 Wealth index quintiles Poorest 17.1 11.9 8.5 52.6 42.6 30.6 43.9 153 Second 27.6 22.1 17.6 56.8 43.8 36.2 39.2 161 Middle 37.8 32.1 27.7 60.9 53.7 43.7 44.0 139 Fourth 34.0 29.0 24.3 61.4 54.5 45.4 55.3 141 Richest 38.5 38.5 29.8 72.3 72.6 68.1 62.3 127 Total 30.6 26.2 21.2 60.3 52.6 43.9 48.3 721 (*) Percentage based on less than 25 unweighted cases 77 Table CH.3: Neonatal tetanus protection Percentage of mothers with a birth in the last 24 months protected against neonatal tetanus, Yemen, 2006 Percent of mothers with a birth in the last 24 months who: Received at least 2 doses during last pregnancy Received at least 2 doses, the last within prior 3 years Received at least 3 doses, last within prior 5 years Received at least 4 doses, last within prior 10 years Received at least 5 doses during lifetime Protected against tetanus* Number of mothers Residence Urban 24.6 11.3 1.6 1.8 1.1 40.5 429 Rural 17.6 7.8 1.0 0.7 0.1 27.3 1181 Age of mother 15-19 20.7 8.3 0.0 0.0 0.0 29.0 137 20-24 20.1 8.8 1.8 0.8 0.3 31.9 431 25-29 21.3 11.5 0.8 1.2 0.3 35.1 464 30-34 16.2 10.3 0.7 1.1 0.8 29.1 266 35-39 22.1 2.0 1.8 0.8 0.9 27.5 190 40-44 13.0 6.9 2.3 2.9 0.0 25.1 92 45-49 (7.7) (3.5) (0.0) (0.0) (0.0) (11.2) 30 Mother’s education None 17.3 7.1 0.5 0.4 0.0 25.3 1035 Basic 20.8 10.4 3.0 1.6 0.7 36.3 412 Secondary + 30.0 15.5 1.0 3.0 2.3 51.8 162 Wealth index quintiles Poorest 16.0 5.2 0.3 0.6 0.0 22.1 378 Second 17.5 11.3 0.9 0.4 0.0 30.1 352 Middle 17.2 9.2 1.6 0.9 0.5 29.3 322 Fourth 20.2 7.6 1.8 0.8 0.7 31.2 307 Richest 29.4 11.4 1.6 2.8 1.1 46.2 251 Total 19.5 8.8 1.2 1.0 0.4 30.8 1610 * MICS indicator 32 Total includes 2 children with missing information on mother's education who are not shown separately Percentages shown in parenthesis are based on less than 50 unweighted cases 78 Table CH.4: Oral rehydration treatment Percentage of children age 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Yemen, 2006 Children with diarrhoea who received: Had diarrhoea in last two weeks Number of children age 0-59 months Fluid from ORS packet Good Drinking Water Rice Water Vegetable Soup Fruit Juice No treatment ORT Use Rate * Number of children age 0-59 months with diarrhoea Sex Male 34.6 1925 31.4 73.3 18.5 9.9 32.2 14.2 85.8 667 Female 32.4 1858 34.2 74.6 24.0 11.8 29.9 12.3 87.7 602 Residence Urban 29.2 1021 29.5 78.2 15.8 15.3 38.7 9.6 90.4 298 Rural 35.2 2762 33.7 72.6 22.8 9.4 28.7 14.5 85.5 971 Age > 6 months 25.3 421 28.9 64.1 12.4 2.1 12.3 28.6 71.4 107 0-11 months 46.6 432 40.2 74.3 21.7 8.1 21.6 8.3 91.7 201 12-23 months 43.4 721 38.9 75.7 25.3 15.6 37.6 10.8 89.2 313 24-35 months 36.6 741 28.5 78.0 21.1 10.9 35.4 10.8 89.2 271 36-47 months 28.0 774 22.4 66.2 19.9 10.5 28.3 18.9 81.1 217 48-59 months 23.1 691 34.9 80.0 19.9 10.7 39.1 11.1 88.9 160 Mother’s education None 33.5 2483 32.5 73.2 21.9 9.6 28.2 13.9 86.1 831 Basic 33.2 941 34.7 74.3 18.2 10.5 34.1 13.4 86.6 312 Secondary + 33.6 316 30.0 76.9 22.8 22.1 45.2 10.4 89.6 106 Non Standard (42.9) 41 (*) (*) (*) (*) (*) (*) (*) 18 Wealth index quintiles Poorest 35.0 878 30.5 70.2 18.9 8.9 25.1 18.0 82.0 307 Second 36.3 810 31.4 74.0 22.0 6.9 26.0 14.7 85.3 294 Middle 35.2 759 33.9 77.5 24.2 12.3 32.8 10.0 90.0 267 Fourth 32.7 738 33.2 73.4 20.1 11.5 37.9 13.0 87.0 241 Richest 26.5 598 36.5 75.9 20.1 18.1 38.8 7.9 92.1 159 Total 33.5 3783 32.7 73.9 21.1 10.8 31.1 13.3 86.7 1269 * MICS indicator 33 Total includes 1 child missing information on mother's education who is not shown separately (*) Percentage based on less than 25 unweighted cases Percentages shown in parenthesis based on less than 50 unweighted cases 79 Table CH.5: Home management of diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode, Yemen, 2006 Children with diarrhoea who: Had diarrhoea in last two weeks Number of children age 0- 59 months Drank more Drank the same or less Ate somewhat less, same or more Ate much less or none Home manage- ment of diarrhoea* Received ORT or increased fluids AND continued feeding** Number of children age 0-59 months with diarrhoea Sex Male 34.6 1925 60.2 38.2 49.4 48.1 29.7 46.6 667 Female 32.4 1858 59.5 39.5 52.1 47.4 31.8 48.7 602 Residence Urban 29.2 1021 61.6 37.5 51.9 46.9 32.6 49.9 298 Rural 35.2 2762 59.4 39.2 50.3 48.0 30.1 46.9 971 Age 0-11 months 36.1 853 51.1 48.2 40.8 56.2 19.7 37.1 308 12-23 months 43.4 721 62.2 35.9 46.1 52.8 29.1 44.4 313 24-35 months 36.6 741 66.1 33.5 58.5 41.2 37.5 56.1 271 36-47 months 28.0 774 59.1 37.8 58.1 39.6 35.1 53.3 217 48-59 months 23.1 691 62.8 36.7 54.9 43.8 37.3 51.9 160 Mother’s education None 33.5 2483 59.2 39.3 49.4 48.8 29.3 45.9 831 Basic 33.2 941 62.2 37.0 50.1 48.6 31.7 48.0 312 Secondary + 33.6 316 60.1 38.6 59.6 39.1 38.7 56.5 106 Non Standard (42.9) 41 (*) (*) (*) (*) (*) (*) 18 Wealth index quintiles Poorest 35.0 878 58.7 39.0 44.1 53.1 27.8 41.4 307 Second 36.3 810 56.6 42.0 54.0 43.8 31.3 49.8 294 Middle 35.2 759 62.7 36.3 46.9 52.5 28.3 45.2 267 Fourth 32.7 738 61.9 38.1 56.1 43.5 33.9 51.3 241 Richest 26.5 598 60.7 37.6 55.0 43.3 34.0 53.8 159 Total 33.5 3783 59.9 38.8 50.6 47.8 30.7 47.6 1269 * MICS indicator 34 ** MICS indicator 35 Total includes 1 child missing information on mother's education who is not shown separately (*) Percentage based on less than 25 unweighted cases Percentages shown in parenthesis based on less than 50 unweighted cases 80 Table CH.6: Antibiotic treatment of pneumonia Percentage of children age 0-59 months with suspected pneumonia who received antibiotic treatment, Yemen, 2006 Had acute respiratory infection/suspected pneumonia Number of children age 0-59 months Percentage of children age 0- 59 months with suspected pneumonia who received antibiotics in the last two weeks * Number of children age 0-59 months with suspected pneumonia in the two weeks prior to the survey Sex Male 13.4 1925 37.2 257 Female 12.5 1858 38.6 231 Residence Urban 11.6 1021 48.6 118 Rural 13.4 2762 34.4 370 Age 0-11 months 12.1 853 38.3 103 12-23 months 14.3 721 42.6 103 24-35 months 10.7 741 41.2 79 36-47 months 13.0 774 35.8 101 48-59 months 14.8 691 32.1 102 Mother’s education None 14.0 2483 36.6 348 Basic 11.0 941 42.7 104 Secondary + 8.8 316 (34.6) 28 Non Standard (18.5) 41 (*) 8 Wealth index quintiles Poorest 15.4 878 29.7 135 Second 15.9 810 39.2 129 Middle 11.8 759 44.5 90 Fourth 11.2 738 42.0 83 Richest 8.7 598 38.1 52 Total 12.9 3783 37.9 488 * MICS indicator 22 Total includes 1 child missing information on mother's education who is not shown separately (*) Percentage based on less than 25 unweighted cases Percentages shown in parenthesis are based on less than 50 unweighted cases 81 Table CH.7A: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children age 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility, and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately, Yemen, 2006 Percentage of mothers/caretakers of children age 0-59 months who think that a child should be taken immediately to a health facility if the child: Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficult breathing Has blood in stool Is drinking poorly Mothers/caretakers who recognize the two danger signs of pneumonia Number of mothers/caretakers of children age 0- 59 months Residence Urban 17.2 51.1 80.3 33.4 42.5 32.7 9.5 27.5 1021 Rural 16.0 56.4 69.6 21.5 24.2 21.5 8.7 16.7 2762 Mother's education None 15.3 54.2 72.0 21.7 25.8 21.2 7.9 16.4 2483 Basic 16.8 52.8 74.7 27.5 33.0 28.2 10.5 23.7 941 Secondary + 21.7 65.8 69.3 40.4 44.4 40.4 13.1 33.4 316 Non Standard (21.6) (21.6) (21.6) (21.6) (21.6) (21.6) (21.6) (21.6) 41 Wealth index quintiles Poorest 13.1 53.2 66.0 19.0 20.7 16.8 8.3 14.5 878 Second 16.5 55.7 68.0 16.3 21.7 16.4 6.3 12.2 810 Middle 18.4 57.0 70.7 27.0 29.3 26.9 10.9 19.5 759 Fourth 19.5 56.2 80.9 32.8 40.3 34.5 9.8 28.8 738 Richest 14.3 52.5 80.0 31.5 37.8 31.4 9.9 26.0 598 Total 16.3 55.0 72.5 24.7 29.2 24.5 8.9 19.6 3783 Total includes 1 child missing information on mother's education who is not shown separately Percentages shown in parenthesis are based on less than 50 unweighted cases 82 Table CH.8: Solid fuel use Percent distribution of households according to type of cooking fuel, and percentage of households using solid fuels for cooking, Yemen, 2006 Percentage of households using: Electricity Liquified Petroleum Gas (LPG) Kerosene Charcoal/Wood /Coal/Animal Dung/Crop residue Other source Total Solid fuels for cooking* Number of households Residence Urban 1.0 93.5 3.3 1.0 1.2 100.0 1.0 1132 Rural 0.4 42.9 3.5 52.4 0.7 100.0 52.4 2454 Education of household head None 0.3 45.5 4.4 48.8 1.0 100.0 48.8 1532 Basic 0.9 63.9 4.1 30.6 0.5 100.0 30.6 930 Secondary + 0.8 81.0 1.1 16.1 1.0 100.0 16.1 812 Non Standard 0.7 52.6 2.9 43.1 0.8 100.0 43.1 303 Wealth index quintiles Poorest 0.0 0.8 5.0 93.7 0.6 100.0 93.7 815 Second 0.8 36.3 7.8 54.0 1.1 100.0 54.0 743 Middle 0.7 78.9 2.8 15.7 1.8 100.0 15.7 695 Fourth 0.6 93.9 0.8 3.6 1.1 100.0 3.6 653 Richest 0.8 99.1 0.0 0.1 0.0 100.0 0.1 680 Total 0.6 58.9 3.4 36.2 0.9 100.0 36.2 3586 * MICS indicator 24; MDG Indicator 29 Total includes 9 households missing information on education of household head who are not shown separately 83 Table EN.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Yemen, 2006 Main source of drinking water Improved sources Unimproved sources Piped into dwelling Piped into yard/ plot Public tap/ stand- pipe Tube- well/ bore- hole Pro- tected well Pro- tected spring Rain- water Bottled water1 Unpro- tected well Unpro- tected spring Tanker truck Cart with tank/ drum Surface water Bottled water1 Other Total Improved source of drinking water* Number of household members Residence Urban 49.0 5.1 1.0 0.4 0.8 0.0 0.3 17.2 0.0 0.0 14.7 3.4 0.0 5.7 2.4 100.0 73.8 8022 Rural 19.1 6.0 2.7 6.9 9.6 3.4 4.1 0.5 20.1 11.4 4.8 3.6 6.3 0.5 1.0 100.0 52.2 18066 Education of household head None 24.2 7.4 1.8 5.3 7.3 2.5 3.2 2.2 16.8 9.9 7.6 3.6 5.0 1.5 1.6 100.0 54.0 11506 Basic 32.5 4.7 2.7 4.0 7.4 2.7 2.3 6.8 12.1 6.9 7.9 3.7 3.3 2.0 0.8 100.0 63.3 6628 Secondary + 36.1 4.7 0.9 2.7 5.2 0.7 2.5 13.1 8.4 3.7 8.6 3.3 4.0 3.8 2.5 100.0 65.8 5312 Non Standard 19.8 2.8 5.1 10.0 7.0 4.2 3.9 3.0 16.3 10.0 7.2 3.2 5.6 1.5 0.6 100.0 55.7 2592 Missing 31.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 33.1 0.0 14.6 20.6 0.0 0.0 0.0 100.0 31.7 50 Wealth index quintiles Poorest 0.4 3.8 0.4 1.0 15.2 5.2 2.1 0.2 34.7 22.0 1.8 3.3 8.9 0.0 1.0 100.0 28.2 5219 Second 11.2 6.9 4.0 4.9 12.5 3.6 3.8 0.0 26.5 10.1 3.4 3.8 7.5 0.1 1.7 100.0 46.9 5218 Middle 29.1 11.8 3.9 10.9 4.0 2.4 4.2 0.7 6.5 6.1 8.6 3.7 4.8 0.9 2.3 100.0 67.0 5215 Fourth 46.2 5.6 2.0 5.0 1.7 0.5 2.9 6.8 1.7 1.3 16.2 4.6 0.6 3.4 1.7 100.0 70.6 5215 Richest 54.7 0.5 0.7 2.9 1.0 0.0 1.4 20.6 0.0 0.0 9.2 2.3 0.2 6.0 0.6 100.0 81.7 5221 Total 28.3 5.7 2.2 4.9 6.9 2.3 2.9 5.7 13.9 7.9 7.9 3.5 4.4 2.1 1.5 100.0 58.9 26088 * MICS indicator 11; MDG indicator 30 Improved sources includes: piped water (into dwelling, yard or plot), public tap/standpipe, tubewell/borehole, protected well, protected spring, rainwater collection 1 For households using bottled water as the main source of drinking water, the source used for other purposes such as cooking and handwashing is used to determine whether to classify the source as improved. 84 Table EN.2: Household water treatment Percent distribution of household population according to drinking water treatment method used in the household, and percentage of household population that applied an appropriate water treatment method, Yemen, 2006 Water treatment method used in the household All drinking water sources Improved drinking water sources Unimproved drinking water sources None Boil Add bleach/ chlorine Strain through a cloth Use water filter Let it stand and settle Other Appropriate water treatment method* Number of household members Appropriate water treatment method Number of household members Appropriate water treatment method Number of household members Residence Urban 91.4 4.7 0.0 0.6 3.5 0.0 0.4 7.9 8022 7.8 5922 8.3 2100 Rural 92.9 2.2 0.6 3.6 0.4 0.5 0.2 3.2 18066 3.6 9433 2.7 8633 Education of household head None 93.8 2.0 0.3 3.0 0.6 0.1 0.2 2.9 11506 4.0 6208 1.7 5298 Basic 93.6 3.1 0.4 1.4 1.3 0.6 0.3 4.8 6628 4.2 4195 5.8 2433 Secondary + 88.2 5.3 0.6 2.6 3.1 0.3 0.5 8.9 5312 9.6 3493 7.5 1819 Non Standard 91.6 2.0 0.1 5.1 1.2 0.3 0.0 3.3 2592 3.1 1443 3.5 1149 W3ealth index quintiles Poorest 92.4 2.5 0.0 4.7 0.0 0.9 0.0 2.5 5219 1.5 1469 2.9 3750 Second 93.3 2.2 0.3 3.6 0.2 0.5 0.2 2.7 5218 2.2 2448 3.2 2769 Middle 93.4 1.8 1.2 3.2 0.2 0.1 0.3 3.2 5215 3.6 3493 2.3 1722 Fourth 93.9 2.8 0.5 1.6 1.0 0.2 0.3 4.3 5215 3.9 3681 5.2 1534 Richest 89.2 5.5 0.0 0.4 5.4 0.0 0.4 10.4 5221 10.6 4264 9.4 957 Total 92.4 3.0 0.4 2.7 1.4 0.3 0.2 4.6 26088 5.2 15355 3.8 10733 * MICS indicator 13 Includes 34 household members with missing information on the education of the household head who are not shown separately. 85 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Yemen, 2006 Time to source of drinking water Water on premises Less than 15 minutes 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more Don't know Missing Total Mean time to source of drinking water* Number of households Residence Urban 89.4 2.1 2.4 2.5 3.0 0.3 0.3 100.0 45.0 1132 Rural 34.0 8.5 7.6 12.9 35.8 0.9 0.2 100.0 64.8 2454 Education of household head None 43.3 7.5 6.6 10.6 30.8 0.9 0.3 100.0 65.2 1532 Basic 50.1 6.8 5.5 10.7 25.9 0.9 0.2 100.0 58.9 930 Secondary + 64.2 5.3 4.7 8.4 16.6 0.5 0.3 100.0 53.3 812 Non Standard 41.5 6.6 8.8 8.9 33.8 0.4 0.0 100.0 83.8 303 Wealth index quintiles Poorest 10.2 6.7 6.7 15.0 60.4 0.6 0.4 100.0 76.6 815 Second 26.6 10.0 11.4 14.5 36.6 0.8 0.2 100.0 61.4 743 Middle 60.0 10.2 6.1 9.4 13.7 0.4 0.1 100.0 42.7 695 Fourth 82.0 3.5 2.9 5.7 4.9 1.1 0.0 100.0 39.9 653 Richest 90.8 1.3 1.9 1.5 3.0 1.0 0.5 100.0 66.2 680 Total 49.3 6.8 6.2 10.0 26.8 0.8 0.2 100.0 63.7 3586 * The mean time to source of drinking water is calculated based on those households that do not have water on the premises. Includes 3 households with missing information on the education of the household head that are not shown separately. 86 Table EN.4: Person collecting water Percent distribution of households according to the person collecting drinking water used in the household, Yemen, 2006 Person collecting drinking water Adult woman Adult man Female child under age 15 Male child under age 15 Don't know Missing Total Number of households Residence Urban 19.7 45.1 2.7 4.7 1.1 26.6 100.0 98 Rural 71.1 9.4 11.4 5.0 0.5 2.6 100.0 1611 Education of household head None 66.9 9.6 13.3 5.6 0.9 3.7 100.0 849 Basic 68.0 14.9 8.7 4.6 0.3 3.4 100.0 434 Secondary + 68.2 12.4 7.9 5.2 0.0 6.3 100.0 250 Non Standard 75.2 10.3 8.0 3.1 0.0 3.4 100.0 173 Wealth index quintiles Poorest 73.6 6.4 12.3 6.5 0.3 0.9 100.0 732 Second 71.6 9.7 12.2 4.2 0.6 1.8 100.0 545 Middle 69.5 11.9 7.5 3.0 0.7 7.4 100.0 276 Fourth 32.3 33.8 6.1 6.6 0.7 20.5 100.0 108 Richest (19.9) (55.2) (4.5) (0.0) (1.7) (18.7) 100.0 48 Total 68.2 11.4 10.9 5.0 0.5 4.0 100.0 1709 Includes 3 households with missing information on the education of the household head that are not shown separately. Figures shown in parentheses are based on less than 50 unweighted cases 87 Table EN.5: Use of sanitary means of excreta disposal Percent distribution of household population according to type of toilet facility used by the household, and the percentage of household population using sanitary means of excreta disposal, Yemen, 2006 Type of toilet facility used by household Improved sanitation facility Unimproved sanitation facility Flush/pour flush to: Piped sewer system Septic tank Pit latrine Ventilated improved pit latrine Pit latrine with slab Flush/ pour flush to some- where else Flush/pour flush to unknown place/not sure/don't know Pit latrine without slab/ open pit Bucket No facilities / bush / field Other Total Percentage of population using sanitary means of excreta disposal* Number of household members Residence Urban 41.8 2.3 46.8 0.7 0.7 4.9 0.3 1.6 0.0 0.7 0.2 100.0 92.3 8022 Rural 0.4 0.9 27.3 3.3 1.7 24.1 0.6 6.3 0.6 30.6 4.1 100.0 33.6 18066 Education of household head None 6.5 1.5 30.7 2.4 1.4 20.6 0.4 5.7 0.5 26.3 4.0 100.0 42.4 11506 Basic 16.3 1.8 34.3 2.8 1.2 17.2 0.6 3.6 0.5 19.8 1.9 100.0 56.3 6628 Secondary + 26.6 0.7 38.6 3.0 1.1 12.8 0.6 4.2 0.1 10.6 1.7 100.0 70.1 5312 Non Standard 6.9 0.8 31.4 1.5 2.4 21.7 0.3 6.3 0.0 26.1 2.6 100.0 43.1 2592 Wealth index quintiles Poorest 0.0 0.0 2.2 0.2 0.8 9.8 0.2 5.5 0.4 75.0 5.9 100.0 3.2 5219 Second 0.0 0.4 20.2 2.3 2.6 30.4 1.0 11.5 0.6 27.4 3.8 100.0 25.4 5218 Middle 3.3 1.2 40.6 5.3 2.3 32.2 1.0 5.7 0.7 3.9 3.6 100.0 52.7 5215 Fourth 17.6 2.2 57.9 3.3 1.1 14.0 0.3 1.6 0.2 0.8 0.9 100.0 82.1 5215 Richest 44.5 2.8 45.7 1.6 0.2 4.8 0.0 0.1 0.0 0.0 0.2 100.0 94.9 5221 Total 13.1 1.3 33.3 2.5 1.4 18.2 0.5 4.9 0.4 21.4 2.9 100.0 51.7 26088 * MICS indicator 12; MDG indicator 31 Includes 50 household members with missing information on the education of the household head who are not shown separately. 88 Table EN.6: Use of improved water sources and improved sanitation Percentage of household population using both improved drinking water sources and sanitary means of excreta disposal, Yemen, 2006 Percentage of household population: Using improved sources of drinking water* Using sanitary means of excreta disposal** Using improved sources of drinking water and using sanitary means of excreta disposal*** Number of household members Residence Urban 73.8 92.3 68.4 8022 Rural 52.2 33.6 22.9 18066 Education of household head None 54.0 42.4 28.9 11506 Basic 63.3 56.3 41.8 6628 Secondary + 65.8 70.1 51.4 5312 Non standard 55.7 43.1 30.6 2592 Missing 31.7 56.3 22.5 50 Wealth index quintiles Poorest 28.2 3.2 1.7 5219 Second 46.9 25.4 14.0 5218 Middle 67.0 52.7 35.8 5215 Fourth 70.6 82.1 56.0 5215 Richest 81.7 94.9 77.1 5221 Total 58.9 51.7 36.9 26088 * MICS indicator 11; MDG indicator 30 89 Table FE.1: Current Fertility Age specific and total fertility rate for the three years preceding the survey, Yemen, 2006 Residence Age group Urban Rural Total 15-19 66 86 80 20-24 156 243 211 25-29 210 266 247 30-34 185 239 221 35-39 122 175 156 40-44 45 96 78 45-49 21 50 39 TFR 4.0 5.8 5.2 Note: Age-specific fertility rates are per 1,000 women. TFR: Total fertility rate for ages 15-49, expressed per woman. Table FE.2: Fertility by background characteristics Total fertility rate 0-14 years preceding the survey by background characteristics, Yemen, 2006 Number of years preceding the survey 0-2 3-5 6-8 9-11 12-14 Residence Urban 4.0 4.5 5.3 5.3 6.8 Rural 5.8 6.6 7.9 7.1 7.9 Education of woman None 5.8 6.5 7.7 6.8 7.6 Any education 4.7 5.9 6.4 6.6 8.8 Wealth index quintiles Poorest 6.6 7.7 8.3 7.2 7.7 Second 6.2 6.4 8.1 8.1 7.8 Middle 5.2 6.6 7.6 6.7 8.1 Fourth 4.9 6.8 7.5 6.5 8.7 Richest 3.4 3.3 4.4 4.6 5.9 Total 5.2 5.9 7.0 6.5 7.5 Table FE.3: Fertility Trends Age specific fertility rates for three-year periods preceding the survey, by mother's age at the time of the birth, Yemen 2006 Number of years preceding the survey Mother's age at birth 0-2 3-5 6-8 9-11 12-14 15-19 80 102 141 166 198 20-24 211 232 308 312 351 25-29 247 265 326 304 359 30-34 221 226 295 264 300 35-39 156 169 200 221 299 40-44 78 98 130 31 . 45-49 39 88 . . . 90 Table RH.1: Use of contraception Percentage of currently married women age 15-49 years who are using (or whose partner is using) a contraceptive method, Yemen, 2006 Percent of women (currently married) who are using: Not using any method Female sterili- zation Pill IUD Injections Condom LAM Periodic abstin- ence With- drawal Other Total Any modern method Any tradi- tional method Any method* Number of currently married women Residence Urban 57.7 4.2 15.9 8.8 3.7 1.1 4.0 2.2 0.7 1.7 100.0 33.7 8.6 42.3 1088 Rural 78.9 1.4 5.9 1.9 3.4 0.1 6.6 0.6 0.5 0.7 100.0 12.7 8.3 21.1 2426 Age 15-19 89.6 0.0 4.6 1.2 0.2 0.0 3.5 0.0 0.0 0.8 100.0 6.1 4.3 10.4 312 20-24 74.8 0.0 10.5 1.7 3.6 0.6 7.4 0.4 0.6 0.3 100.0 16.4 8.7 25.2 675 25-29 70.6 0.8 9.0 5.3 3.7 0.4 7.7 1.1 0.8 0.6 100.0 19.2 10.2 29.4 774 30-34 66.2 1.7 9.9 7.5 3.8 1.0 7.4 1.6 0.6 0.3 100.0 23.9 9.9 33.8 522 35-39 65.0 3.5 10.9 6.1 5.1 0.4 4.8 2.0 0.7 1.6 100.0 26.0 9.0 35.0 498 40-44 71.1 5.5 9.1 2.9 4.6 0.0 3.1 1.3 0.5 1.8 100.0 22.2 6.7 28.9 390 45-49 77.2 7.3 5.8 1.1 2.2 0.0 2.3 1.0 0.5 2.7 100.0 16.4 6.4 22.8 342 Number of living children** 0 98.5 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.3 0.9 100.0 0.3 1.2 1.5 421 1 75.1 0.5 7.9 3.1 2.6 0.5 8.6 0.8 0.8 0.0 100.0 14.7 10.2 24.9 416 2 69.6 0.5 12.1 4.2 3.3 0.5 7.4 1.1 0.2 1.0 100.0 20.6 9.7 30.4 398 3 71.5 1.1 8.3 5.1 4.1 1.2 5.6 0.9 1.1 0.9 100.0 19.9 8.6 28.5 432 4+ 66.5 3.8 10.7 4.8 4.5 0.3 6.2 1.4 0.5 1.3 100.0 24.1 9.4 33.5 1848 Education None 76.9 2.9 6.1 2.3 3.6 0.2 6.0 0.6 0.3 1.0 100.0 15.2 8.0 23.1 2305 Basic 65.8 1.4 13.2 6.9 3.6 0.8 5.6 1.4 0.7 0.7 100.0 25.9 8.4 34.2 870 Secondary + 57.9 0.0 17.8 8.2 3.2 1.0 5.3 3.4 1.6 1.8 100.0 30.1 12.0 42.1 334 Wealth index quintiles Poorest 85.3 0.5 2.3 0.1 1.9 0.0 9.5 0.0 0.3 0.0 100.0 4.9 9.8 14.7 697 Second 83.6 1.0 3.9 1.2 2.9 0.0 6.1 0.6 0.3 0.4 100.0 9.0 7.4 16.4 693 Middle 72.9 2.1 8.6 2.4 5.4 0.1 5.5 0.8 0.8 1.3 100.0 18.6 8.4 27.1 687 Fourth 64.6 4.0 13.1 5.0 5.6 0.6 4.7 0.9 0.2 1.2 100.0 28.4 7.0 35.4 697 Richest 56.3 3.5 16.7 10.8 1.9 1.2 3.3 3.0 1.1 2.0 100.0 34.2 9.5 43.7 740 Total 72.3 2.3 9.0 4.0 3.5 0.4 5.8 1.1 0.5 1.0 100.0 19.2 8.4 27.7 3514 * MICS indicator 21; MDG indicator 19C Includes 6 women missing information on education who are not shown separately 91 Table RH.2: Unmet need for contraception Percentage of currently married women age 15-49 years with an unmet need for family planning and percentage of demand for contraception satisfied, Yemen, 2006 Unmet need for contraception Current use of contraception* For spacing** For limiting*** Total**** Number of women currently married Percentage of demand for contraception satisfied***** Number of women currently married with need for contraception Residence Urban 42.3 8.2 5.6 13.8 1088 75.4 611 Rural 21.1 15.1 12.8 28.0 2426 43.0 1189 Age 15-19 10.4 27.4 2.9 30.4 312 25.5 127 20-24 25.2 20.8 4.7 25.6 675 49.6 343 25-29 29.4 17.6 9.6 27.2 774 52.0 438 30-34 33.8 9.5 13.7 23.2 522 59.3 298 35-39 35.0 6.5 18.1 24.7 498 58.7 297 40-44 28.9 2.4 14.4 16.8 390 63.2 179 45-49 22.8 0.5 11.5 12.0 342 65.5 119 Education None 23.1 12.1 13.1 25.2 2305.2 47.9 1113 Basic 34.2 15.2 6.9 22.1 869.7 60.8 490 Secondary + 42.1 13.4 3.1 16.5 333.9 71.9 196 Wealth index quintiles Poorest Second 14.7 17.5 14.2 31.7 697 31.7 323 Middle 16.4 15.4 14.1 29.5 693 35.7 318 Fourth 27.1 11.6 11.7 23.3 687 53.7 346 Richest 35.4 11.9 8.4 20.2 697 63.6 388 43.7 8.8 5.0 13.8 740 76.0 425 Total 27.7 13.0 10.6 23.6 3514 54.0 1800 * MICS indicator 21; MDG indicator 19C **** MICS indicator 98 ***** MICS indicator 99 Includes 2 women missing information on education who are not shown separately 92 Table RH.3: Antenatal care provider Percent distribution of ever-married women age 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Yemen, 2006 Person providing antenatal care Medical doctor Nurse Midwife Traditional birth attendant Community Health Worker Relative/ Friend Other No antenatal care received Total Any skilled personnel* Number of women who gave birth in the preceding two years Residence Urban 60.3 4.1 3.8 0.3 0.3 0.8 2.4 27.9 100.0 68.2 429 Rural 32.0 4.8 2.5 0.4 0.0 0.9 0.0 59.3 100.0 39.3 1181 Age 15-19 46.4 1.9 0.9 0.0 0.0 0.6 1.0 49.3 100.0 49.1 137 20-24 41.3 4.5 4.2 0.5 0.3 0.0 0.5 48.6 100.0 50.0 431 25-29 41.3 4.9 3.4 0.4 0.0 1.5 1.0 47.4 100.0 49.7 464 30-34 38.5 5.0 1.8 0.0 0.0 1.1 0.7 53.0 100.0 45.2 266 35-39 31.9 6.7 2.0 0.7 0.0 1.4 0.0 57.3 100.0 40.6 190 40-44 36.9 4.3 0.7 1.4 0.0 0.9 0.0 55.8 100.0 41.9 92 45-49 (21.7) (0.0) (3.2) (0.0) (0.0) (0.0) (0.0) (75.1) (100.0) (24.9) 30 Education None 31.3 4.5 2.2 0.5 0.0 0.9 0.2 60.4 100.0 38.0 1035 Basic 51.5 3.9 3.9 0.4 0.4 0.7 1.4 38.1 100.0 59.2 412 Secondary + 61.4 8.0 3.9 0.0 0.0 1.4 1.5 23.8 100.0 73.3 162 Wealth index quintiles Poorest 24.6 5.1 2.3 0.2 0.0 1.2 0.0 66.6 100.0 32.0 378 Second 30.1 3.7 1.4 0.4 0.0 0.4 0.0 64.2 100.0 35.1 352 Middle 34.4 4.9 4.1 0.4 0.0 0.8 0.0 55.4 100.0 43.4 322 Fourth 48.9 4.9 2.8 0.9 0.5 1.2 3.0 37.9 100.0 56.6 307 Richest 70.6 4.8 4.0 0.2 0.0 0.8 0.5 19.2 100.0 79.3 251 Total 39.5 4.6 2.8 0.4 0.1 0.9 0.7 51.0 100.0 47.0 1610 * MICS indicator 20 Skilled health personnel includes doctors, nurses and midwives. Includes 2 women missing information on education who are not shown separately Percentages shown in parenthesis are based on less than 50 unweighted cases 93 Table RH.4: Antenatal care Percentage of pregnant women receiving antenatal care among women age 15-49 years who gave birth in two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, Yemen, 2006 Percent of pregnant women who had: Percent of pregnant women receiving ANC one or more times during pregnancy Blood test taken* Blood pressure measured* Urine specimen taken* Weight measured* Number of women who gave birth in two years preceding survey Residence Urban 72.1 57.6 64.0 54.9 49.1 429 Rural 40.7 29.5 31.8 26.4 18.6 1181 Age 15-19 50.7 39.3 41.5 37.1 31.2 137 20-24 51.4 39.7 42.2 39.7 27.6 431 25-29 52.6 40.7 43.0 34.9 29.0 464 30-34 47.0 34.5 38.3 31.6 24.1 266 35-39 42.7 27.9 36.2 24.4 23.8 190 40-44 44.2 35.0 37.6 32.3 25.5 92 45-49 24.9 18.1 22.2 9.3 7.2 30 Education None 39.6 29.4 31.0 26.7 19.9 1035 Basic 61.9 47.6 54.1 45.4 34.7 412 Secondary + 76.2 57.8 65.0 50.8 50.5 162 Wealth index quintiles Poorest 33.4 23.0 25.3 20.5 16.2 378 Second 35.8 26.2 28.8 22.1 13.9 352 Middle 44.6 31.9 35.6 29.5 22.9 322 Fourth 62.1 45.9 51.8 45.3 35.2 307 Richest 80.8 68.8 71.6 62.7 55.5 251 Total 49.0 37.0 40.4 34.0 26.8 1610 * MICS indicator 44 Includes 2 women missing information on education who are not shown separately Percentages shown in parenthesis are based on less than 50 unweighted cases 94 Table RH.5: Assistance during delivery Percent distribution of women age 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery, Yemen, 2006 Person assisting at delivery Medical doctor Nurse Midwife Traditi onal birth attend ant Commu nity Health Worker Relative/ Friend Other No attendant Total Any skilled person nel* Delive red in health facility ** Number of women who gave birth in precedin g two years Residence Urban 38.3 11.6 11.8 6.7 0.2 27.4 2.3 1.7 100.0 61.7 40.3 429 Rural 14.6 4.0 7.8 8.7 0.0 58.2 2.3 4.5 100.0 26.3 17.4 1181 Age 15-19 23.6 5.3 8.1 3.8 0.0 53.2 0.8 5.2 100.0 37.0 23.4 137 20-24 20.6 6.3 9.5 9.5 0.0 51.1 1.6 1.5 100.0 36.3 22.4 431 25-29 21.9 4.0 8.2 9.7 0.2 49.6 2.4 4.1 100.0 34.1 23.4 464 30-34 18.1 9.5 10.3 6.3 0.0 47.4 4.4 4.0 100.0 37.9 22.8 266 35-39 20.3 6.3 9.3 7.6 0.0 50.7 1.1 4.7 100.0 35.9 23.8 190 40-44 25.7 7.2 4.3 7.4 0.0 45.6 2.8 7.1 100.0 37.2 31.5 92 45-49 (11.1) (1.4) (10.5) (7.0) (0.0) (59.0) (6.8) (4.3) (100.0) (23.0) (21.4) 30 Education None 16.6 3.6 7.0 7.8 0.0 57.2 3.1 4.5 100.0 27.2 19.3 1035 Basic 26.8 9.3 11.1 7.9 0.2 40.7 1.2 2.8 100.0 47.2 28.1 412 Secondary + 33.3 13.5 14.7 10.9 0.0 26.8 0.0 0.9 100.0 61.4 39.2 162 Wealth index quintiles Poorest 8.3 1.4 7.3 10.8 0.0 66.5 2.3 3.3 100.0 17.1 8.7 378 Second 10.3 4.9 4.7 9.4 0.0 62.6 3.0 5.3 100.0 19.8 14.4 352 Middle 15.3 6.1 10.6 7.9 0.0 52.2 2.9 5.1 100.0 32.0 18.9 322 Fourth 29.4 7.5 13.2 7.7 0.3 35.6 2.6 3.7 100.0 50.1 34.6 307 Richest 51.5 12.7 9.4 3.3 0.0 22.2 0.5 0.5 100.0 73.6 51.0 251 Total 20.9 6.0 8.8 8.1 0.1 50.0 2.3 3.7 100.0 35.7 23.5 1610 * MICS indicator 4; MDG indicator 17 ** MICS indicator 5 Skilled health personnel includes doctors, nurses and midwives. Includes 2 women missing information on education who are not shown separately Percentages shown in parenthesis are based on less than 50 unweighted cases 95 Table CD.1: Family support for learning Percentage of children age 0-59 months for whom household members are engage in activities that promote learning and school readiness, Yemen, 2006 Percentage of children age 0-59 months For whom household members engage in four or more activities that promote learning and school readiness* Mean number of activities household members engage in with the child For whom the father engage in one or more activities that promote learning and school readiness** Mean number of activities the father engage in with the child Living in a household without their natural father Number of children age 0- 59 months Sex Male 25.1 2.5 34.1 0.6 7.9 1925 Female 26.0 2.5 30.2 0.6 7.7 1858 Residence Urban 38.5 3.0 46.1 0.9 5.9 1021 Rural 20.7 2.3 27.1 0.5 8.5 2762 Age 0-23 months 14.2 2.0 26.6 0.5 7.3 1574 24-59 months 33.6 2.9 36.2 0.7 8.2 2209 Mother’s education None 19.3 2.2 27.8 0.5 7.7 2483 Basic 34.5 2.8 36.3 0.7 8.6 941 Secondary+ 46.0 3.3 51.4 1.1 5.9 316 Non-standard curriculum (37.8) (3.1) (54.3) (1.1) (8.6) 41 Father’s education None 15.0 2.1 25.7 0.4 0.0 737 Basic 24.7 2.4 30.8 0.6 0.0 1365 Secondary+ 34.2 2.8 45.0 0.9 0.0 1217 Non-standard curriculum 17.0 2.1 27.5 0.5 0.0 164 Father not in household 24.5 2.4 4.4 0.1 100.0 295 Wealth index quintiles Poorest 13.5 1.9 21.3 0.4 8.5 878 Second 20.0 2.3 28.5 0.6 8.3 810 Middle 24.2 2.4 32.9 0.6 6.8 759 Fourth 31.7 2.9 36.6 0.7 7.5 738 Richest 44.6 3.2 47.0 0.9 7.8 598 Total 25.5 2.5 32.2 0.6 7.8 3783 * MICS indicator 46 ** MICS Indicator 47 Includes 1 child with missing information on mother's education and 6 children with missing information on mother's education who are not shown separately. Figures in parenthesis are based on less than 50 unweighted cases 96 Table CD.2: Learning materials Percentage of children age 0-59 months living in households containing learning materials, Yemen, 2006 Children living in households with: Child plays with: 3 or more non- children's books* 3 or more children's books** Household objects Objects and materials found outside the home Home- made toys Toys that came from a store No playthings mentioned 3 or more types of playthings *** Number of children age 0- 59 months Sex Male 59.5 10.8 42.2 51.5 14.2 46.5 18.7 19.4 1925 Female 57.7 9.8 44.0 46.9 15.2 42.1 19.6 16.5 1858 Residence Urban 73.1 21.3 43.1 31.9 15.5 68.0 16.4 20.4 1021 Rural 53.3 6.3 43.1 55.6 14.4 35.6 20.2 17.1 2762 Age 0-23 months 59.1 10.2 33.2 27.8 10.1 35.2 40.0 10.9 1574 24-59 months 58.3 10.4 50.1 64.5 18.0 50.8 4.3 23.0 2209 Mother’s education None 50.3 5.9 44.5 55.1 14.4 34.6 20.8 17.1 2483 Basic 71.2 16.4 37.4 36.3 14.1 60.1 16.8 16.4 941 Secondary+ 84.2 25.0 47.5 40.9 19.1 71.3 14.5 28.0 316 Non-standard curriculum (77.0) (24.1) (51.9) (49.3) (14.8) (64.2) (10.6) (28.5) 41 Wealth index quintiles Poorest 33.4 3.5 45.4 63.9 8.4 15.0 24.2 10.3 878 Second 48.3 3.7 44.0 56.6 13.4 31.8 20.5 15.7 810 Middle 63.7 8.2 42.9 49.4 17.6 47.0 19.0 20.4 759 Fourth 72.5 10.9 40.8 38.7 19.9 65.6 15.2 22.5 738 Richest 86.1 31.3 41.5 30.5 15.6 74.7 15.1 23.5 598 Total 58.6 10.3 43.1 49.2 14.7 44.3 19.2 18.0 3783 * MICS indicator 49 ** MICS indicator 48 *** MICS indicator 50 Includes 1 child with missing information on mother's education who are not shown separately. Figures in parenthesis are based on less than 50 unweighted cases 97 Table CD.3: Children left alone or with other children Percentage of children age 0-59 months left in the care of other children under the age of 10 years or left alone in the past week, Yemen, 2006 Percentage of children age 0-59 months Left in the care of children under the age of 10 years in past week* Left alone in the past week Left with inadequate care in past week Number of children age 0-59 months Sex Male 32.2 9.9 35.6 1925 Female 29.2 9.8 32.5 1858 Residence Urban 18.6 4.6 20.8 1021 Rural 35.2 11.8 39.0 2762 Age 0-23 months 25.0 10.7 29.4 1574 24-59 months 34.8 9.2 37.5 2209 Mother’s education None 34.1 11.3 37.6 2483 Basic 26.1 7.2 29.3 941 Secondary+ 18.6 6.2 21.9 316 Non-standard curriculum (20.0) (9.1) (27.4) 41 Wealth index quintiles Poorest 40.8 18.5 46.4 878 Second 35.6 10.6 40.0 810 Middle 28.4 7.5 29.9 759 Fourth 25.1 4.7 27.1 738 Richest 19.3 5.5 22.0 598 Total 30.7 9.8 34.1 3783 * MICS indicator 51 Includes 1 child with missing information on mother's education who are not shown separately. Figures in parenthesis are based on less than 50 unweighted cases 98 Table ED.1: Early childhood education Percentage of children age 36-59 months who are attending some form of organized early childhood education programme, Yemen, 2006 Percentage of children age 36-59 months currently attending early childhood education* Number of children age 36-59 months Sex Male 2.5 771 Female 2.6 694 Residence Urban 5.3 384 Rural 1.6 1081 Age of child 36-47 months 2.1 774 48-59 months 3.1 691 6 years . na Mother's education None 1.6 1007 Basic 3.3 335 Secondary+ 8.4 104 Non-standard curriculum (*) 18 Wealth index quintiles Poorest 0.0 346 Second 0.5 309 Middle 1.9 302 Fourth 4.2 288 Richest 8.4 219 Total 2.6 1465 * MICS indicator 52 Total includes 1 child missing information on mother’s education who is not shown separately. (*) Figures based on less than 25 unweighted cases Figures shown in parenthesis are based on less than 50 unweighted cases 99 Table ED.2: Primary school entry (Basic Education) Percentage of children of primary school entry age attending grade 1, Yemen, 2006 Percentage of children of primary school entry age currently attending grade 1* Number of children of primary school entry age Sex Male 41.7 438 Female 37.5 411 Residence Urban 50.8 226 Rural 35.7 624 Age of child 6 39.7 850 Mother's education None 33.9 622 Basic 54.1 157 Secondary+ 66.3 55 Non-standard curriculum (*) 13 Wealth index quintiles Poorest 25.5 217 Second 39.3 158 Middle 42.1 167 Fourth 46.2 171 Richest 51.7 136 Total 39.7 850 Table based on estimated age as of the beginning of the school year * MICS indicator 54 Total includes 2 children missing information on mother’s education who are not shown separately. (*) Figures based on less than 25 unweighted cases 100 Table ED.3: Primary school net attendance ratio (Basic Education) Percentage of children of primary school age attending primary or secondary school (NAR), Yemen, 2006 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio* Number of children Residence Urban 84.9 1008 80.4 939 82.7 1947 Rural 72.4 2419 53.1 2450 62.7 4869 Age 6 45.4 438 39.7 411 42.6 850 7 69.3 432 58.3 440 63.7 872 8 81.8 328 72.2 324 77.0 652 9 84.7 416 69.9 476 76.8 892 10 87.5 328 76.8 285 82.5 612 11 87.6 409 74.0 3

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