Zambia - Demographic and Health Survey - 1993

Publication date: 1993

Zambia Demographic and Health Survey 1992 University of Zambia • ! ,~ Central Statistical Office ~DHS Demographic and Health Su~'eys Macro International Inc, Zambia Demographic and Health Survey 1992 KwesiGaisie Anne R. Cross Geoffrey Nsemukila University of Zambia Lusaka, Zambia Central Statistical Office Lusaka, Zambia Macro International Inc. Columbia, Maryland USA March 1993 This report summarises the findings of the 1992 Zambia Demographic and Health Survey (ZDHS) conducted by the University of Zambia, in collaboration with the Central Statistical Office and the Ministry of Health. Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Develop- ment (USAID), the United Nations Population Fund (UNFPA), the Norwegian Agency for Development (NORAD) and the Government of Zambia. The ZDHS is part of the worldwide Demographic and Health Surveys (DHS) programme, which is designed to collect data on fertility, family planning and maternal and child health. Additional information about the Zambia survey may be obtained from the DeparUnent of Social Development Studies, School of Humanities and Social Sciences, University of Zambia, P.O. Box 32379, Lusaka, Zambia (Telephones 260632, 260637, 260640, 252514, 260644, 260645, 260626, 260627; Fax 260-1-253952; Telex ZA44370). Additional information about the DHS programme may be obtained by writing to: DHS, Macro International Inc., 8850 Stanford Boulevard, Suite 4000, Columbia, MD 21045, USA (Telephone 410-290-2800; Fax 410-290-2999). CONTENTS Page TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii F IGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii SUMMARY OF F INDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv MAP OF ZAMBIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii CHAPTER 1 INTRODUC~ON 1.1 History, Geography and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . . . . . . 4 1.4 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.5 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 CHARACTERIST ICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.2 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.3 Background Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 CHAPTER 3 FERTILITY 3.1 Fertility Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.2 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.3 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.4 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.5 Teenage Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 CHAPTER 4 FERTILITY REGULAT ION 4.1 Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 4.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 4.3 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.4 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.5 Knowledge of Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.6 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.7 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.8 Exposure to Family Planning Messages on Radio and Television . . . . . . . . . . . . . . . . 52 4.9 Approval of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 iii CHAPTER 5 Page OTHER PROXIMATE DETERMINANTS OF FERTILITY 5.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 5.3 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.4 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.5 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . . . . . . . 65 5.7 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 CHAPTER 6 FERTILITY PREFERENCES 6.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 6.2 Demand for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 6.3 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.4 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 CHAPTER 7 INFANT AND CHILD MORTALITY 7.1 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 7.2 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.3 Socioeconomic Differentials in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . 82 7.4 Demographic Differentials in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . 83 7.5 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 CHAPTER 8 MATERNAL AND CHILD HEALTH 8.1 Antenatal Care and Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 8.2 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 8.3 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 8.4 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 8.5 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 CHAPTER 9 INFANT FEEDING AND CHILDHOOD AND MATERNAL NUTRITION 9,1 Bmasffeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 9.2 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 9.3 Nutritional Status of Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 iv CHAPTER 10 10.1 10.2 10.3 Page KNOWLEDGE OF AIDS Knowledge About AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Sources of Information about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Attitudes about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 APPENDIX A A.1 A.2 A.3 APPENDIX B APPENDIX C APPENDIX D APPENDIX E SURVEY DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Sample Design and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 EST IMATES OF SAMPL ING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 DATA QUAL ITY TABLES . 153 PERSONS INVOLVED IN THE ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 SURVEY INSTRUMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 V CHAPTER 1 Table 1.1 Table 1.2 CHAPTER 2 Table 2.1 Table 2.2 Table 2.3 Table 2.4.1 Table 2.4.2 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 CHAPTER3 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 3.11 CHAPTER 4 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 TABLES Page INTRODUCTION Demographic indicators, Zambia 1969, 1989 and 1990 . . . . . . . . . . . . . . . . . . . . 4 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . 9 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . 11 Population by age from other sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . 16 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . 17 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Percent distribution of women of reproductive age, Zambia, 1980 and 1992 . . . . 21 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 FERTILITY Age-specific fertility rates over time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Children bom to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 FERTILITY REGULATION Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . 37 Knowledge of modem contraceptive methods and source for methods . . . . . . . . 39 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . 42 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . 44 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . 46 Time to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . 48 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 vii Table 4.12 Table 4.13 Table 4.14 Table 4. I5 Table 4.16 CHAPTER 5 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 CHAPTER 6 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 CHAPTER7 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 CHAPTER 8 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Page Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . 51 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . 52 Acceptability of the use of mass media for disseminating family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 55 OTHER PROXIMATE DETERMINANTS OF FERTILITY Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Number of co-wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Postpartum amenorrhoea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . 65 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . 67 FERTILITY PREFERENCES Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . 70 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Desire to limit (stop) childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . 76 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 INFANT AND CHILD MORTALITY Indices for underreporting of infant deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . 82 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . 84 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 MATERNAL AND CHILD HEALTH Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . 91 Tetanus toxoid vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 viii Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 8.14 Table 8.15 CHAPTER 9 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 9.8 CHAPTER 10 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 APPENDIX A Table A.1 Table A.2 APPENDIX B Table B.1 Table B.2 Table B.3 Table B.4 Table B.5 Table B.6 Table B.7 Table B.8 Table B.9 Table B.10 Page Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Prevalence and tmalment of acute respiratory infection . . . . . . . . . . . . . . . . . . 101 Prevalence and trealment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Knowledge and use of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 INFANT FEEDING AND CHILDHOOD AND MATERNAL NUTRITION Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Breasffeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Breastfeeding and supplememation by age . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . 113 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . 115 Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . 117 Anthmpometric indicators of maternal nutritional status . . . . . . . . . . . . . . . . . 119 Differentials in maternal anthmpometric indicators . . . . . . . . . . . . . . . . . . . . . 120 KNOWLEDGE OF AIDS Knowledge of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Perceived modes of AIDS transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Perceptions about AIDS prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Sources of AIDS information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Attitudes toward AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 SURVEY DESIGN Sample design parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 ESTIMATES OF SAMPLING ERRORS List of selected variables for sampling errors, Zambia 1992 . . . . . . . . . . . . . . 139 Sampling errors, entire sample, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . . . . 140 Sampling errors, urban areas, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Sampling errors, mral areas, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Sampling errors, Central Province, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . . 143 Sampling errors, Copperbelt Province, Zambia 1992 . . . . . . . . . . . . . . . . . . . 144 Sampling errors, Eastem Province, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . . 145 Sampling errors, Luapula Province, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . 146 Sampling errors, Lusaka Zambia 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Sampling errors, No,them Province, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . 148 ix Page Table B. 11 Table B.12 Table B.13 Sampling errors, North-Westem Province, Zambia 1992 . . . . . . . . . . . . . . . . . 149 Sampling errors, Southern Province, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . 150 Sampling errors, Western Province, Zambia 1992 . . . . . . . . . . . . . . . . . . . . . 151 APPENDIX C DATA QUALITY TABLES Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . 157 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 CHAPTER 2 Figure 2.1 Figure 2.2 Figure 2.3 CHAPTER 3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 CHAPTER 4 Figure 4.1 Figure 4.2 Figure 4.3 CHAPTER 6 Figure 6.1 Figure 6.2 Figure 6.3 CHAPTER 7 Figure 7.1 Figure 7.2 CHAPTER 8 Figure 8.1 Figure 8.2 Figure 8.3 CHAPTER 9 Figure 9.1 CHAPTER 10 Figure 10.1 FIGURES Page CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Number of persons reported at each age by sex, Zambia 1992 . . . . . . . . . . . . . . . . . . 12 Distribution of the (de facto) household population by age, Zambia 1992 . . . . . . . . . 12 Percentage of the household population with no education . . . . . . . . . . . . . . . . . . . . . 18 FERTILITY Age-specific fertUity rates, Zambia, 1980 and 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Age-specific fertility rates by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Total fertility rates by province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Percentage of teenagers who have begun childbearing, by age . . . . . . . . . . . . . . . . . . 36 FERTILITY REGULATION Percentage of currently married women who know specific contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Percentage of currently married women using a contraceptive method . . . . . . . . . . . . 43 Distribution of current users of contraception by source of supply . . . . . . . . . . . . . . . 47 FERTILITY PREFERENCES Fertility preferences among currently married women 15-49 . . . . . . . . . . . . . . . . . . . 69 Fertility Preferences among currently married women by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Number of women with uumet need for family planning services, by province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 INFANT AND CHILD MORTALITY Infant mortality rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Infant mortality rates by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 85 MATERNAL AND CHILD HEALTH Antenatal care, tetanus vaccinations, place of delivery, and delivery assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Vaccination coverage among children age 12-23 months . . . . . . . . . . . . . . . . . . . . . . 97 Percentage of children 12-23 months who am fully vaccinated . . . . . . . . . . . . . . . . . . 99 INFANT FEEDING AND CHILDHOOD AND MATERNAL NUTRITION Percentage of children under five who are chronically undernourished (stunted) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 KNOWLEDGE OF AIDS Knowledge of AIDS among women age 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 xi PREFACE The Zambia Demographic and Health Survey (ZDHS) was a nationwide sample survey of women of reproductive age designed to provide, among other things, information un fertility, family planning, child survival and health of children. The survey was conducted by the University of Zambia (Department of Social Development Studies) in collaboration with the Central Statistical Office (CSO) and Ministry uf Health (MOH) as part of the worldwide Demographic and Health Surveys programme which is being administered by Macro International Inc. of Columbia, Maryland. The major objectives of the ZDHS were to provide the country with data useful for informed policy choices and for enhancing the design and implementation ofprogrammes aimed at promoting family planning and improving the health status of the populafmn. As noted above, the survey collected data on major health phenomena, family planning, fertility and infant and child mortality. Besides providing a primary source uf population and health data, it developed the technical skills and resources necessary to the conduct future demographic and health surveys. The successful implementation of all aspects of the project including the production of this volume was due to untiring effo~s and contributions of many individuals and organizations. We owe a special debt of gratitude to the Central Statistical Office (CSO) for providing strong logistical support and financial assistance, which facilitated the successfulimplementation ufthe project. Our grateful thanks are due to David Diangamo, Director of the Central Statistical Office, fur his unparalleled cooperation, encouragement and advice. We wish to thank Emmanuel Silanda, Modesto Banda, Kumbutso Dzekedzeke (Sampler), George Namasiku, Isaac Muzeya and all the CSO staffwho participated in the survey in many specific ways. We are deeply grateful to the Ministry of Health which provided the bulk of the field staff. We thank Dr. John A. Mbomena, Assistant Director of Medical Services, for spearheading the contributions of the Ministry. We wish to record our sincere gratitude to many individuals at the University of Zambia, especially in the Demography Division of the Department of Social Development Studies and the Bursar's office. Our heartfelt thanks are due to Kwesi Gaisie (Project Director), Geoffrey Nsemukila (Deputy Director), Muses Nzima (Head, Demography Division), Record Malungo (Research Assistant), Joyce Simbeya, Lister Madubansi and Felicitas Moyo (Secretaries). We wish to acknowledge the unstinting support andassistance of the Dean of the School of Humanities and Social Sciences, Dr. John Chileshe. We owe an immense debt to the Field Coordinators, Interviewers, Supervisors, Field Editors, Provincial Statist'teal Officers and Drivers for their meticulous assistance and hard work; theirs was the most delicate and risky job. We have therefore printed a list of their names in Appendix D as a perpetual token of our deepest gratitude for their help and kindness. We are also grateful to all the respondents for their patience and generosity with their time. Very special acknowledgment is due to U.S, Agency for Intemational Development (USAID), the United Nations Population Fund (UNFPA), the Norwegian Agency for Development (NORAD), the Government of the Republic of Zambia and the United Nations Department of Economic and Social Development (DESD) for providing funding and technical assistance fur the survey. We thank Moses Mukasa, UNFPA Country Director and Charles Ejiogu, Chief, Population Branch, Population Division (DESD) for their unfailing encouragement, advice and assistance. xiii Finally, we are most grateful to Macro International Inc. for providing technical assistance. We wish to record our deepest gratitude to Anne Cross, Thanh Le, Kaye Mitchell, Guillermo Roj as, Robert Wolf, and George Bicego. Special thanks are due to the reviewers of the ZDHS report. These include Albert Marckwardt, Jeremiah Sullivan, Ties Boerma, Elisabeth Sommerfelt, George Bicego, Shea Rutstein, and Sidney Moore. Prof. A.A. Siwela Acting Vice-Chancellor University of Zambia xiv SUMMARY OF FINDINGS The 1992 Zambia Demographic and Health Survey (ZDHS) was a nationally representative sample survey of women age 15-49. The survey was designed to provide information onlevels and trends of fertility, infant and child mortality, family planning knowledge and use, and maternal and child health. The ZDHS was carried out by the University of Zambia in collaboration with Central Statistical Office and the Ministry of Health. Fieldwork was conducted from mid-January to mid-May 1992, during which time, over 6000 households and 7000 women were interviewed. Results imply that fertility in Zambia has been declining over the past decade or so; at current levels, Zambian women will give birth to an average of 6.5 children during their reproductive years. Fertility rates are highest in Luapula and Northem Provinces and lowest in Lusaka Province, Childbearing begins early in Zambia; over one-quarter of teenagers (age 15-19) have borne a child. By the time they reach age 19, two- thirds of Zambian women am either mothers or pregnant with their first child. Contraceptive knowledge is nearly universal in Zambia; over 90 percent of married women reported knowing about at least one modern contraceptive method. Fifteen percent of married women am using contraception; 9 percent am using modern methods and 6 percent are using traditional methods. The most popular contraceptive methods are the pill (4 percent), withdrawal (3 percent), female sterilisation (2 percent) and condoms (2 percent). Contraceptive use is twice as high among urban women as among rural women; it is also highest in the more urbanised provinces of Lusaka and Copperbelt. Contraceptive use increases steadily with increasing level of education, from 8 percent of married women with no education to 59 percent of those with more than secondary education. Over half of women using modern methods obtained them from government sources. Women in Zambia am marrying somewhat later than they did previously. The median age at marriage has increased from 17 years or under among women now in their 30s and 40s to 18 years or older among women in their 20s. Women with secondary education marry three years later (19.9) than women with no education (16.7). Over one-fifth (22 percent) of currently married women do not want to have any more children. An additional41 percentofwomenwantto wait atleasttwoyearsbeforehaving anotherchild. When asked how many children they would like to have if they could live their lives over and choose exactly, women reported an average ideal family of 5.8 children. Results from the survey suggest that if all unwanted births were eliminated, the total fertility rate at the national level would be 5.4 children per woman, one child lower than the actual level of 6.5. One of the most striking findings from the ZDHS is the high level of child mortality and its apparent increase in recent years. Currently, nearly 1 in 5 Zambian children dies before reaching age five. From 1977- 81 to 1987-91, under-five mortality rose by 15 percent, from 152 to 191 deaths per 1000 births. The infant mortality rate is currently 107 deaths per 1000 births. Infalat and child mortality are higher in Lnapula and Northern Provinces and lowest in Southern Province. ZDHS data indicate that spacing births can potentially reduce childhood mortality levels; children born less than two years after a preceding birth were almost three times more likely to die during their first year of life than children born at least four years after a preceding birth. Information on various aspects of maternal and child healtlr--antenatal care, vaccinations, bmastfeeding and food supplementation, and illness---was collected in the ZDHS on births in the five years preceding the survey. The findings show that 90 percent ofbirtha were to mothers who had received antenatal XV care during pregnancy. Thirty-nine percent of births were to mothers who received two or more injections of tetanus toxoid during pregnancy. ZDHS data indic ate that haft of the births in Zambia are delivered at home and half in health facilities. For this reason, only half are assisted by medically trained personnel; one-third of births in Zambia are assisted by relatives and 7 percent are delivered without assistance. Based on information obtained from health cards and mothers' reports, 95 percent of children age 12- 23 months are vaccinated against tuberculosis, 94 percent have received at least one dose of DPT and polio vaccines, and 77 percent have been vaccinated against measles. Sixty-seven percent of children age 12-23 months have been fully immunised and only 4 percent have not received any immuhisations. During the two weeks preceding the survey, 13 percent of children under age five had symptoms of acute lower respiratory infection (cough with difficult breathing). Almost two-thirds of these children were taken to a health facility for treatment. Over the same two-week period, 44 percent of children under five suffered from a fever, of whom 61 percent were taken to a health facility. Twenty-three percent of children had diarrhoea during the two weeks before the survey. Over half of these children were given a solution prepared from ORS packets (oral rehydration salts), and 23 percent received a homemade solution of sugar, salt and water. Knowledge and use of ORS packets is widespread in Zambia; 95 percent of women who gave birth in the five years before the survey had heard of ORS and 78 percent had used it. Almost all children in Zambia (98 percent) are breastfed. The median duration of breasffeeding is relatively long (19 months), but supplemental liquids and foods are introduced at an early age. By age 2-3 months, half of all children are being given supplementary food or liquid. ZDHS data indicate that undemutrition is an obstacle to improving child health; 40 percent of children under age five are stunted or short for their age, compared to an international reference population. Five percent of children are wasted or thin for their height and 25 percent are underweight for their age. The ZDHS included several questions about knowledge of AIDS. Almost all respondents (99 percent) had heard of AIDS and the vast majority (90 percent) knew that AIDS is transmitted through sexual intercourse. xvi ZAMBIA I I ANGOLA [ : NORTH WESTERN NAMIBIA • MULTIPLE URBAN CSAs • URBAN C.5A II RURAL CSA ZAIRE .- 4 II LAKE MWERU LAKE • CENTRAL TANZANIA II NORTHERN I l l i LAKE BANGWEULU I A II • / "• SOUTHERN ~ • " . y • • LAKE" KARIBA • • ZIMBABWE i • I1• f" , • ~.J MALAWI EASTERN ~'~ MOZAMBIQUE xviii CHAPTER 1 INTRODUCTION 1.1 History, Geography and Economy History Historical and archaeological evidence indicates that by 1500 much of modern Zambia was occupied by fanning people who were ancestors of the present inhabitants. In the late nineteenth century various parts of what was to become Northern Rhodesia were administered by the British South Africa Company. In 1924 the British Colonial Office assumed responsibility for administering the territory and in 1953 Northern Rhodesia (Zambia) and Southern Rhodesia (Zimbabwe) joined Nyasaland (Malawi) to form the Central African Federation of Rhodesia and Nyasaland, despite the opposition of Northern Rhodesia's Africans. The Federation was, however, dissolved in 1963. In October 1964, Zambia became an independent nation and adopted a multiparty system with the United National Independence Party (UNIP) as the ruling party and the African National Congress (ANC), led by Harry Nkumbula, in the opposition. By 1973, Zambia had become a one-party participatory democracy under President Kenneth Kaunda's UNIP. The present government headed by President Frederick Chihiba came to power hi November 1991 after winning both presidential and parliamentary elections in the reinstituted multi-party democracy. There are 73 officially recognised ethno-linguistic groups in Zambia. The major groups are Bemba, Kaonde, Lozi, Lunda, Luvale, Mambwe, Ngoni, Nyanja, Tonga, and Tumbuka. However, the ethnic and provincial alignments seldom involve the smaller ethnic groups among the seventy-three official groups. Most ethnic groups are concentrated in different parts of the country. The Bemba live primarily in Northern and Luapula Provinces, the Tonga inhabit Southern Province, the Lozi Western Province, the Nyanja and Nsenga Eastem and Central Provinces and the Luvale, Lunda and Kaonde are found in North-Western Province. Most people in Zambia are Christians; however, indigenous traditional religion is the second most widespread belief system. Geography Zambia is a land-locked country covering an area of 752,614 square kilometres and consisting of about 2.5 percent of the area of Africa. It shares borders with Zaire and Tanzania in the north; Malawi and Mozambique in the east; Zimbabwe and Botswana in the south; Namibia in the southwest and Angola in the west. Administratively, the country is divided into nine provinces and fifty-seven districts. Zambia lies in the southern tropics between 8 and 18 degrees south latitude and between 20 and 35 degrees east longitude, a huge butterfly sprawling over the Central African Plateau, with an average altitude of 1,127 metres above sea level. The mountainous areas are found chiefly along the border with Tanzania (Mbala Highlands in the northeast) and Malawi (Mafmga Mountains, particularly the Muchinga Escarpment) where the land rises to 2,000 metres above sea level. The broad depressions at the edges of the plateau form Lakes Tanganyika, Mwem and Bangweulu in the north, the Luangwa River in the east, and the Kafue basin and the alluvial plains of the Zambezi River in the west. The Zambezi River forms Zambia's southern border with Zimbabwe. Among the other major rivers in the country are the Kafue, Luangwa and Luapula. Zambia has a tropical climate and vegetation. There are three distinct seasons: the warm-wet season stretching from November through April, a cool dry winter season from May to August with the mean temperature varying between 14 and 30 degrees centigrade and a hot dry season during September and October with mean daytime temperatures rising to between 29 and 32 degrees centigrade in the north and northwest and to 35 degrees centigrade over most of westem Zambia. The Copperbelt, North-Western, Northem and Luapula Provinces receive the highest precipitation, with the annual average ranging from 1,100 mm to over 1,400 mm. There is a systematic decrease in rainfall towards the south and east, with an annual average ranging between 600 mm and 1,100 mm. The typical vegetation cover is woodland savanna with a mixture of various types of trees, tall grass, herbs and other woodlands which are mainly of the deciduous type usually found on the main plateau. These are also found in other areas, especially the successful maize- farming areas of Southern and Lusaka Provinces. Forests are found in North-Western and Northem Provinces. Grasslands occur mainly in the seasonal flood plains of Western Province and in the Kafue and Bangweulu swamps. Economy Zambia has a mixed economy consisting of a modem and urban-oriented sector confined to the line of rail (the area roughiy within forty kilometres of either side of the north-south railroad running from the Copperbelt in the north to Livingstone on the Zambezi River) and a rural agricultural sector. The modem sector is dominated by parastatal organisations, while the private sector has been predominant in construction and agriculture. Most of these parastatals are now being privatised by the Movement for Multiparty Democracy (MMD) Government. Copper mining is the country's main economic activity, accounting for 95 percent of export eamings and contributing 45 percent of govemment revenue during the decade following the attainment of political independence (i.e., 1965-1975). This situation was sharply changed by the drastic decline in world copper prices in late 1974 and 1975. Some improvement in prices began in 1978, but in 1981 and 1982 prices dropped sharply again. The fall in copper prices, rising oil prices and the slow pace of industrialisation with a heavy dependence on imports have driven the economy to a very difficult situation. In 1989 the gross domestic product grew by a meagre 0.1 percent in contrast to 6.3 percent in 1988. Real output declined by an average of about 1.0 percent annually between 1989 and 1991, with the decline in 1991 amounting to 1.8 percent. Real per capita gross domestic product, on the other hand, declined by an average of 1.6 percent per annum between 1984 and 1990. In spite of attractive copper prices in 1989, acute shortage of foreign exchange remained a major constraint in the development of the economy. This was largely attributed to reduced volume of copper sales associated with difficulties in production and transportation. The development of non-traditional exports remained below expectations. Essential commodities and services cominued to remain in short supply and inflation reached an unprecedented level of well over 100 percent. As a result of an apparent decline in the national economy, the provision of social services such as health and education were drastically affected. For instance, the share of the Government budget for the education sector in 1989 was only 8 percent and in the health sector there was growing evidence of increased malnutrition and higher infant mortality. In an effort to halt the economic recession, the Movement for Multiparty Democracy (MMD) Govemment has launched an Economic Recovery Programme (ERP) to turn around the "protracted decline of the economy into sustained positive real growth, coupled with lower inflation and consequent improvement in living standards and the quality of life of the people" (Republic of Zambia, 1992). In the 1992 budget, the Government adopted certain policy measures which were intended to achieve, among other things, the following objectives: i) To halt the decline in real gross domestic product in the economy and achieve a moderate rate of growth in 1992; ii) To limit the growth in the money supply to around 25 percent and consequently bring inflation down to around 60 percent; iii) To reduce the budget deficit to 1.9 percent of GDP so as to minimise the use of inflationary finance and facilitate the reduction in inflation; iv) To restore medical and educational services to decent levels by increasing recurrent and capital funding to these sectors; and v) To rehabilitate the mad network in both rural and urban areas (Republic of Zambia 1992). 1.2 Population The 1969, 1980 and 1990 national censuses reported total populations of 4.0 million, 5.7 million and 7.8 million respectively, implying growth rates of 3.1 and 3.2 percent per annum between 1969-80 and 1980- 90 respectively (see Table 1.1). The growth rates, however, range from 2.2 and 2.3 percent in Luapula, Western and Copperbelt Provinces to 4.0 percent in Eastern Province and 5.6 percent in Lusaka Province during the 1980-90 intercensal period. The enumerated population in 1990 is lower by 0.25 million than the projected population based on the 1980 census data (Central Statistical Office, 1985b), by 0.20 million from the World Bank projections and by 0.63 million from the latest medium variant projections of the United Nations for the same year (World Bank, 1992; United Nations, 1991). Thus, there seems to be an undercount in the 1990 population census by between 2 and 7 percent. The growth rates would therefore be underestimates. The population density increased from 5.3 people per square kilometre in 1969 to 7.5 in 1980 and 10.4 in 1990. The average density in 1990 ranged from 55 people per square kilometre in Lusaka Province and 50 in Copperbelt Province (both heavily urbanised) to 5 and 3 people per square kilometre in Western and North-Western Provinces, respectively. There has been almost continuous migration of people to mining towns and urban centres and as a result, the proportion of the population living in urban areas has increased steadily from 29 percent in 1969 to 42 percent in 1990. The proportion urban varies among the provinces from 91 percent in Copperbclt Province to 9 percent in Eastern Province. While the population in urban areas has grown by 3.7 percent per annum during the decade 1980-90, the population of rural areas has increased by 2.8 percent. During the previous period 1969-80, the urban population grew at an even higher 5.8 percent per annum, compared with 1.6 in the rural areas. Thus, the speed of migration to the urban areas slowed down considerably during the 1980-90 period compared to the earlier period. Table 1.1 Demographic indicators, Zambia 1969 T 1989 and 1990 National censuses Indicator 1969 1980 1990 Population (millions) 4.0 5.7 7.8 Density (pop./sq.km.) 5.3 7.5 10.4 Percent urban 29.4 39.9 42.0 Crude birth rate (per 1000) 47.7 50.0 49.5 a Crude death rate (per 1000) 19.7 16.7 13.2 a Growth rate (per 1000) 28.0 33.3 36.0 a Total fertility rate 7.1 7.2 7.0 a Completed family size (women age 40-49) 5.1 b 6.7 b NA Infant mortality rate 141 97 89.6 a Life expectancy at birth Male 41.8 50.4 52.9 a Female 45.0 52.5 55.0 a NA = Not applicable aEstimates based on projections of 1980 census data bRepor ted figures Sources: Central Statistical Office, 1974; Central Statistical Office, 1985a and 1985b; Central Statistical Office, 1990a. The estimated fertility levels have remained virtually constant during the 1969-80 period. The crude birth rate has ranged between 48 and 50 bin/as per 1000 population per year and the crude death rate is estimated to have declined from 16.7 during the quinquennium 1975-1980 to 13.2 during 1985-1990 (Central Statistical Office, 1985b). The previously estimated total fertility rates lie in the neighbourhood of 7.0 children per woman. The reported total fertility rate of 4.0 in 1969 and 5.7 in 1980 are indicative of underreporting of live births in the two censuses. The life expectancy at birth climbed from 43 years in 1969 to 51 years in 1980; it was projected to have risen to 54 years by 1990. Zambian women live, on average, 2 to 3 years longer than men. Mortality levels are highest in Eastern, Luapula and Western Provinces, followed by Northern and Southern Provinces, with Lusaka, Copperbelt and Central Provinces experiencing the lowest mortality rates; life expectancy at birth ranged from 44.9 years in Eastern Province to 56.5 years in Copperbelt (Central Statistical Office, 1985b). The overall child mortality declined from 175 deaths per 1000 births in the mid- 1970s to 160 in the late 1970s and early 1980s. 1.3 Population and Family Planning Policies and Programmes For the first decade and a half after independence, Zambia did not view her high rate of population growth as a developmental problem. The only concern then was with the high rate of migration from rural to urban areas and uneven spatial distribution of the population. The results of the 1980 Population and Housing Census exposed the rapidity with which the population was expanding and the implied adverse effect on development and individual welfare. This led to government reappraisal of the perceptions of the role of population in national development efforts. The government realised that the nation's development planning 4 and plan implementation processes should not only aim at accommodating the increased demands for goods and services brought about by population growth, but should also aim at influencing those aspects of the country's sociocultural life that underpin high levels of reproduction and thus of population growth. In 1984, the National Commission for Development Planning (NCDP)---now the Ministry of Planning and Development Cooperation--was given a mandate to initiate a draft population policy which would aim at achieving a population growth rate consistent with the growth rate of the economy. The National Population Policy was formally launched by the President in May 1989. The ultimate objective of the policy is to improve the standard of living and quality of life of all Zambians. The immediate objectives of the policy are to: i) Initiate, improve and sustain measures aimed at slowing down the nation's high population growth rate; ii) Enhance the people's health and welfare and prevent premature death and illness especially among the high health risk groups of mothers and children; iii) Systematically integrate population factors into the nation's development planning and the plan implementation processes; iv) Ensure that all couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so; v) Achieve a more even distribution of the population between urban and rural areas and to regulate international migration; vi) Expand and maintain the nation's population database. The main targets of the national population policy are to: i) Reduce the rate of population growth from 3.7 percent per annam in 1989 to 3.4 percent per annum by the year 2000 and to 2.5 percent per annum by the year 2015; ii) Reduce the total fertility rate from 7.2 to 6 by the year 2000 and 4 by the year 2015; i i i) Reduce the infant mortality rate from 97 per 1000 live births to 65 per 1000 live births by the year 2000 and to 50 by the year 2015; iv) Make family planning services available, accessible and affordable by at least 30 percent of all adults in need of such services by the year 2000 (National Commission for Development Planning, n.d.). The strategies for implementing the policy are predicated on the voluntary acceptance of family planning methods in accordance with fundamental haman rights. The main strategies include: i) Formulating and implementing fertility regulation and family planning programmes within the context of the nation's health care and related systems; ii) Providing necessary information and education on the value of a small family size norm to both the individual family and the nation as a whole in achieving self-reliance; iii) Intensifying the primary health care programme especially matemai and child health care, so as to reduce the levels of infant, child and matemal morbidity and mortality; iv) Improving the status of women through the removal of various social, legal, administrative and cultural barriers to their effective participation in national affairs in order to enhance their participation in national development efforts and as a way of ensuring demographic transition from high to low population growth rates (National Commission for Development Planning, n.d.). Non-governmental agencies such as the United Nations Population Fund (UNFPA), Intemationai Planned Parenthood Federation (IPPF) through its Zambian affiliate--the Planned Parenthood Association of Zambia (PPAZ)--and the Family Life Movement of Zambia (FLMZ) provide material, financial and technical assistance and operate family planning clinics, supplementing the efforts of the Ministry of Health (MOH). 1.4 Health Priorities and Programmes The Government's commitment to the objectives of attaining health for all means not only improving the accessibility of health services and reducing mortality and morbidity, but also improving the quality of life of all Zambians. The strategy for achieving this objective is the Primary Health Care (PHC) programme, which constitutes an important component of the health care delivery system. To ensure that the PHC programme operates efficiently in tackling the main health problems of the individual, the family, and the community, the health service has been decentralised, with the responsibility of planning, implementing, monitoring, and managing PHC programmes falling to the districts. The integrated health plans developed out of the District Heaith Boards' Basic Health Programme constitute the PHC package. The reformulated PHC programme aims, among other things, to tackle the main health problems in the community, focusing on the needs of the underserved, high risk, and vulnerable groups. Thus, attention is paid to the rural and peri-urban areas where the health needs of the people are greatest, with particular emphasis placed on maternal and child care, family planning, nutrition, control of communicable diseases (e.g., diarrhoea, cholera, dysentery, sexually transmitted diseases, HIV/AIDS, malaria, etc.), immunisation, and environmental sanitation in order to secure adequate health care for all Zambians. The 1992 National Health Policies and Strategies (Health Reforms) establishes the Government's commilment to improve the health of the population by progress towards the achievement of the following targets by the year 2000: To make family planning (child spacing) available, accessible, and affordable by at least 30 percent of all adults in need. To reduce the percentage of underweight children (0-5 years) from 23 to 18 percent. To bring under control 80 percent of tuberculosis cases. To reduce matemal mortality (through promotion of safe motherhood) by 50 percent. To increase from 75 to 85 percent the proportion of infants vaccinated with DPT, polio, measles and BCG and to increase the tetanus immunisation coverage of pregnant women as follows: TT5 from 10 to 50 percent and TT3 from 33 to 70 percent in 5 years' time. To increase the percentage of the population having adequate sanitation from 66 to 75 percent in urban areas and from 37 to 57 percent in rural areas in 5 years' time (Ministry of Health, 1992). The implementation of all these aspects of the PHC programmes requires multi-sectoral action and close collaboration among the various govemment institutions. The Govemment has therefore set up multi- sectoral PHC committees as an integral part of the PHC basic supportive manpower and inter-sectoral collaboration with other ministries has been given prominence. 1.5 Objectives and Organisation of the Survey Objectives The Zambia Demographic and Health Survey (ZDHS) is a nationwide sample survey of women of reproductive age designed to provide, among other things, information on fertility, family planning, child survival and health of children. The primary objectives of the ZDHS are: i) To collect up-to-date information on fertility, infant and child mortality and family planning; ii) To collect information on health-related matters such as breastfeedIng, antenatal care, children's immunisations and childhood diseases; iii) To assess the nutritional status of mothers and children; iv) To support dissemination and utilisation of the results in planning, managing and improving family planning and health services in the country; and v) To enhance the survey capabilities of the institutions Involved in order to facilitate the implementation of surveys of this type in the future. Organisation The Zambia Demographic and Health Survey (ZDHS) was conducted by the University of Zambia (Department of Social Development Studies), with the assistance of the Central Statistical Office (CSO) and the Ministry of Health (MOH). Macro Intemational Inc. of Columbia, Maryland provided technical assistance to the project through its contract with the United States Agency for International Development (USAID). Funding for the survey was supplied by Macro International (from USAID), the United Nations Population Fund (UNFPA), the Norwegian Agency for Development (NORAD), and the Government of Zambia (through the University of Zambia and the Central Statistical Office (CSO)). 7 Funds from USAID were administered by Macro International and were used for training of interviewers, supervisors and editors, field allowances for interviewers and supervisors, purchase of anthropometric and other survey equipment, data processing, printing of questionnaires and publication of reports. NORAD funds were used for training interviewers, supervisors, editors and purchase of a personal computer and a printer. UNFPA provided funds for fuel and field allowances for the Survey Director and his deputy. In addition to providing vehicles for the survey, the Central Statistical Office (CSO) paid the field allowances for editors, field coordinators and drivers, as well as providing fuel for the household listing exercise. The Ministry of Health contributed most of the field staff. Sample In preparation for the 1990 Census of Population, Housing and Agriculture, the entire country was demarcated into Census Supervisory Areas (CSAs). Each CSA was in turn divided into Standard Enumera- tion Areas (SEAs) of roughly equal size. The frame of 4240 CSAs was stratified into urban and rural areas within each province. The ZDHS sample was selected from this frame in three stages. First, 262 CSAs were selected from this frame with probability proportional to size. One SEA was then selected from within each CSA, again with probability proportion to size. After a household listing operation in all selected SEAs, a systematic sample of households was then selected. As a result of oversampling of households in Luapula, North-Western and Western Provinces in order to pmduce province-level estimates for some variables, the ZDHS sample is not self-weighting at the national level. A more detailed description of the sample design is presented in Appendix A. Questionnaires Two types of questionnaires were used for the ZDHS: the Household Questionnaire and the Individual Questionnaire. The contents of these questionnaires were based on the DHS Model B Questionnaire, which is designed for use in countries with low levels of contraceptive use. Additions and modifications to the model questionnaires were made after consultation with members of the Department of Social Development Studies of the University of Zambia, the Central Statistical Office (CSO), the Ministry of Health, the Planned Parenthood Association of Zambia (PPAZ), and the National Commission for Development Planning (see Appendix E). The questionnaires were developed in English and then translated into and printed in seven of the most widely spoken languages (Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja and Tonga). The Household Questionnaire was used to list all the usual members and visitors of a selected household. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women who were eligible for the individual interview. In addition, information was collected on the household itself, such as the source of water, type of toilet facilities, material used for the floor of the house, and ownership of various consumer goods. The Individual Questionnaire was used to collect information from women age 15-49 about the following topics: Background characteristics (education, religion, etc.); Reproductive history; Knowledge and use of family planning methods; Antenatal and delivery care; Breastfeeding and weaning practices; Vaccinations and health of children under age five; 8 Marriage; Fertility preferences; Husband's background and respondent's work; and Awareness of AIDS. In addition, interviewing teams measured the height and weight of all children under age five and their mothers. Fieldwork The fieldwork for the ZDHS was carried out by 10 interviewing teams. Each consisted of one supervisor, one field editor, four interviewers and one driver;, however, due to heavier workloads in two provinces, one team had five interviewers and another six. In total, there were 10 supervisors, 10 field editors, 43 interviewers, and 10 drivers. Of the interviewers, 34 were women and 9 were men. In addition, each team was assigned a fieldwork coordinator, generally one of the trainers, who spent approximately half of the fieldwork time in the field with his/her team. Fieldwork commenced on 18th January and was completed on 15th May 1992. The people involved in the survey are listed in Appendix D. A more complete description of the fieldwork is presented in Appendix A. Table 1.2 is a summary of response rates from the household and the individual interviews. A total of 6,709 households were selected; of these 6,209 were successfully interviewed. The shortfall is due primarily to dwellings being vacant at the time they were visited by the interviewing team. Of the 6,458 households that were occupied, 96 percent were successfully interviewed. In these households, 7,247 women were identified as eligible for the individual interview and 7,060 were successfuUy interviewed. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates. Zambia 1992 Result Urbma Rural Total Households sampled 2577 4132 6709 Households found 2522 3936 6458 Households interviewed 2480 3729 6209 Household response rate 98.3 94.7 96.1 Eligible women 3446 3801 7247 Eligible women inte~iewed 3358 3702 7060 Eligible women response rate 97.4 97.4 97.4 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Information on the characteristics of the households and the individual women interviewed in the survey is essential for the interpretation of survey findings and can provide an approximate indication of the representativeness of the survey. This chapter presents this information in three sections: characteristics of the household population, housing characteristics, and background characteristics of survey respondents. 2.1 Characteristics of the Household Population The Zambia Demographic and Health Survey collected information on all usual residents and visitors who spent the previous night in the household. The household was defined as a person or group of people l iving together and sharing a common source of food. Age and Sex The distribution of the household population in the ZDHS is shown in Table 2.1 by f ive-year age groups, according to sex and urban-rural residence. The age distribution is typical of high fertility populations, i.e., a much higher proportion of the population in the younger than in the older age groups. Examination of the single-year age distributions (see Appendix C. 1 and Figure 2.1 ) indicates slight distortions Table 2.1 Household population by age r residence and sex Percent distribution of the de facto household population by five-year age group, according to urban-rural residence and sex, Zambia 1992 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 16.5 17.0 16.8 18.8 17.4 18.1 17.7 17.2 17.5 5-9 15.1 15.8 15.4 16.1 16.2 16.2 15.6 16.0 15.8 10-14 12.9 15.5 14.2 14.0 13.9 13.9 13.4 14.6 14.0 15-19 13.0 13.9 13.5 11.9 10.9 11.3 12.4 12.3 12.4 20-24 10.1 9.6 9.9 7.4 8.2 7.8 8.8 8.9 8.8 25-29 7.6 7.9 7.7 6.4 6.5 6.5 7.0 7.2 7.1 30-34 6.1 6.4 6.2 4.7 4.9 4.8 5.4 5.6 5.5 35-39 5.3 4.4 4.8 4.0 3.6 3.8 4.6 4.0 4.3 40-44 3.8 2.8 3.3 2.6 3.3 3.0 3.2 3.1 3.1 45-49 3.2 1.7 2.5 2.4 3.0 2.7 2.8 2.4 2.6 50-54 2.3 2.3 2.3 2.4 3.6 3.1 2.4 3.0 2.7 55-59 1.6 1.2 1.4 2.3 2.8 2.6 2.0 2.0 2.0 60-64 1.0 0.7 0.8 2.5 2.1 2.3 1.7 1.4 1.6 65-69 0.6 0.4 0.5 1.5 1.4 1.5 1.1 0.9 1.0 70-74 0.4 0.3 0.4 1.4 1.2 1.3 0.9 0.8 0.8 75-79 0.2 0.1 0.1 0.9 0.5 0.7 0.5 0.3 0.4 80 + 0.2 0A 0.1 0.6 0.4 0.5 0.4 0.2 0.3 Missing, don't know 0.2 0.0 0.1 0.1 0.0 0.0 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 8247 8275 16527 8414 8985 17406 16662 17261 33933 11 Figure 2.1 Number of Persons Reported at Each Age by Sex, Zambia 1992 No. of Persons 800 r 633 400 200 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Age ZDHS 1992 Age 80+ 75 70 65 60 55 50 45 4O Figure 2.2 Distribution of the (de facto) Household Population by Age, Zambia 1992 35 33 25 20 15 10 5 3 10 9 8 7 6 5 4 3 2 1 0 1 Percent 2 3 4 5 6 7 8 9 1 0 ZDHS 1392 12, of the data due to misreporting of date of birth and/or age and preference for particular digits, though this preference is much less pronounced than in census data and data in many other countries. The distribution by five-year age groups is depicted in Figure 2.2. There appears to be a slight deficit of males at age 10-14 (especially in urban areas), which causes the excess of females over males to be high at this age group. The irregular bulge of women at age 50-54 is indicative of slight pushing of women from age group 45-49 to 50-54, presumably to reduce the workload of the interviewer. This pattern has been observed to a much greater degree in other DHS surveys (Rutstein and Bicego, 1990). However, the impact of these phenomena on the quality of the data is minimal because the shifting is not as pronounced as noted in other surveys. Table 2.2 compares the population structures derived from the 1969 and 1980 Population and Housing Censuses and the 1992 ZDHS. Dependency ratios are also shown. The age dependency ratio is the ratio of the number of persons aged 0-14 and 65 and over divided by the number of persons aged 15-64. It is an indication of the dependency responsibility of adults in their productive years. Table 2.2 Population by age from other sources Percent distribution of the population by broad age groups, 1969, 1980 and 1992, Zambia Census ZDHS 1992 Age group 1969 1980 De jure De facto Less than 15 46.4 49.8 46.7 47.3 15-64 51.3 47.4 50.6 50.1 65+ 2.3 2.8 2.6 2.6 Missing 0.0 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 Median age 15.3 16.3 16.0 Dependency ratio 0.95 1.11 0.98 1.00 Sources: Central Statiatieal Office, 1974; Central Statistical Office, 1985a and 1985b. The dependency burden in Zambia is similar to that found in other African countries. With close to 50 percent of the population under age 15 and about 3 percent over age 64, there is one dependent person for each adult in the population. As in many rapidly growing populations, old age dependency is minimal, compared to child dependency. Household Composition The vast majority of households in Zambia are headed by males (84 percent), with only 16 percent headed by women (see Table 2.3). The ZDHS data show a higher proportion of male-headed households than the 1980 census (72 percent; Central Statistical Office, 1991). Both sources show that female-headed households arcmorecommoninthe ruralthanintheurbanarcas (19vs. 13 percentintheZDHS). A sizeable number of households in Western (33 percent), North-Western (22 percent) and Eastern (20 percent) Provinces are headed by women. 13 Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, relationship st~uctttm, mad presence of foster children, according to urban-rural residence and province, Zambia 1992 Cbaract~fistic Residence Province Copper- North- South- Urban Rural Central belt Eastern Luapula Lusaka Northern Western era Western Total Household headship Male 86.9 81,3 86.0 88.3 80.0 80.6 87.2 82.1 78.2 87.8 67.4 83.8 Female 13.1 18.7 14.0 11.7 20.0 19.4 12.8 17.9 21.8 12.2 32.6 16.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of usual members 1 5,2 7.6 9.6 4.1 5.8 6.2 6.3 6.6 10.6 6.3 9.3 6.5 2 8.0 11.4 I lA 5.9 11.7 14.9 9.0 8.2 17.5 8.9 13.4 9.9 3 9.9 14.2 10.4 8.8 13.1 12.6 12.9 17.4 18.5 10.1 14.7 12.3 4 11.8 14.8 15.3 10.2 14.8 16.5 11.5 16.5 18.0 11.3 16.5 13.5 5 13.1 13.4 11.8 12.7 14.7 15.1 12.7 14.1 13.1 11.8 15.2 13.2 6 11.2 10.1 9.8 10.8 11.7 10.5 11.5 12.5 7.9 8.9 8.5 10.6 7 10.2 8.5 9.5 10.9 9.1 8.7 10.2 8.1 6.1 8.1 8.2 9.2 8 9.5 6.4 8.0 10.5 7.0 6.9 8.3 6.9 4.2 7.0 5.4 7.8 9+ 21.1 13.7 14.4 26.1 12.1 8.5 17.4 9.7 4.1 27.6 8.8 17.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 I00.0 100.0 100.0 100.0 Meanslze 6.0 5.3 5.3 6.5 5.2 4.8 5.7 4.9 4.0 6.7 4.7 5.6 Relationship structure One adult 7.9 12.2 13.4 6.5 8.6 12.3 8.7 12.4 18.9 8.7 16.3 10.3 Two related adults: Of opposite sex 29.8 41.6 34.9 27.5 40.3 45.6 35.2 43.8 54.2 32.0 36.9 36.3 Of same sex 3.4 3.6 4.0 2.6 2.2 5.8 2.6 3.5 5.2 3.6 6.6 3.5 Three or more related adults 54.1 38.3 43.8 60.2 44.8 31.6 49.4 37.1 19.6 47.7 32.7 45.4 Other 4.7 4.3 3.6 3.3 4.0 4.3 4.1 3.3 2.0 7.9 7.5 4.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 With foster children I 26.0 23.3 22.7 27.8 23.6 22.5 24.5 18.7 22.2 27.9 24.5 24.5 Note: Table is based on de jure members, i.e., usual residents. Zoster children are those under age 15 living in households with neither their mother nor their father present. 14 Single person households are also more common in the rural areas as well as in North-Western, Western, and Central Provinces than in the urban and the other provinces. On the other hand, large households with nine or more persons are common in the urban areas (21 percent) and in Southern (28 percent), Copperbelt (26 percent), and Lusaka (17 percent) Provinces. As a result, average household size is larger in the urban than rural areas (6.0 vs. 5.3 people), and in Southern (6.7), Copperbelt (6.5), and Lusaka (5.7) Provinces than in the other provinces (between 4 and 5). Overall, households in Zambia consist of an average of 5.6 people. Almost hail of the households in Zambia consist of those with three or more related adults, while most of the rest consist of those with two adults of opposite sex. Ten percent of households consist of only one adult, either with or without children. The patterns of the household structures have been influenced by the high rates of rural-urban migration and urbanisation experienced by the country over the past two decades. One-quarter of the households include one or more children under age 15 years who have neither their natural mother nor natural father living with them. The proportion of households with foster children is higher in the urban areas (26 percent), Copperbelt (28 percent), Southem (28 percent) Lusaka (25 percent) and Westem (25 percent) Provinces than in the rural areas and in the other provinces (19 to 23 percent). Education On the eve of independence, Zambia had barely 1,000 Africans with secondary school certificates and only 109 university graduates. Development plans were therefore designed to provide educated and skilled manpower for the civil service and industry. The government adopted a policy of achieving universal first level education; one of the major objectives of the Fourth National Development Plan (1989-1993) was to reach this goal of universal primary education by the year 2000. Zambia's formal education is based on a three-tier system. Under this system, primary education consists of 7 years and secondary education of 5 years (2 years junior secondary and 3 years senior secondary). Graduates of secondary school may then choose to further their education either by attending university for a four-year course leading to a degree or by attending a vocational or technical institute for a two- or three-year certificate/diploma course. The goal is for the nation to meet its manpower requirements in various areas of social, economic and political growth, as well as achieving national development and modemisation. The information presented in Tables 2.4.1 and 2.4.2 indicates that one-fifth of the population age 6 and over has received no formal education (15 percent of males and 24 percent of females). About 60 percent of both males and females have attended only primary school and 22 percent of males and 13 percent of females have attended secondary school. Only 2 percent of males and 1 percent of females have obtained higher education. There is evidence that the sharp differential in educational attainment by sex is narrowing (see Figure 2.3). For example, among people in their early fifties, the propo~on of women with no education is thrice the proportion of men with no education (60 vs. 19 percent); among those age 15-19, the difference is considerably smaller (10 vs. 7 percen0. The proportion with no education is much higher in rural than in urban areas for both males and females. Rural residents are more than thrice as likely to have never attended school (30 percent) as urban dwellers (9 percent). Of the provinces, Eastern Province has the highest proportion of both men and women with no education, while Copperbelt Province has the lowest. 15 Table 2.4.1 Educatinnal level of the male household population Percent distribution of the de facto male household population age six and over by highest level of education attended, according to selected background characteristics, Zambia 1992 Level of education Don't Number Median Background More than know/ of number characteristic None Primary Secondary secondary missing Total men of years Age ~ 6-9 39.4 59.0 0.1 0.0 1.5 100.0 2079 0.8 10-14 10.7 87.5 1.6 0.1 0.1 100.0 2237 3.9 15-19 6.7 65.9 27.3 0.1 0.1 100.0 2074 6.9 20-24 7.3 45.9 45.2 1.2 0.3 100.0 1460 7.7 25-29 5.4 45.8 43.5 5,2 0.2 100.0 1163 7.9 30-34 4.6 45.7 42,9 6.5 0.3 100.0 899 7.9 35-39 5.4 39.1 47.5 7.8 0.2 100.0 768 8.4 40-44 9.2 45.1 37.6 7.7 0.4 100.0 531 7.7 45-49 10.0 58.0 24.7 5.4 1.8 100.0 462 6.5 50-54 18.9 61.8 15.3 2.8 1.I 100.0 396 4.6 55-59 24.3 65.3 6.6 3.1 0.7 100.0 328 3.5 60-64 32.5 59.7 4.1 1.0 2.7 100,0 290 2.4 65+ 46.0 48.1 2.8 1.3 1.8 100.0 489 1.2 Residence Urban 6.7 54.6 34.2 3.6 0.8 I00.0 6638 7.2 Rural 24.0 64.3 10.3 0.9 0.6 100.0 6561 3.7 Province Central 15.1 66.2 17.0 1.4 0.3 100.0 1310 4.9 Copperbelt 7.3 55.4 34.4 1.7 1.2 100.0 3317 7.1 Eastern 32.0 56,2 10,6 0.6 0,7 100.0 1422 2.8 Luapula 15.5 63.7 16,6 3.3 0.9 100.0 725 4.3 Lusaka 9.3 53.4 31.1 5.7 0.5 100.0 2276 7.2 Northern 19.7 65.3 13.3 0.9 0.9 100.0 1166 4.4 North-Western 24.6 60.6 11.4 3.0 0.4 100.0 331 3.6 Southern 16,9 63.9 17.5 1.6 0.1 100.0 1942 5.0 Western 23.2 65.2 9.9 1.1 0.6 100.0 710 3.4 Total 15.3 59.4 22.3 2.2 0.7 100.0 13199 5.5 1Excludes 21 men with age missing. 16 Table 2.4.2 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, according to selected background characteristics. Zambia 1992 Level of education Don't Number Median Background More than know/ of number characteristic None Primary Secondary secondary missing Total women of years Age t 6-9 36.3 62.5 0.0 0.0 1.2 100.0 2180 0.8 10-14 10.6 86.4 2.8 0.0 0.2 100.0 2526 4.1 15-19 10.1 65.7 24.0 0.1 0.1 100.0 2123 6.9 20-24 11.5 58.4 29.1 0.8 0.2 100.0 1531 7.2 25-29 12.5 59.6 25.0 2.9 0.0 100.0 1241 7.1 30-34 17.3 60.9 18.7 3.1 0.0 100.0 964 7.0 35-39 19.5 55.3 20.8 4.3 0.0 100.0 687 6.5 40-44 34.9 51.1 10.5 3.4 0.1 100.0 534 2.8 45-49 45.7 49.4 4.4 0.5 0.0 100.0 410 1.3 50-54 60.2 35.7 1.9 0.6 1.6 100.0 518 0.0 55-59 66.1 31.5 1.1 0.3 1.0 100.0 354 0.0 60-64 77.7 19.9 0.5 0.0 1.9 100.0 247 0.0 65+ 83.9 14.5 0.0 0.0 1.6 100.0 385 0.0 Residence Urban 11.5 64.7 21.7 1.7 0.4 100.0 6598 6.0 Rural 36.4 58.4 4.5 0.3 0.5 100.0 7105 2.1 Provtnee Cuntral 26.0 62.4 10.6 0.9 0.1 100.0 1246 3.2 Copperhelt 11.5 66.9 20.0 0.9 0.7 I00.0 3272 5.9 Eastern 45,6 49,5 4,3 0,5 0,2 100,0 1495 1,0 Luapula 26.5 63.3 8.3 1.0 0.9 100.0 825 2.9 Lusaka 15.7 61.2 20.3 2,7 0.2 100.0 2239 5.8 Northern 35.3 57.0 6,7 0.3 0.7 100.0 1325 2.3 North-Western 36.2 54.8 8.1 0.6 0.3 100.0 370 2.4 Southern 23.2 66.3 9.7 0.5 0.3 100.0 2075 3.9 Western 35.8 57.0 6.1 0.5 0.6 100.0 855 2.3 Total 24.4 61.4 12.7 1.0 0.4 100.0 13703 4.0 IExcludes 3 women with age missing. 17 Figure 2.3 Percentage of the Household Population with No Education, by Sex Percent 100 60 40 20 ' ~ - f 0 i 10-14 15-19 20-24 25-29 30-'~4 35-39 40-44 45-49 50-54 55-59 80-84 65+ Age ZDHS 1992 Table 2.5 presents enrolment rates by age, sex and residence. Seventy percent of children aged 6-15 years are enrolled in school. Enrolment is higher in urban areas (8 of 10 children are enrolled) than in rural areas (nearly 6 of 10 children are enrolled); and boys and girls have a virtually equal chance of being enrolled (71 percent vs. 69 percent). Enrolment after age 15 drops substantially; only 34 percent of the older teenagers are still in school and only 5 percent of those in their early twenties are still in school; the proportions are higher in urban than rural areas in all groups. By age group 11-15 and above, women are much less likely than men to be enrolled in school; this may in part be due to early childbearing. Table 2.5 School enrolment Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban- rural residence, Zambia 1992 Age group Male Female Total Urban Rural Total Urbma Rural Total Urban Rural Total 6-10 75.9 48.9 61.7 81.5 51.3 65.6 78.8 50.2 63.8 11-15 89.7 72.3 80.8 82.2 64.5 73.8 85.7 68.4 77.2 6-15 82.4 59.7 70.6 81.9 57.1 69.4 82.1 58.4 70.0 16-20 51.5 39.7 45.9 32.0 12.7 22.9 41.6 26.1 34,3 21-24 9.6 6.4 8.2 2.6 0.3 1.5 6.1 3.0 4.7 18 2.2 Housing Characteristics Socioeconomic conditions were assessed by asking respondents specific questions relating to their household environment. Table 2.6 presents this information for all households in which women were interviewed. Table 2.6 Housing characteristics Percent dis~bufion of households by housing characteristics, according to urban-rural residence and province, Zambia 1992 Residence Province Copper- North- South- Characteristic Urban Rural Cena'al bblt Eastern Luapula Lusakn Northern Western em Western Total Electrldty 39.2 3.1 13.8 45.8 2.7 6.3 31.0 2.1 5.2 17.0 0.9 19.2 Source of drinklng water Piped into rcsldoncc 55.5 3.3 13.1 66.7 1.4 7.9 50.2 4.9 5.0 15.0 2.0 26.6 Public tap 33.6 7.2 22.2 18.5 10.2 2.7 39.2 4.6 10.2 24.0 17.8 19.0 Well in ~sidence 2.8 2.6 6.9 3,3 1,9 4.1 0.6 2.2 1.2 2.9 0.6 2.7 Public well 6.2 38.0 42.2 7.3 42.0 24.7 4.6 9.3 58.6 21.4 64.8 23.8 Spring 0.9 12,3 9.9 0.3 0,0 36.3 0.1 31.3 0.8 1.6 0.2 7.2 River, sUcam 0.5 23.5 4.8 3.3 13.3 18.3 4.5 34.8 24.0 24.2 10.0 13.2 Pond, lake 0.3 12.6 0.7 0.1 30.4 5.7 0.3 12.7 0.0 11.0 4.1 7.1 Other 0.0 0.2 0.0 0.0 0.8 0.2 0.2 0.0 0.0 0.0 0.0 0.2 Missing, don't know 0.2 0.3 0.2 0.5 0.0 0.2 0.2 0.0 0.2 0.I 0.5 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Sanitation fadHty Own flush t~let 43.3 1.4 12.2 57.4 1,1 8.3 30,8 3.6 4.1 7.0 0.5 20,2 Shared flush toilet 4.6 0.3 0.4 4.1 0.5 1.2 1.4 0.3 0.0 7.2 0.2 2.2 Trad. pit toilet 46.6 42.4 55.9 35.8 30.6 59.5 57.8 60.4 77.0 24.0 22.9 44.3 Vent.imp.pit latrine 1.0 1.8 1.6 0.4 7.3 0.2 1.3 0.2 1.7 0.1 0.5 1.5 No fertility, bush 4.3 53.8 29.9 1.8 60.5 30.7 8.5 35.3 17.1 61.5 75.9 31.7 Other 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0 Missing. don't know 0,1 0.2 0.0 0.4 0.0 0,2 0.1 0.0 0.2 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Flooring Earth, sand 14.1 83.8 65.7 12.5 84.5 79.1 12.7 85.1 82.2 56.7 90.6 52.6 Wood pianks/~aarquet 1.1 0.2 0.4 0.2 0.2 0.2 2.6 0.2 0.0 0.4 0.0 0.6 PVC/~rrazo tiles 4.6 0.1 0.6 3.8 0.0 0.8 7.4 0.0 0.0 0.3 0.0 2.1 Cement 78,9 15.2 32.5 81.2 15.1 19.4 76.8 14.6 17.6 42.0 8.4 43.7 Other 1.0 0,2 0.9 1.3 0.0 0,4 0.4 0.0 0.0 0.4 0.7 0.6 Missing, don't know 0.3 0.4 0.0 1.1 0.3 0.2 0.2 0.2 0.2 0.1 0.3 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Persons per sleeping room 1-2 54.2 55.2 65.9 52.1 66.4 58.3 52.4 37.3 58.1 49.8 61.0 54.8 3-4 37.7 33.7 29.5 41.0 29.4 30.2 36.8 40.6 32.6 37.1 31.3 35.5 5-6 6.0 7.4 2.6 4.8 3.2 5.7 8.7 13.2 6.6 10.1 6.1 6.8 7 + 1.4 3.0 0.6 1.0 0.6 4.0 1.8 8.9 2.0 2.0 1.5 2.3 Missing, don't know 0.7 0.6 0.5 1.1 0.3 1.7 0.4 0.0 0.6 1.0 0.0 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Mean 2.8 2.8 2.4 2.8 2.5 2.8 2.9 3.5 2.6 3.0 2.6 2.8 Number of households 2777 3432 626 1271 717 437 1010 659 247 793 448 6209 19 Electricity is available to only 19 percent of the households in Zambia. Moreover, most of those with electricity are urban households; 39 percent and 3 percent of the urban and rural households, respectively, have electricity. The proportion of households with electricity ranges from less than 1 percent in Western Province to 31 and 46 percent in Lusaka and Copperbelt Provinces, respectively. Sources of drinking water differ considerably by area of residence. In urban areas, piped water is the primary source; 56 percent of households have water piped into the residence and another 34 percent obtain water from a public tap. In rural areas, public wells (38 percent) and rivers and streams (24 percent) are the main sources of drinking water. A sizeable proportion of rural households depends on ponds or lakes (13 percent) and springs (12 percent) for drinking water. Seven in ten households in the Copperbelt and half in Lusaka Province have water piped into their residence, compared with only 1 and 2 percent in Eastem and Western Provinces, respectively. Public wells are the major sources of drinking water in Central, Eastem, North-Westem and Westem Provinces. Households in Northern, North-Westem and Southern Provinces also depend to a large extent on rivers and streams. One in five Zambian households has a flush toilet, while two in five have traditional pit toilets; almost one-third have no sanitation facilities at all, using the bush. Modem sanitation facilities are absent from virtually all rural households as well as more than one-half of urban households. Traditional pit toilets are common in both urban and rural areas (47 percent and 42 percent, respectively); in urban areas, most of the rest of the households have flush toilets (48 percent), while in rural areas, the majority of the households have no toilet facilities (54 percent). Besides Copperbelt, Lusaka and North-Western Provinces, between one- quarter and three-quarters of households in the other provinces have no toilet facilities. In North-Western Province, eight in ten households use traditional pit toilets. Almost all Zambian households live in residences with either earthen (53 percent) or cement (44 percent) floors. Cement flooring is most common for urban households (79 percent), whilst earthen floors are most common for rural households (84 percent). Cement flooring is most common in the Copperbelt and Lusaka Province and, to some extent, in Southern Province. Earth is the common flooring material in the remainder of the provinces. Information was collected on the number of rooms households use for sleeping (a measure of crowding). The majority of households have one or two persons per sleeping room, while in one third of the households, three or four persons share a room for sleeping. Although there are more people per household in urban areas, the dwelling units there must consist of more bedrooms, since there is almost no difference between urban and rural households in number of people per sleeping room. Households in Northern and Southem Provinces tend to sleep in relatively more crowded conditions than those in other provinces; the average number of persons per room ranges between 3.0 and 3.5, compared with between 2.4 and 2.9 in the other provinces (See Table 2.6). Household Durable Goods Respondents were asked about ownership of particnlar household goods such as radios and televisions (to assess access to media), refrigerators (to assess food storage) and modes of transportation (bicycle, motorcycle, car). The results presented in Table 2.7 indicate that 39 percent of households own a radio (59 percent in urban areas and 23 percent in rural areas) and 8 percent own a television (18 percent in urban areas, 1 percent in rural areas). Seven percent of households own refrigerators (15 percent in urban and 1 percent in rural areas). Thus, televisions and refrigerators are mostly restricted to urban areas, presumably as a result of lack of electricity and/or financial resources in the rural areas. Due to the greater level of urbanisation, households in the Copperbelt and Lusaka Provinces are more likely to own radios, televisions and refrigerators than households in the other provinces. 20 Table 2.7 Household durable goods Percentage of households possessing wrious durable consumer goods, according to urbaa-rmal residence and !m-evince, Zambia 1992 Residence Province Copper- North- Soudi- Characteristic Urban Rural Central belt Eastern Luapala Lusaka Northern Western era Western Total Radio 59.4 23.0 39.0 54.5 25.0 23.0 64.3 19.5 24.5 37.7 18.5 39.3 Television 17.5 0.9 5.6 16.5 1.1 2.7 21.6 0.3 3.2 2.7 0.5 8.3 Refrigerator 15.0 0.7 5.9 15.2 0.8 1.8 16.9 0.7 2.3 2.0 0.2 7.1 Bicycle 15.8 21.7 26.4 16.7 27.3 11.9 13.5 23.9 31.4 19.3 8.3 19.1 Motorcycle 1.3 0.5 1.6 0.9 0.3 0.7 1.1 0.9 1.1 0.6 0.5 0.9 Car 8.1 1.0 4.0 6.6 1.7 1.1 11.9 0.7 0.2 1.0 0.2 4.2 Number of households 2777 3432 626 1271 717 437 1010 659 247 793 448 6209 Overall, one in five households owns a bicycle, while only 4 percent own a car and less than one percent own a motorcycle. Bicycles are the only household possession listed that are more common among rural than urban households. The proportion owning a private car ranges from 12 percent of households in Lusaka Province to less than one percent in the Western and Norda-Westem Provinces. 2.3 Background Characteristics of Survey Respondents General Characteristics Women were asked two questions in the individual interview to assess their age: "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained to probe situations in which respondents did not know their age or date of birth; and as a last resort, interviewers were instructed to record their best estimate of the respondent's age. Examination of the single-year age distribution of women (not shown) indicates no systematic preference for reporting ages ending in particular digits (age heaping) that is often found in sur- veys and censuses. The irregularities found in the ZDHS may be attributable to nonsystematic misreporting of date of birth and/or age. The distortions are, however, virtually eliminated by the con- ventional five-year grouping of the data. Table 2.8 presents the age distribution of women in the ZDHS compared with that of women enumerated in the 1980 census. Although the proportion of women of reproductive age is virtually the same in both cases (44 percent of the female population), the age structure for women 15-49 in the ZDHS is younger than that for women 15-49 in the census. Specifi- cally, the proportion of women age 15-19 is higher in the ZDHS than in the census: 28 percent, compared with 25 percent in 1980. It is not clear whether this difference is real or whether it is the result of some pattern of age misreporting. Table 2.8 Age distribution of women) 1980 and 1992 Percent distribution of women of reproductive age, Zambia, 1980 and 1992 1980 1992 Age Census ZDHS 15-19 24.6 28.1 20-24 20.0 20.4 25-29 16.3 16.7 30-34 13.3 13.0 35-39 10.5 9.3 40-44 8.6 7.2 45~.9 6.7 5.4 Total 100.0 100.0 21 Table 2.9 Background characteristics of respondents Percent distribution of women by selected background characteristics, Zambia 1992 Number of women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 28.1 1984 1964 20-24 20.4 1441 1435 25-29 16.7 1179 1178 30-34 13.0 915 922 35-39 9.3 656 660 40-44 7.2 505 5 l l 45-49 5.4 380 390 Marital status Single 25.4 1791 1765 Married 61.1 4316 4334 Living together 2.0 141 133 Widowed 2.3 162 166 Divorced 7.0 493 508 Separated 2.2 156 154 Education No education 16.4 1161 1212 Primary 59.7 4213 4246 Secondax2¢ 22.1 1561 I486 ttig her 1.8 124 115 Residence Urban 51.5 3636 3358 Rural 48.5 3424 3702 Province Central 8.8 622 565 Copperbeit 24.7 1743 1606 Eastern 10.3 729 658 Luapula 6.1 431 589 Lusaka 17.5 1234 1137 Northern 9.2 652 590 North-Western 2.6 183 387 Southern 14.8 1045 947 Western 6.0 422 581 Religion Catholic 27.9 1973 1914 Protestant 69.0 4871 4912 Other 3.0 210 228 Missing, don't know 0.I 7 6 Ethnic group Bemba 34.4 2430 2421 Tonga 18.5 I308 1193 Northwestern 9.1 645 864 Baroste 6.9 485 567 Nyanja 17.5 1238 1133 Mambwe 5.6 393 362 Tumbuka 5.4 381 349 Other 2.4 167 155 Missing, don't know 0.2 15 16 All women 100.0 7060 7060 22 The data in Table 2.9 indicate that 63 percent of the respondents are currently in a union (either married or living together), ~ 25 percent have never been married, 9 percent are either divorced or separated and 2 percent are widowed. The percentage of women who are currently married appears to be declining. The 1980 census reported a higher percentage currently married (67 percent) among women age 15-49. Marriage pattems are discussed in detail in Chapter 5. A large majority of the ZDHS respondents have had some education. Sixty percent have attended only primary school, 22 percent have attended secondary school and 2 percent have gone beyond the secondary level; 16 percent have never attended school. The rapid increase in urbanisation in the country over the past two decades is reflectexl in ZDHS data on the distribution of the women by residence: nearly equal numbers of women live in urban and rural areas. The data indicate that over 40 percent of the women live in the most urbanised provinces: Copperbelt (25 percent) and Lusaka (18 percent); 19 percent reside in Central and Eastern Provinces, 6 percent in Luapula and 15 percent in Southern Province, whilst North-Western and Western Provinces account for a total of 9 percent of the women interviewed. Nearly all the women interviewed report themselves as Christian (97 percent), either Protestant (69 percent) or Catholic (28 percent). Those who adhere to other belief systems (traditional religion, Islam, and no religion) account for 3 percent (with less than 0.5 percent reporting themselves as Muslim). The Bemba group is the largest ethnic grouping, accounting for a little over one-third of the respondents; 19 and 18 percent of women belong to the Tonga and Nyanja groups, respectively. The No~th- Western group (comprised of Luvale, some Lunda groups, Kaonde, and other smaller tribes in North-Western Province) is the fourth largest with 9 percent of the women; the B aroste language group (which includes Lozi) comprises 7 percent of respondents, with Mambwe and Tumbuka accounting for 6 and 5 percent, respec- tively. Differentials in Education Table 2.10 presents the distribution of the respondents by education according to selected characteristics. Education is inversely related to age; that is, older women are generally less educated than younger women. For instance, 46 percent of the women aged 45-49 years have had no formal schooling, compared to only 11 percent of the women age 15-19 years. Rural women are educationally disadvantaged compared to urban women. More than one-quarter of rural women of childbearing age have never been to school, compared to only 7 percent of urban women. Conversely, four times as many urban women go beyond the primary level as rural women (38 percent vs. 9 percent). Table 2.10 also indicates that women residing in Copperbelt and Lusaka Provinces are more likely to have received secondary education, followed by women in Central and Southern Provinces. And though the differences by province in the percentage of women who have had only primary schooling are minor, the percentage of women with no education is higher in four provinces; Eastem (36 percent), Northern (27 percent), Western (25 percent) and North-Westem (23 percent). Throughout this report, the l~rm "married" includes both those in formal and informal marriages (living together). 23 Table 2.10 Level of education Percent distribution of women by the highest level of education attended, according to selected background characteristics, Zambia 1992 Level of education Number Background of characteristic None Primaly Secondary Higher Total women Age 15-19 10.7 65.2 24.1 0.1 100.0 1984 20-24 11.4 58.9 28.9 0.8 100.0 1441 25-29 11.9 59.8 25.5 2.8 100.0 1179 30-34 17.2 60.6 18.9 3.3 100.0 915 35-39 20.5 55.1 19.8 4.4 100.0 656 4044 35.1 52.0 9.5 3.4 100.0 505 45-49 46.1 49.6 4.0 0.3 100.0 380 Residence Urban 7.0 55.2 34.9 2.9 100.0 3636 Rural 26.5 64.5 8.6 0.5 100.0 3424 Province Central 15.7 63.1 19.5 1.8 100.0 622 Copperbelt 6.7 58.5 33.3 1.5 100.0 1743 Eastern 36.4 54.3 8.4 0.9 100.0 729 Luapula 16.6 66.4 15.1 1.8 100.0 431 Lusaka 11.5 52.5 31.6 4.4 100.0 1234 Northern 27.0 60.2 12.3 0.5 100.0 652 Nor th-Westem 23.2 61.6 14.0 1.2 100.0 183 Southern 13.7 67.4 18.0 0.9 100.0 1045 Western 25.3 62.1 11.9 0.7 100.0 422 Total 16.4 59.7 22.1 1.8 100.0 7060 Access to Media Women were asked if they usually read a newspaper, listen to the radio or watch television at least once a week. This information is important to programme planners seeking to reach women with family planning and health messages through the media. Table 2.11 shows that whilst nearly 57 percent of the women interviewed listen to radio weekly, 42 percent read a newspaper and only 22 percent watch television at least once a week. Media access is higher among younger women (i.e., age 15-39 years), about 43 percent of whom read a newspaper at least once a week, slightly over 20 percent watch television and between 56 and 60 percent listen to the radio once a week. Much higher proportions of educated women, women in urban areas and women residing in Copperbelt and Lusaka Provinces read newspapers, watch television and listen to the radio. 24 Table 2.11 Access to mass media Percentage of women who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by selected background characteristics, Zambia 1992 Read Watch Listen to Number Background newspaper television radio of characteristic weekly weekly weekly women Age 15-19 43.0 27.4 56.4 1984 20-24 44.3 21.1 60.2 1441 25-29 43.9 22.4 60.9 1179 30-34 45.2 20.7 60.5 915 35-39 42.9 20.7 56.7 656 40~14 32.3 12.9 46.5 505 45-49 21.7 4.8 38.4 380 Education No education 1.9 3.6 27.5 1161 Primary 37.5 16.1 55.0 4213 Secondary 79.0 45.6 80.3 1561 Higher 92.2 72.8 96.5 124 Residence Urbma 59.2 38.5 76.7 3636 Rural 23.3 3.5 35.6 3424 Province Central 44.7 15.8 54.2 622 Copperbelt 59.1 39.6 75.1 1743 Eastern 23.8 5.4 36.2 729 Luapula 32.9 5.9 38.2 431 Lusaka 62.9 41.2 81.7 1234 Northern 26.7 3.0 33.4 652 Nor th-Westom 30.8 8.2 49.9 183 Southern 23.6 9.6 41.7 1045 Westem 17.0 5.9 43.3 422 Total 41.8 21.5 56.8 7060 Compared to DHS surveys in other countries, women in Zambia are r~latively morn likely to read newspapers and less likely to watch television. For example, the proportion of women who read newspapers once a week is 11 perccnt in Jordan, 16 percent in the Dominican Republic, 14 percent in Pakistan, 27 percent in Indonesia and about 70 perccnt in Peru and Paraguay. The proportion of women who watch television at least once a week is lower in Zambia than in all these other countries. This implies that printed media might be a more effective vehicle than television for disseminating messages. 25 CHAPTER 3 FERTILITY The fertility measures presented in this chapter are based on the reported reproductive histories of women age 15-49 who were interviewed in the ZDHS. Each woman was asked the number of sons and daughters living with her, the number living elsewhere, and the number who had died. She was then asked for a history of all her live-born children, including the month and year each was born, the name, the sex, and if dead, the age at death and if alive, the current age and whether he/she was living with the respondent. Based on this information, measures of completed fertility (number ofchildron ever born) and current fertility (age-specific and total fertility rates) are examined. These measures are also analysed in connection with various background characteristics. 3.1 Fertility Levels and Trends Age-specific fertility rates for the three-year perind preceding the survey are shown in Table 3.1, along with data from the 1980 census for comparison. It appears that fertility has declined in Zambia over the past decade (see Figure 3.1); data from the 1990 census should shed more light on trends in fertility. The sum of the age-specific fertility rates (known as the total fertility rate) is a useful means of summarising the level of fertility. It can be interpreted as the number of childron a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. If fertility were to remain constant at the levels measured in the ZDHS, a Zambian woman would bear 6.5 children in her lifetime. This is lower than the rate of 7.2 estimated from the 1980 census data, implying a decline of about 10 percent over the past decade. Age-specific fertility rates from the ZDHS are shown in Table 3.2 by urban-rural residence and by province. ~ Data for some provinces have been combined to increase sample sizes to acceptable levels; however, despite this precaution, readers are urged to view the data with caution as sampling errors are probably still large. Table 3.1 Al~e-specific fertility rates over time Age-specific fertility rates as reported and adjusted in the 1980 census and as reported in the 1992 ZDH$ 1980 ~ ZDHS As As Age group reported. Ad'~te~ T~ported 15-19 61 153 156 20-24 239 318 294 25-29 253 323 271 30-34 223 289 242 35-39 181 225 194 40-44 108 115 105 45-49 70 17 31 TFR 15-49 5.7 7.2 6.5 Note: The ZDH$ rates refer to the three-year period preceding the survey, Source: Central Statistical Office~ 1985b. ' Numerators of the age-specific fertility rates in Table 3.2 are calculated by summing the number of live births that occurred in the period 1-36 months preceding the survey (determined by the da~ of interview and date of birth of the child), and classifying them by the age (in five-year groups) of the mother at the time of birth (determined by the mother' s date of birth). The denominators of the rates are the number o[ woman-years lived in each of the specified five- year age groups during the 1-36 months preceding the survey. 27 550 300 250 200 150 ' 100 50 0 Figure 3.1 Age-Specific Fertility Rates Zambia, 1980 and 1992 i i i , ; 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Table 3.2 Current fertility Age-specific and cumulative fertility rates and crude birth rates for the three years preceding the survey, by urban-rural residence and province, Zambia 1992 Province Residence North- Age Copper- Eastern, Luapula, Western, group Urban Rural beh Central Lusaka Northern Southern Western Total 15-19 133 184 130 204 134 159 168 158 156 20-24 263 328 291 289 263 363 284 268 294 25-29 265 276 274 268 268 274 284 245 271 30-34 222 264 234 269 168 282 296 223 242 35-39 171 221 168 208 170 243 (213) 188 194 40-44 78 121 (104) 94 (76) 126 (120) (112) 105 45-49 28 32 (43) (29) * (33) * (10) 31 TFR 15-49 5.8 7.1 6.2 6.8 5.5 7.4 7.1 6.0 6.5 TFR 15-44 5.7 7.0 6.0 6.7 5.4 7.2 6.8 6.0 6.3 GFR 199 238 208 232 191 241 230 207 218 CBR 44 46 44 46 43 50 46 43 45 TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Rates shown in parentheses are based on 125-249 woman-years of exposure; an asterisk means the rate was based on fewer than 125 woman-years of exposure and has been suppressed. Some provinces have been grouped together to increase sample sizes. 28 350 300 250 2OO 150 100 50 Figure 3.2 Age.Specific Fertility Rates By Residence Births per 1,000 Women 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age ZDHS 1992 Figure 3.3 Total Fertility Rates by Province No. o! Chi|dren / 7.4 8.0 6.0 i 4.0 J 2.0 J i / 0.0 Copperbelt 9.8 _/ / Eastern, Lusaka Luapula, Southern North-West., Central Northern Western ZDHS 1992 29 The data show that rural fertility rates are higher than urban rates; a rural woman can expect to have 7.1 children on average, compared to 5.8 for an urban wom- an. Rural fertility also peaks at an earlier age than urban fertility (see Figure 3.2). There is considerable variation in fertility levels by province. Fertility is lowest in Lusaka Province with a total fertility rate of 5.5 children born per woman, fol- lowed by North-Western and Western Provinces, with a combined total fertility rate of 6.0 children per woman. Fertility is highest in Luapula and Northem Provinces, with a combined total fertility rate of 7.4. Thus, women in the latter two provinces give birth to an average of two more children than women in Lusaka Province by the time they finish childbearing (see Figure 3.3). Fertility also varies considerably by education level of women (see Table 3.3). Women with no educa- tion can expect to give birth to 7.1 children on average, compared to 4.9 for women with secondary or higher education. In addition to comparing the ZDHS data with previous data such as the 1980 census, another way of examining trends in fertility over time is to compare the Table 3.3 Fertility by background characteristics Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40-49, by selected background characteristics, Zambia 1992 Mean number of children Total ever born Background fertility to women characteristic rate t age 40-49 Residence Urban 5.8 7.4 Rural 7.1 7.9 Province Copperbelt 6.2 7.9 Eastern, Central 6.8 7.8 Lusaka 5.5 7.1 Luapula, Northern 7.4 8.1 Southern 7.1 8.0 North-Western, Western 6.0 7.0 Education No education 7.I 7.8 Primary 6.8 7.8 Secondary+ 4.9 6.7 Total 6.5 7.7 tWomen age 15-49 years total fertility rates for the three years preceding the survey with the average number of children ever bom to women at the end of their childbearing period, age 40-49. The former is a measure of current fertility, while the latter is a measure of past or completed fertility. The data in Table 3.3 imply that there has been a decline of about one child over the past 10-20 years in Zambia. Further evidence of a fertility decline ap- pears in Table 3.4, which shows age-specific fer- tility rates for five-yearperiods prior to the survey, using data from respondents' birth histories. Fig- ures in brackets represent partial fertility rates due to truncation; women 50 years of age and older were not included in the survey and the further back into time rates are calculated, the more se- vere is the truncation. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years before the survey, because those women would have been age 50-54 at the time of the sur- vey and were not interviewed. It should also be noted that misreporting of the date of birth of chil- dren can result in the appearance of false trends in fertility. The data, however, show a steady decline in fertility rates at all ages for almost all periods, but this will have to be confirmed by analysis of other sources of fertility information. Table 3.4 Age-specific fertility rates Age-specific fertility rates for five-yearpefiods preceding the survey, by mother's age, Zaml~a 1992 Numberofyearspreceding thesurvey Mother's age 0-4 5-9 10-14 15-19 15-19 152 173 200 243 20÷24 281 295 328 364 25-29 266 309 304 352 30-34 238 281 280 [331] 35-39 189 239 [246] 40-44 109 [156] 45-49 ~2] Note: Age-specific fertility rates are per 1,000 women. Es~rnams enclosed in brackets are truncated. 30 Table 3.5 presents fertility rates for ever-married women by duration since first marriage for five-year periods preceding the survey. It is analogous to Table 3.4, but is con- fined to ever-married women and replaces age with duration since first marriage. The data confirm that the decline in fertility is apparent for all marriage durations. 3.2 Children Ever Born The distribution of women by number of children ever bom is presented in Table 3.6 for all women and for currently married wom- en. The table also shows the mean number of children ever born (CEB) to women in each five-year age group. On average, women have given birth to three children by their late twen- Table 3.5 Fertility by marital duration Fertility rates for ever-married women by duration since first marriage in years, for five-year periods preceding the survey, Zambia 1992 Marriage Number of years preceding the survey duration at birth 0-4 5-9 10-14 15-19 0-4 341 348 367 398 5-9 296 321 324 382 10-14 256 298 316 355 15-19 223 279 266 [300] 20-24 169 216 [211] 25-29 76 [155] Note: Fertility rates are per 1,000 women. Estimates enclosed in brackets ~e truncated. ties, six children by their late thirties, and eight children by the end of their childbearing years. The distribution of women by number of births indicates that over one-quarter of teens (age 15-19) have already bome a child, and over one-third of women age 45-49 have borne ten or more children. Table 3.6 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Zambia 1992 Number of children ever born (CEB) Number Mean no. Mean no. Age of of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN Age 15-19 72.8 22.5 4.0 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1984 0.3 0.3 20-24 20.4 29.6 28.7 15.3 5.0 0.8 0.1 0.0 0.0 0.0 0.0 100.0 1441 1.6 1.3 25-29 8.2 11.3 16.3 23.6 19.9 12.7 5.2 2.4 0.3 0.1 0.0 100.0 1179 3.1 2.6 30-34 3.9 4.4 7.8 11.6 15.5 17.7 15.3 12.8 7.9 2.5 0.5 100.0 915 4.8 4.0 35-39 2.0 2.7 3.8 5.4 8.4 11.9 14.7 14.9 16.3 9.7 10.1 100.0 656 6.4 5.4 40-44 1.4 1.9 3.9 3.3 6.8 9.8 7.8 12.0 13.3 13.9 25.9 100.0 505 7.4 6.0 45-49 1.4 2.5 2.7 2.8 3.6 5.3 7.5 11.2 12.1 14.9 35.9 100.0 380 8.1 6.4 Total 26.9 15.4 11.5 9.6 7.8 6.7 5.2 4.9 4.2 3.0 4.8 100.0 7060 3.1 2.6 CURRENTLY MARRIED WOMEN Age 15-19 36.1 48.8 13.3 1.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 526 0.8 0.7 20-24 10.7 28.1 33.7 19.4 6.8 1.0 0.2 0.0 0.0 0.0 0.0 100.0 989 1.9 1.5 25-29 5.1 8.2 15.4 25.1 21.8 15.1 6.3 2.6 0.3 0.1 0.0 100.0 943 3.4 2.8 30-34 2.0 3.4 7.6 9.9 14.1 18.8 16.8 14.2 9.4 3.0 0.7 100.0 755 5.1 4.3 35-39 1.2 1.8 2.5 5.0 7.0 11.2 15.3 15.3 17.6 11.3 12.0 100.0 537 6.7 5.7 40-44 0.9 1.8 3.8 2.0 5.6 9.1 6.9 12.3 13.0 15.5 29.4 100.0 412 7.7 6.3 45-49 1.3 1.7 1.9 2.1 3.7 4.7 6.6 11.7 12.1 14.3 39.9 100.0 295 8.4 6.7 Total 8.4 14.8 14.4 12.4 10.1 9.1 7.1 6.7 5.8 4.3 6.9 100.0 4457 4.2 3.5 31 The results for younger women who are currently married differ from those for the sample as a whole because of the large number of unmarried women with minimal fertility. Differences at older ages, though minimal, generally reflect the impact of marital dissolution (either divorce or widowhood). The parity distribution for older, currently married women provides a measure of primary infertility--the proportion of women who are unable to have children at all. Voluntary childlessness is rare in Zambia, and married women with no live binahs are most likely unable to bear children. The ZDHS results suggest that primary infertility is low, with only about one percent of Zambian women unable to bear children. It should be noted that this estimate of primary infertility does not include women who may have had one or more births but who are unable to have more (secondary infertility). Table 3.7 Birth intervals Percent distiibution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Zambia 1992 Number of months since previous birth Characteristic 7-17 18-23 24-35 3647 48+ Median number of Number months since of Total previous bh-th births Age of mother 15-19 17.8 22.5 50.2 5.7 3.8 100,0 26,3 103 20-29 7.7 14.5 51.0 14.0 12.8 100.0 29.9 2465 30-39 5.1 9.4 47.5 18.3 19.7 100.0 33.2 1818 40 + 3.3 9.7 41.0 20.5 25.6 I00.0 36.2 482 Birth order 2-3 7.5 14.5 47.6 13.2 17.2 100.0 30.2 1937 4-6 5.8 10.5 50.0 17.7 16.0 100.0 32.0 1721 7 + 6.0 11.2 48.5 18.4 15.9 100.0 32.6 1212 Sex of prior birth Male 6.7 l l .8 49.3 15.1 17.1 100.0 31.5 2409 Female 6.3 12.8 48.1 17.1 15.8 100.0 31.4 2460 Survival of prior birth Living 3.4 11.0 51.9 17.0 16.8 100.0 32.0 3983 Dead 20.7 18.1 34.4 12.0 14.9 100.0 27.3 887 Residence Urban 6.3 12.1 47.2 16.4 18.1 100.0 31.4 2230 Rural 6.7 12.4 49.9 15.8 15.1 100.0 31.5 2640 Province Cenmd 5.9 11.6 52.4 16.7 13.4 100.0 30.9 467 Copperbelt 6.6 10.6 51.8 14.6 16.4 100.0 31.0 1129 Eastern 10.1 11.2 47.2 16.1 15.4 100.0 31.8 504 Luapula 8.3 14.8 52.7 12.1 12.2 100.0 29.2 332 Lusaka 5.2 13.3 43.4 16.1 22.0 100.0 32.0 707 Northern 7.5 14.9 48.1 17.7 11.9 100.0 30.8 520 North-Western 7.2 11.2 46.7 19.4 15.5 100.0 32.4 143 Southern 4.7 13.1 49.9 16.5 15.8 100.0 31.5 802 Western 4.7 9.9 39.3 20.1 25.9 100.0 35.9 264 Education No education 6.1 12.8 46,0 15.5 19.5 100.0 32.9 893 Primary 6.9 11.8 50.7 15.7 14.9 100.0 31.1 3093 Secondary 5.3 13.5 44.9 18.2 18.2 100.0 31.3 805 Higher 8.5 15.6 34.9 15.6 25.5 100.0 31.6 77 Total 6.5 12.3 48.7 16.1 16.5 100.0 31.4 4869 Note: First-order births are excluded. The interval for multiple Waths is the number of months since the preceding pregnancy that ended in a live birth. 32 3.3 Birth Intervals Research has shown that children born too close to a previous birth are at increased risk of dying. The risk is particularly high when the interval between births is less than 24 months. Table 3.7 shows the percent distribution of births in the five years preceding the survey by the number of months since the previous birth. Almost one in five births occurs after an interval of less than 24 months. Half the births take place 24-35 months (two years) after the previous birth and one-third have a previous birth interval of three years or more. The median birth interval length (31 months) is only six months longer than the minimum considered safe. The median birth interval is relatively short for younger women and for women living in Luapula Province. As expected, children whose preceding sibling died before the survey had the shortest previous birth interval; almost 40 percent of these children were bern less than 24 months after the birth of the preceding child. Birth intervals in Western Province are notably longer than in other provinces (36 months). 3.4 Age at First Birth The age at which childbearing begins has important demographic consequences for society as well as health consequences for the mother and child. On the demographic side, early initiation into childbearing is generally a major determinant of large family size and rapid population growth, particularly in countries where family planning is not widely used. On the health side, bearing children at a young age involves substantial risks to the health of both the mother and child. Early childbearing also tends to restrict educational and economic opportunities for women. Table 3.8 presents the distribution of Zambian women by age at first birth, according to their current age. Childbearing begins early in Zambia, with the majority of women becoming mothers before they reach the age of 20. Childbearing before age 15 was not uncommon among older women; however, it has become less common over time. More than 40 percent of women age 25-49 had their first birth before age 18 and about 70 percent had their first birth by age 20. It seems that younger cohorts am tending to delay somewhat their Hrst births. The median age at first birth is slightly l'dgher among women age 20-24 than among women in their late 20s or 30s. Also, the proportion of women who begin childbearing in their teenage years shows a decline, from 76 percent of women age 35-39 to 61 percent of women age 20-24. Table 3.8 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Zambia 1992 Current age Women Median with Age at fast birth Number age at no of first births <15 15-17 18-19 20-21 22-24 25+ To ml women birth 15-19 72.8 1.8 17.4 8.0 NA NA NA 100.0 1984 a 20-24 20.4 3.7 30.5 27.1 14.5 3.7 NA 100.0 1441 19.1 25-29 8.2 5.7 33.3 25.5 14.9 9.4 3.0 100.0 1179 18.8 30-34 4.0 8.2 38.4 25.2 13.7 7.2 3.4 100.0 915 18.2 35-39 2.0 9.0 37.9 28.9 11.6 7.3 3.4 100.0 656 18.2 4044 1.4 9.7 32.9 25.2 15.6 9.1 6.2 100.0 505 18.6 45-49 1.4 14.0 31.7 24.0 12.5 9.6 6.8 100.0 380 18.3 NA = Not applicable aLess than 50 percent of the women in the age group x to x+4 have had a birth by age x 33 Differentials in the age at first birth are shown in Table 3.9. The median age at first birth for all women age 20-49 is 18.6. Overall, there is little variation in the median age at first birth by background characteristics of women, except that women with secondary education or higher tend to delay their first birth later than those with less education. Women in Lusaka, Eastern and Northern Provinces have the highest median age at first birth, while women in North-Western Province have the lowest. Table 3.9 Median age at first birth Median age at first birth among women age 20-49 years, by current age and selected b~ekground characteriatics, Zambia 1992 Current age Background Ages Ages characteristic 20-24 25-29 30-34 35-39 40-44 45.49 20.49 25.49 Residence Urban 19.5 19.0 18.2 18.1 18.6 18.3 18.8 18.5 Rural 18.8 18.6 18.3 18.3 18.7 18.3 18.6 18.4 Province Central 18.7 18.8 18.1 (18.2) (18.2) (17.7) 18.5 18.4 Copperbelt 19.5 19.1 18.3 17.9 18.0 18.1 18.7 18.4 Eastern 18.7 18.9 18.8 19.2 18.4 (18.3) 18.8 18.8 Luapula 18.8 18.7 18.4 18.6 18.0 (17.5) 18.5 18.4 Lusaka 19.7 19.0 18.2 18.1 19.2 (19.2) 18.9 18.6 Northern 19.1 18.8 17.9 (18.4) (19.9) (18.9) 18.8 18.6 North-Western 18.0 18.5 18.1 (17.2) (17.4) * 18.1 18.1 Southern 19.1 18.5 17.6 18.0 18.5 (18.7) 18.4 18.2 Western 19.1 18.4 19.0 18.2 (18.9) 17.7 18.7 18.5 Education No education 19.0 18.8 18.1 18.3 18.3 18.5 18.5 18.4 Primary 18.5 18.2 17.8 17.8 18.3 18.2 18.2 18.0 Secondary+ a 20.5 20.0 19.2 20.4 * a 20.0 To~l 19.1 18.8 18,2 18.2 18.6 18.3 18.6 18.5 Note: Rates shown in parentheses are based on 25-49 women, while an asterisk meeaas the rate is based on fewer than 25 women and has been suppressed. The medians for cohort 15-19 could not be determined because half the women have not yet had a birth. aMedians were not calculated for these cohorts because less than 50 percent of women in the age group x to x+4 have had a birth by age x. 34 3.5 Teenage Fertility Fertility among teenagers (those under age 20) is receiving increasing attention from policymakers. Table 3.10 shows the percentage of wometa age 15-19 who arc mothers or pregnant with their first child. The sum of these two percentages represents the proportion of young women who have begun childbearing. More than one-quarter of teenage women have already had a child and another 7 percent were preg- nant with their first child at the time of the survey. As stated before, childbearing begins early in Zambia, Table 3.10 Teenage pref~nency and motharhood Percentage of teenagers 15-19 who are mothers or wegnent with their first child, by selected background characteristics, Zambia 1992 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing ~enagers Age 15 1.9 3.4 5.3 384 16 8.7 6.1 14.7 427 17 22.1 7.8 29.9 392 18 44.2 10.2 54.3 380 19 59.9 5.7 65.6 401 Residence Urban 22.6 5.8 28.5 1076 R~al 32.5 7.5 40.0 907 Province Central 31.9 7.8 39.8 155 Copperbelt 23.8 4.3 28.0 535 Eastern 35.7 8.1 43.7 193 Luapuia 29.5 6.6 36.1 127 Lusaka 22.0 8.5 30.5 320 Northern 26.8 9.8 36.7 202 North-Western 28.7 3.2 31.9 50 Southern 29.5 5.0 34.4 311 Western 27.6 8.7 36.4 91 Education No education 37.3 8.2 45.4 211 Primary 29.0 7.6 36.5 1293 Secondary 17,9 3.3 21.2 479 Total 27.2 6.6 33.8 1984 35 with the proportion of women having begun childbearing increasing rapidly in the late teen years. By age 17, one-third of women have begun childbearing; by age 18, one-half of women and by age 19, two-thirds have (see Figure 3.4). Early childbearing is particularly characteristic of rural women, those in Eastern Province, and those who have not attended school. Whereas most teenage women who have begun childbearing have given b i~ only once, a small proportion have had two births. Table 3.11 shows the distribution of women age 15-19 by number of children ever born. Overall, five percent of women age 15-19 have delivered more than one child. Fifteen percent of women age 19 have had two or more births. 80 60 40 20 Figure 3.4 Percentage of Teenagers Who Have Begun Childbearing by Age Percent 66 15 16 17 18 Age []Mothers []Pregnant (let child) i 19 • ZDHS 1992 Table 3.11 Children born to teenagers Percent distribution of teenagers 15-19 by namber of children ever born (CEB), Zambia 1992 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB teenagers 15 98.1 16 91.3 17 77.9 18 55.8 19 40.1 Total 7Z8 1.7 0.2 I00.0 0.07, 384 8.7 0.0 100.0 0.09 427 21.1 1.0 100.0 0.23 392 37.5 6.7 100.0 0.52 380 44.5 15.4 100.0 0.77 401 22.5 4.6 100.0 0.32 1984 36 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Contraception Determining the level of knowledge of contraceptive methods and of services was a major objective of the Zambia Demographic and Health Survey, since knowledge of specific methods and of the places whom they can be obtained is a precondition for their use. Information about knowledge of contraceptive methods was collected by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked if she recognised it. Eight modem methods---the pill, IUD, injection, vaginal methods (foaming tablets, jelly, sponge and diaphragm), condoms, female sterilisation and male sterilisation---were described, as well as two traditional methods--natural family planning (periodic abstinence or the rhythm method) and withdrawal. Any other methods mentioned by the respondent, such as herbs, st]hags or breastfceding, were also recorded. For each method recognised, the respondent was asked if she knew where a person could go to get the method. Ifsbe reported knowing about natural family planning, she was asked if she knew where a person could obtain the advice on how to use the method. Table 4.1 indicates that nine of ten Zambian women aged 15-49 know at least one method of family planning. In other words, only 11 percent reported that they did not know any method of family planning. Table 4.1 Knowledge of contraceptive methods and source for methods Percentage of all women mad of currently married women who know specific contraceptive methods and who know a source (for information or services), by specific methods, Zambia 1992 Know method Know a source Currently Curremfly Contraceptive All married All married method women women women women Any method 89.4 93.7 81.4 87.5 Any modern methnd 87.1 90.7 81.1 g7.2 Pill 78.1 84.7 71.1 79.0 IUD 43.0 49.2 38.1 44.0 Injection 38.1 42.9 34.3 39.0 Diaphragm/foam/jelly 23.8 26.7 21.5 24,6 Condom 72.0 73.3 60.7 64.4 Femal~ sterilisatlon 63,6 7t,0 58A 66,0 Male sterllisation 17,9 20.8 16.8 19.7 Any traditional method 66.4 77.6 NA NA Periodic abstinence 36.1 40.3 29.0 33.0 Withdrawal 47.8 58.5 NA NA Other 34.7 42.7 NA NA Number of women 7060 4457 7060 4457 NA = Not applicable 37 Knowledge of methods is slightly higher among currently married women than among all women. Since it is currently married women who are at greatest risk of pregnancy, this chapter focuses primarily on them. A high proportion of married women reported knowing a modem method (91 percent) and 78 percent of them have some knowledge about a traditional method. The most widely known methods are the pill, condom, and female sterilisation, known by 85, 73 and 71 percent of married women, respectively (see Figure 4.1). Following these, IUD and injection are the most commonly known methods (reported by 49 and 43 percent of married women, respectively). Twenty-seven percent of married women know about foaming tablets, jelly or diaphragm and just over one-fifth know about male sterilisation. As regards the traditional methods, 59 and 40 percent of married women know of withdrawal and periodic abstinence (natural family planning), respectively, while 43 percent reported other methods (mostly strings and herbs). Figure 4.1 Percentage of Currently Married Women Who Know Specific Contraceptive Methods Pil l~ IUD~ Injection Diaph ragm/Foam/Jelly ~ Condom i Female Sterilisation Male Sterillsation Periodic Abstinence Withdrawal 0 ~ 8 5 49 ~ 4 3 ~ 2 7 1 7 3 ~ 9 9 20 40 60 80 100 Percent ZDHS 1992 Knowledge of sources for obtaining family planning methods is widespread in Zambia. Overall, nearly nine of ten married women know a place where they can obtain some method of family planning and 90 percent or more of the women who know specific modem family planning methods also know where they can obtain them. Knowledge of places to get information about periodic abstinence is somewhat lower, with about 80 percent of the women who know the method knowing a source of information. As with knowledge of the methods themselves, knowledge of places where specific methods can be obtained is slightly higher among currently married women than among all women. The proportion of women who know of at least one contraceptive method is higher among women in their 20s and 30s than among younger and older women (see Table 4.2). This is also true for knowledge of at least one modem method and knowledge of a place to obtain a modem method. 38 Table 4.2 Knowledge of modern contraceptive methods and source for methods Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by selected baekgrotmd characteristics, Zambia 1992 Know a Know Know sot~ce for Number Background any a modem modem of characteristic method method 1 method women Age 15-19 86.7 83.6 77.3 526 20-24 94.6 92.7 89.1 989 25-29 95.9 94.3 92.3 943 30-34 96.3 92.7 90.8 755 35-39 95.4 94.4 91.0 537 40-44 91.4 86.2 80.2 412 45-49 g9.6 80.1 76.1 295 Residence Urban 97.2 96.5 94.1 2091 Rural 90.6 85.7 81.2 2366 Province Central 74.3 70.6 66.4 418 Copperbelt 99.2 98.8 97.0 1023 Eastern 92.5 89.8 84.7 536 Luapula 94.9 90.0 87.7 281 Lusaka 95.4 94.5 91.0 738 Northern 91.9 82.1 80.6 423 North-Weatem 91.6 90.9 87.4 124 Southern 96.7 94.7 90.3 673 Weatem 95.7 86,2 78.3 24l Education No education 84.5 76.9 70.5 864 Primary 95.0 92.7 89.2 2754 Secondary 98.5 98.4 97.6 745 Higher 100.0 100.0 100.0 93 Tom] 93.7 90.7 87.2 4457 lIncludes pill, IUD, injection, vaginal methods (foaming tablets/diaphragm/ foam/jelly), condom, female sterilisation, and male sterillsadon. Knowledge of contraceptive methods and their sources is somewhat more widespread in urban than in rural areas. The proportion of urban married women who know at least one family planning method is 97 percent, compared with 91 percent of rural women. The differential, however, widens with respect to knowledge of a modem method and a source for a modem method, with 94 percent of urban women knowing a source, compared to 81 percent of rural women. Differences in contraceptive knowledge by province are not large except for Central Province where the proportion of married women who have heard of at least one family planning method is relatively low: 39 74 percent as compared to between 92 and 99 percent in the other provinces. The level of knowledge of at least one modem method is higher in Copperbelt (99 percent), Southern (95 percent) and Lusaka (95 percent) Provinces than in the other provinces. The same pattem holds for knowledge of where these methods can be obtained. The level of knowledge of family planning methods and places where they can be obtained increases with the level of education, with knowledge of modem family planning methods increasing from 77 percent among uneducated women to an estimated 100 percent among women with higher education (more than secondary). Married women with no education or only primary education are also less likely than women with secondary or higher education to know of a source of these methods; the proportions increase from 71 percent among married women with no education to an estimated 100 percent among women with higher education (see Table 4.2). 4.2 Ever Use of Contracept ion All women interviewed in the ZDHS who said that they had heard of a method of family planning were asked if they had ever used it. Forty percent of Zambian women of reproductive age have used a method of family planning sometime and nearly one-quarter have used a modem method (see Table 4.3). Table 4.3 Ever use of contraception Among all women and among currently married women, the percentage who have ever used a contraceptive method, by specific method and age, Zambia I992 Any Any modern Age method method Pill IUD Modem methods I Traditional methods Diaphragm/ Female Male Any Periodic Number Injec- Foam/ Con- sterili- sterili- tra& absfi- With- of tion Je l ly dom sarion sation method nence drawal Other women ALL WOMEN Age 15-19 12.9 7.3 1.9 0.0 0.1 0.4 5.6 0.0 0.1 8.4 2.6 5.2 1.8 1984 20-24 41.6 24.1 12.8 0.6 0.5 1.6 15.1 0.1 0.0 28.7 8.7 19.8 5.8 1441 25-29 53.5 32.3 24.2 2.3 1.0 2.8 13.7 0.4 0.2 35.8 10.9 25.1 8.5 1179 30-34 55.2 31.7 25.3 3.9 1.6 1.3 9.8 1.4 0.0 38.4 10.0 25.9 12.7 915 35-39 58.9 36.0 29.7 7.8 4.5 3.5 6.1 5.0 0.5 39.8 8.8 25.1 16.8 656 40-44 52.1 27.3 21.4 4.2 4.7 1,5 2.9 6.2 0.2 36.7 5.7 21.6 20.3 505 45-49 47.1 20,9 14.3 3.3 5.5 0.5 1.6 5.7 0.3 36.9 4.2 20.4 20.4 380 Total 39.9 22.9 15.5 2.2 1.5 1.5 9.1 1.5 0.1 27.5 7.1 18.0 8.9 7060 CURRENTLy MARKIED WOMEN Age 15-19 27.0 14.7 4.1 0.0 0.2 0.4 11.6 0.0 0.0 19.3 4.6 13.9 3.6 526 20-24 45.4 24.7 13.2 0.7 0.5 1.6 15.6 0.1 0.0 32.5 8.0 23.6 7.5 989 25-29 54.2 31.2 23.9 2.1 0.7 2.9 14.2 0.2 0.2 37.5 10.9 27.0 9.1 943 30-34 56.3 31.4 25.1 3.9 1.7 1.4 9.5 1.3 0.1 39.9 8.7 27.9 13.2 755 35-39 56.9 34.6 27.9 7.2 4.5 3.2 5.6 6.1 0.4 38.5 8.4 24.8 16.3 537 40-44 52.3 26.7 19.8 4.3 5.0 1.1 2.8 7.3 0.3 37.2 5.9 20.8 21.6 412 45-49 49.1 19.5 13.3 2.1 5.3 0,2 1.3 5,3 0.4 40,1 4.7 22.6 22.0 295 Total 49.2 27.1 18.8 2.6 1.9 1.8 10.5 2.1 0.2 34.9 7.9 23.7 11.7 4457 1Includes pill, IUD, injection, vaginal methods (foaming tablet s/diaphragm/fomn/j elly), condom, female sterilisatio~a, and male sterilisatinn. 40 The corresponding proportions among currently married women are 49 and 27 percent, respectively. Ever- use is lowest among the youngest age group (15-19 years), rises to a peak among the 35-39 year olds and then drops slightly among older women. More married women have used traditional methods than modem methods, with the most widely used methods being withdrawal (24 percent) and the pill (19 percent). Condom and natural family planning (periodic abstinence) have also been commonly used methods, with 11 and 8 percent of married women having used them. Three percent of married women have used the IUD, while 2 percent have used female sterilisation, injection, and vaginal methods (foaming tablets, jelly, sponge, diaphragm). 4.3 Current Use of Contraception Though over 90 percent of married women in Zambia have heard of and nearly half have used a family planning method, only 15 percent reported that they were currently using a method at the time of the survey (see Table 4.4). Nine percent of women are using modem methods, while 6 percent are using traditional methods. The most popular contraceptive method is the pill (4 percent), followed by withdrawal (3 percent), female sterilisation (2 percent) and condom (2 percent). Other traditional methods---mostly abstinence, strings and herbs---are used by 2 percent of married women. Table 4.4 Current use of contraception Percent distribution of all women and of currently married women by contraceptive method currently used, according to age, Zamb~.a 1992 Age A.y modern Any meth- m eahod od Mnde~'a methods I Traditional methods Dia- Fcmal~ Male Peri- Nm plragm, steri- ,~ i - Any odic With- cur- Injec- foam, Con- lisa- lisa- ~rad. abe- draw- Miss- rently Pill IUD tion jelly dora llon t i~ methnd hence el Oth~ ing using ToNal Ntm~b~ WOMEN 15-19 3.5 1.5 0.7 0.0 0.0 0.I 0.7 0.0 0.0 2.0 0.3 1.0 0.7 0.0 96.5 I00.0 1984 20-24 11.2 7.1 4.2 0.2 0.I 0.I 2.4 0.I 0.0 4.1 0.8 2.4 0.8 0.2 88.8 I00.0 1441 25-29 15.0 9.0 6.2 0,6 0.1 0.0 1.7 0,4 0.0 6.0 1,3 2.7 2.0 0.0 85.0 1(30.0 1179 30-34 17.5 10.7 5.4 1.3 0.1 0.4 2.1 1.4 0.0 6.8 1.0 2.6 3.1 0.1 82.5 100.0 915 35-39 20.6 12.7 5.5 0.3 0.2 0.3 1.2 5.0 0.2 7.9 1,3 3.3 2.8 0.5 79,4 100.0 656 40-44 15.7 10.1 1,7 0.9 0.2 0.2 0.9 6.2 0.0 5.6 0.9 1.0 3.5 0.2 84.3 100.0 505 45~19 9.4 6.4 0.5 0.0 0.3 0.0 0.0 5.7 0.0 3.0 0.0 0.3 2.5 0.2 90.6 100.0 380 ToN 11.6 7.0 3.5 0,4 0,1 0.1 1.4 1.5 0.0 4,6 0.8 1.9 1.7 0.1 88.4 1~.0 7060 CURRENTLY MARRIED WOMEN 15-19 8.7 3.4 1.8 0.0 0.0 0.0 1,7 0.0 0.0 5.2 0.4 3.4 1A 0.0 91.3 100,0 526 20-24 13.1 7.7 4.3 0.I 0.1 0.0 3.0 0. I 0.0 5.5 0.7 3.4 I.I 0.2 86.9 I00.0 989 25-29 15.3 8.6 6.0 0.5 0. I 0.0 1.8 0.2 0.0 6.6 1.3 3.2 2.0 0.0 84.7 100.0 943 30-34 18.3 10.7 5.5 1.3 0. I 0.4 2.0 1.3 0.0 7.6 1.0 3.0 3.5 0. I 81.7 I00.0 755 35-39 22.5 14.1 6.0 0.2 0.2 0.4 1.0 6.1 0.2 8A IA 4.0 2.6 0A 77.5 I00.0 537 40-44 17.4 11.0 1.3 1.1 0.3 0.3 0.8 7,3 0.0 6,4 1.1 1.2 3.8 0.3 82.6 1(30.0 412 4549 9.0 6.3 0.6 0.0 0.4 0.0 0.0 5.3 0.0 2.7 0.0 0,4 2,1 0.2 91.0 1(30,0 295 Total 15£ 8.9 4.3 0.5 0.I 0.1 1.8 2.1 0.0 6.3 0.9 3.0 2.2 0.2 84.8 I00.0 4457 qncludcs pill, IUD, injection, vaginal methods (fo~ming table~diaphragm/foam/j~llly), condom, female st~-ilisatioe, and male st~ilisatice. 41 Contraceptive use is highest among women in their late 30s, and lowest among women aged 15-19 and 45-49 years. This pattern is most likely due to the fact that younger women are just starting their families, whilst older women are more likely to have reached their desired family size and want to stop childbearing altogether. For the same reasons, younger women are more likely to use less effective methods such as withdrawal or temporary methods such as condom, while older women are more likely to use more effective, long-term methods such as female sterilisation. About six percent of married women in their 40s have been sterilised. Use among the oldest women (i.e., 45-49) might be lower because they are more likely to have reached menopause and thus are not in need of family planning. While overall use of family planning is quite low, the ZDHS data show that some married women are more likely to be using contraception than others (see Table 4.5 and Figure 4.2). Women most likely to be using contraception are those resident in urban areas as well as those in Lusaka, Copperbelt, Western and Northern Provinces, those with higher education and those with four or more children. Not only are urban women twice as likely as rural women to be using a method (21 percent vs. 10 percent), but urban users are also more likely to be using a modem method. Urban women depend on methods such as the pill, female stcrilisation and condom, whilst rural women rely primarily on traditional methods such as withdrawal, wearing beads or herbs around the waist, drinking African medicine made with roots and leaves, etc. Table 4.5 Current use of contraception by background characteristics Percent distribution of currently married women by contraceptive method currently used, according to background characteristics, Zambia 1992 Age Any modern Any meth. method od Modem methods I Traditions1 methods Din- Female Male peti- Not phragm, steri- steri- Any odic With- cur- Injec- foam, Con- lisa- lisa- trad. absti- draw- Miss- rently Pill IUD don jelly dora tion tion method nence al Other ing using Total Number Residence Urbma 20.8 15.3 7.9 1.0 0.3 0.3 2.6 3.3 0.0 5.5 1.4 2.3 1.6 0.3 79.2 100.0 2091 Rural 10.3 3.2 1.1 0.0 0.0 0.0 1.1 1.0 0.0 7.0 0.5 3.6 2.8 0.1 89.7 100.0 2366 Province Central 9.2 6.8 4.2 0.0 0.0 0.0 1.6 0.8 0,3 2.4 0,8 0.5 1.1 0.0 90.8 100.0 418 Copperbelt 19.0 13.6 7.1 0.7 0.4 0,1 1.7 3.5 0,0 5.4 1.2 1.8 2.2 0.2 81.0 IG0.0 1023 Eastern 9.7 4.7 1.2 0.2 0.0 0.2 1.7 1.5 0.0 5.0 0.2 1.5 3.3 0.0 90.3 1130.0 536 Luapula 9.5 6.0 2.8 0.0 0.0 1.2 1.2 0.9 0.0 3.5 0.5 0.5 2.5 0.0 90.5 100.0 281 Lusaka 24.2 17.6 8.1 1.3 0.1 0.1 4.3 3.7 0.0 6.6 1.5 3.5 1.3 0.3 75.8 100.0 738 Northern 17.5 3.1 1.8 0.0 0.0 0.0 0.3 1.0 0.0 14.4 1.0 12.1 1.0 0,3 82.5 100.0 423 North-Western 10.4 5,9 1.8 0.0 0.0 0.0 1.3 2.8 0.0 4.4 0.9 1.9 1.3 0.3 89.6 100.0 12tl Southern 8.5 4.2 2.3 0.2 0.0 0.0 1.2 0.7 0.0 4.3 1.0 2.3 0.8 0.2 91.5 100.0 673 Western 17.8 2.9 0.3 0.5 0.5 0.0 0.6 1.1 0.0 14.9 0,3 3.4 10.9 0.3 82.2 100.0 241 Education No education 8.0 2.7 0.9 0.0 0.1 0.0 0.4 1.2 0.0 5.3 0.1 2.3 2.9 0.0 92.0 100.0 864 Primary 12.8 6.3 3.1 0.1 0.2 0.0 1.4 1.4 0.0 6.5 0.4 3.5 2.4 0.2 87.2 100.0 2754 Secondary 27.1 20.7 10.6 1.5 0.1 0.4 4.1 3.8 0.1 6.4 3.0 2.1 1.1 0.1 72.9 100.0 745 Higher 58.5 49.6 19.3 7.0 0.0 2.3 7.0 14,0 0.0 8.9 6.5 1.2 L2 0.0 41.5 I00.0 93 Number or living children 0 0.9 0.4 0.2 0.0 0.0 0.0 0.2 0.0 0.0 0.4 0.2 0.0 0.2 0.0 99.1 100.0 488 1 12.2 7.2 3.4 0.1 0.0 0.0 3.1 0.5 0.0 5.0 1.0 2.6 1.1 0.3 87.8 100.0 802 2 16.3 9.6 4.4 0.9 0.0 0.2 2.6 1.6 0.0 6.7 0.8 4.3 1.5 0.0 83.7 100.0 695 3 15.4 9.9 6.3 0.7 0.0 0.2 2.1 0.6 0.0 5.5 0.5 3.5 1.5 0.1 84.6 100.0 590 4+ 19.7 11.2 5.0 0.5 0.3 0.2 1.2 3.9 0.l 8.5 1.3 3.2 3.7 0.3 80.9 100.0 1882 Total 15.2 8.9 4.3 0.5 0.1 0.1 1.8 2.1 0.0 6.3 0.9 3.0 2.2 0.2 84.8 100.0 4457 Ilncludes pill, IUD, injection, vaginal methods (foaming tablets/diaphragm/foam/jelly), condom, female sterilisation, and male sterilisation. 42 Figure 4.2 Percentage of Currently Married Women Using a Contraceptive Method RESIDENCE Urban Rurnl PROVINCE / Cent re l~ Copperbolt Eastern Luapula Luscka Northern ~ North-Western Southern Western EDUCATION No Education Prlmary~ Secondary H lgher~ 0 21 ~ I 0 ~ 9 1 9 ~ I 0 ~ 1 0 24 ~ 1 8 ~ I 10 ~ 9 r . 18 ~ 8 ~ 1 3 . • . 27 . - . - 59 10 20 30 40 50 60 Percent 70 ZDHS 1992 The proportion of married women using any method of contraception also varies widely by province, from 9 percent in Southern and CentralProvinces to 24 percent in Lusaka Province. In Western and Northern Provinces, traditional methods (withdrawal and African medicine, beads, etc.) are by far the most frequently used methods, accounting for over 80 percent of all contraceptive use. In Southern, Eastern, North-Western and Luapula Provinces, modem and traditional methods are almost equally used, with the pill, condom, withdrawal and other traditional African methods being the most common. In Central Province, the pill and condom are the most widely used methods. In Copperbelt Province, the most commonly used methods are the pill and female sterilisatlon, followed by withdrawal and condom. In addition to the pill, condom, female sterihsation and withdrawal, which are the most frequently used methods in Lusaka Province, the IUD and periodic abstinence have a relatively high level of use. The largest differentials in current use of contraception are found for educational groups. Contraceptive use increases steadily with increasing level of education, from 8 percent of married women with no education to 59 percent of those with higher than secondary education. (The latter figure should be viewed with caution, since the number of women in that category is small.) Moreover, the proportion of users who are using modem methods increases dramatically with education level. For example, twice as many women with no education use traditional as modem methods, mostly withdrawal and other methods like beads and herbs. Among women with primary education, modem methods account for half of all use, with withdrawal being the most common method, followed by the piU. Among those with secondary or higher education, modem methods account for 75 percent or more of total use, with the pill, condom and female sterilisation prominent. Periodic abstinence is also commonly used among highly educated married women. The use of foaming tablets and other vaginal methods appears to be limited to women with more than secondary education. 43 Contraceptive use also increases with the number of children a woman has. As the number of children increases, use of modern methods becomes more important in the overall method mix. 4.4 Number of Children at First Use of Contraception In many cultures, family planning is used only when couples have already had as many children as they want. However, as the concept of family planning gains acceptance, couples may begin to use contraception for spacing births as well as for limiting family size. Moreover, unmarried young women may be particularly motivated to use family planning to avoid an unwanted pregnancy. Table 4.6 shows the number of children ever-married respondents had when they first used contraception. For the older cohorts (35-49 years), women generally started using family planning only after they had four or more children, although almost as many started using after their first child. For the younger cohorts (15-29 years), women are more likely to have started using family planning after their first child. For instance, roughly the same proportion of women age 25-29 and 40-44 have used a contraceptive method (54 and 52 percent, respectively). However, while half of the ever-users age 40-44 years waited until they had had at least three children, half of the ever-users age 25-29 started to use after their first child. Seven percent of ever-married women under age 25 started to use family planning before they had any children, compared to only one percent of women 40-44. This reflects a shift towards use of family planning for spacing purposes. Table 4.6 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Zambia 1992 Number of living children at time Never of first use of contraception Number Current used of age contraception 0 1 2 3 4+ Missing Total women 15-19 73.6 6.9 17.8 0.9 0.0 0.0 0.8 100.0 588 20-24 55,8 6.6 27.6 6.6 2.4 0.3 0.7 100.0 1136 25-29 46.3 4.1 24.8 14.3 6.1 3.4 1A 100.0 1112 30-34 44.6 1.5 21.0 12.9 8.3 10.9 0.7 I00.0 897 35-39 41.3 2.6 17.6 9.8 9.5 18.2 1.0 100.0 652 40-44 48.0 1.0 14.4 6.2 7.6 22.4 0.3 100.0 504 45-49 52.9 0.3 18.0 6.4 5.8 16.5 0.0 100.0 380 Total 51.1 3.7 21.6 9.0 5.5 8.2 0.8 100.0 5269 4.5 Knowledge of Fertile Period A basic knowledge of reproductive physiology is useful for the successful practice of coitus- dependent methods such as withdrawal, the condom, or barrier methods, but it is especially important for users of periodic abstinence or natural family planning. The successful practice of periodic abstinence depends on an understanding of when during the ovulatory cycle a woman is most likely to conceive. Table 4,7 presents the percent distribution of all respondents and those who have ever used periodic abstinence by reported knowledge of the fertile period in the ovulatory cycle. 44 Table 4.7 Knowledge of fertile period Percent distribution of all women and of women who have ever used periodic abstinence by knowledge of the fertile period during the ovulatory cycle, Zambia 1992 Ever USers Perceived All of periodic fertile period women abstinence During menstrual period 0.7 0.4 Right after period has ended 27.5 42.4 In the middle of the cycle 13.7 30.2 Just before period begins 8.1 10.7 Other 0.4 0.7 No particular time 16.0 9.2 Don't know 33.7 6.4 Missing 0.1 0.0 Total 100.0 10O.0 Number 7060 499 Thirty-four percent of the women interviewed said they did not know when a woman is most rtkely to conceive and 28 percent said that a woman is most likely to conceive right after her period has ended. Only 14 percent gave the correct response: that a woman is most likely to conceive in the middle of her ovulatory cycle. Ever-users of periodic abstinence are more knowledgeable about the ovulatory cycle than women in general. Thirty percent identified the fertile period as occurring in the middle of the cycle, and only 6 percent said they did not know when it occurred. It should be noted that the precoded response categories for this question are only one way of dividing the cycle into distinct periods. Women may actually have a more accurate understanding of their fertility cycles than is reflected by these categories, especially those who answered "right after her period has ended." However, it appears that half of all women and one-sixth of those who have used periodic abstinence clearly do not understand the ovulatory process, since they either said that there is no particular time when a woman has a greater chance of becoming pregnant or they said there was a particular time but they did not know when it was or they thought it occurred "during her period." 4.6 Sources of Family Planning Methods All current users of modem methods of family planning were asked to report the source from which they most recently obtained their methods. Since women often do not know exactly which category the source they use falls into (e.g., government hospital, mission health centre, etc.), interviewers were instructed to write the name of the source. Supervisors and field editors were to verify that the name and the type of sources were consistent, asking cluster informants for the names of local family planning sources if necessary. This practice was designed to improve the reporting of data on sources of family planning. 45 Table 4.8 and Figure 4.3 indicate that most users of modem methods (56 percent) obtain their methods from public (government) sources, while 36 percent rely on private medical sources and 7 percent use other sources such as shops or friends. Government health centres are the single most frequently cited source, serving 32 percent of users, followed by government hospitals (24 percent) and private hospitals and clinics (20 percent)) In fact, eight in ten users obtain their methods from hospitals, health centres or clinics, whether public or private. Table 4.8 Source of supply for modem contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Zambia 1992 Female sterili- Source of supply Pill IUD Condom sation Total I PubUc 67.2 (64.0) 41.9 45.1 56.1 Government hospital 17.6 (48.0) 10.9 45.1 24.1 Government health centre 49.5 (16.0) 30.9 0.0 32.0 Private (medical) 26.7 (36.0) 36.8 53.5 36.0 Private hospital, clinic 17.7 (28.0) 5.5 36.3 20.0 Mission hospital, clinic 2.6 (0.0) 3.3 17.2 5.6 Pharmacy 4.4 (0.0) 24.4 0.0 7.6 Private doctor 1.3 (8.0) 0.0 0.0 1.8 Mobile clinic 0.2 (0.0) 3.7 0.0 0.8 Field worker 0.4 (0.0) 0.0 0.0 0.2 Other private 6.2 (0.0) 19.1 0.0 7.2 Shop 4.4 (0.0) 16.3 0.0 5.5 Filends/relatives 1.8 (0.0) 2.8 0.0 1.7 Don't know 0.0 (0.0) 2.2 0.0 0.4 Missing 0,0 (0.0) 0.0 1.4 0.3 Total 100.0 100.0 100~0 100.0 100.0 Number 245 27 100 104 493 1Includes 6 users of injection, 9 of vaginal methods and 1 of made sterilisation. The source a woman uses to obtain contraceptive methods depends on many things, one of which is the type of method she may have chosen. Most pill users obtain their method from public sources, one-half from govemment health centres and about one-sixth from government hospitals. Condom users are likely to use a wide range of sources--government facilities (42 percent), phannacies (24 percen0, shops (16 percent), as well as a few from private or mission clinics and friends or relatives. Female sterilisations are somewhat more likely to be performed in private institutions (54 percent), with almost as many of the operations undertaken in govemment hospitals (45 percent). Interviewers were instructed to consider health facilities run by mining companies as private facilities. 46 Figure 4.3 Distribution of Current Users of Contraception by Source of Supply Govt. Health Centre 3 l e rnment HospRal 24% Don't Know/Missing 1% Other 7% ,J PHvate (medical) 36% ZDHS 1992 Women who were currently using a modem contraceptive method were asked how long it takes to travel from their home to the place where they obtain the method. Nonusers were asked if they knew a place where they could obtain a modem method and, if so, how long it would take to travel there. The results are presented in Table 4.9. Among the women currently using a modem method, 44 percent are within 30 minutes (one-way travel time) of the place to which they go to get their method, while 27 percent are 30 minutes to one hour from their source. One'quarter °fusers °f m°dem meth°ds are °ne h°ur °r m°re fr°m their s°urce °f supply" As expected, urban users are generaUy closer than rural users to their supply sources; half of urban users are within 30 minutes of their supply sources as compared to less than one-fifth of the rural users. Half of the latter have to travel for one hour or more to get their supplies. Among women who are not using a modem method, almost one-quarter do not know a source for a modem contraceptive method. It should be noted that this question was asked of all nonusers and thus includes the 11 percent of women who do not know any method. Since these women presumably do not know of a source for family planning, they would account for almost half of those nonusers who do not know of a source. The last panelofTable 4.9 is based on all women who know a contraceptive method. Among women who know at least one family planning method, 28 percent are within 30 minutes of a source for a modem method and 15 percent say they do not know of a place to get a modem method. 47 Table 4.9 Time to source of supply for modern contraceptive methods Percent dlsa'ibution of women who are currently using a modern contr~eptive method, of women who are not using a modern method, and of women who know a method, by time to reach a source of supply, according to urban-rural residence, Zambia 1992 Woman who are currently using a modern method Woman who are not using a modem method Women who know a contraceptive method Minutes to source Urban Rural Total Urban Rural Total Urban Rural Total 0-14 26.2 16.1 24.2 19.3 10.0 14.6 21.3 11.3 16.7 15-29 24.2 2.9 19.9 16.0 2.7 9.3 17.9 3.2 11.1 30-59 28.7 18.6 26.6 24.8 7.7 16.1 26.5 9.2 18.5 60 or more 18.2 50.8 24.8 20.2 48.1 34.3 21.1 53.7 36.2 Does not know time 2.2 10.0 3.8 1.5 2.8 2.1 1.7 3.5 2.5 Does not know source 0.0 0.0 0.0 17.9 28.5 23.2 11.2 18.8 14.7 Not stated 0.6 1.5 0.7 0.3 0.2 0.2 0.4 0.3 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Median time to source 25.9 60.8 30.3 30.4 50.1 30.3 45.4 Number of women 393 100 493 3243 3324 6567 3387 2926 6313 - Median cannot be calculated 4.7 Intention to Use Family Planning Among Nonusers Women who were not using a contraceptive method at the time of the survey were asked i f they thought they would do something to keep from getting pregnant at any time in the future. Currently married nonusers are about evenly split between those who intend to use family planning in the future (48 percent) and those who say they do not intend to use (45 percent) (see Table 4.10). Almost three-quarters of those who intend to use say they intend to use a method within the next 12 months. Intention to use family planning is closely related to the number of children a woman has. Thus, while only 22 percent of childless nonusers would use family planning in the future, 50 percent of nonusers with four or more children expressed the intention to use a method in the future. About half of the women who say they intend to use contraception in the future have used it in the past, while the other half have never used a method, I f all the married women who say they intend to use family planning were to actually adopt it and use continuously, the contraceptive prevalence rate would rise substantially, from 15 percent of married women to about 56 percent. 48 Table 4.10 Future use of enntraeeption Percent dislxibutien of currently married women who are not using a conta'aceptive method by past experience with cont~caeeption and intention to use in the future, according to nurnbex of living children, Zambia 1992 Past experience with conU, aception end future intentions Number of living children I 0 1 2 3 4+ Total Never used contraception Intend to use in next 12 months 4.5 18.8 18.9 13.2 15.0 15.2 Intend to use later 10.9 11.0 6.3 7.4 3.8 6.7 Unsure as to timing 0.7 1.5 0.4 1.0 1.1 1.0 Unsure as to intention 11.5 7.4 5.5 3.5 3.6 5.3 Do not intend to use 57.7 32.7 28.2 28.0 28.5 31.7 Missing 0.0 0.0 0.4 0.0 0.1 0.1 Previously used contraception Intend to use in next 12 months 0.7 11.9 21.2 22.0 24.7 19.3 Intend to use later 4.7 5.2 6.3 7.7 4.8 5.5 Unsure as to timing 0.0 0.4 0.4 0.4 0.5 0.4 Unsure as to intention 0.8 1.4 2.4 1.9 1.6 1.7 Do not intend to use 8.5 9.7 10.2 14.8 16.2 13.1 Missing 0.0 0.0 0.0 0.2 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 190.0 All currently married nonusers Intend to use in next 12 months 5.2 30.7 40.0 35.2 39.7 34.5 Intend to use later 15.6 16.2 12.6 15.0 8.6 12.2 Unsure as to timing 0.7 1.9 0.8 1.4 1.6 1.4 Unsure as to intention 12.3 8.8 7.9 5.4 5.1 6.9 Do not intend to use 66.2 42.4 38.4 42.8 44.7 44.8 Missing 0.0 0,0 0.4 0.2 0.3 0.2 Total 100.0 100.0 100.0 100.0 100.0 I00.0 Number of women 317 725 599 523 1616 3780 qz~ludes current pregnancy 49 Table 4.11 presents the main masons for not using contraception given by married women who are not using any contraceptive method and do not intend to use it in the future. Over one-third (37 percent) of these women say they do not intend to use because they want children, while another one-third cite infecundity (either "difficult to get pregnant" or "menopausal") as the reason. Other reasons given are lack of knowledge (11 percent) and opposition to family planning, either by the respondent, her husband or someone else (7 percent). The younger cohort (under age 30) are more likely to say they do not to intend to use contraception in the future because they want more children or because they lack knowledge, while those age 30 and over are more likely to cite reasons such as being menopausal or infecund. Table 4.11 Reasons for not using contraception Percent distribution of curtent!y married women who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Zambia 1992 Age Reason for not using contraception 15-29 30-49 Total Want children 50.7 25.2 36.7 Lack of knowledge 15.2 6.9 10.6 Partner opposed 3.5 3.8 3.7 Cost too much 0.1 0.3 0.2 Side effects 6.0 3.3 4.5 Health concerns 1.2 1.7 1.5 Hard to get methods 1.2 0.4 0.8 Religion 0.7 1.9 1.3 Opposed to family planning 2.4 3.1 2.8 Fatalisdc 0.3 0,9 0.6 Other people opposed 0.4 0.1 0.3 Infrequent sex 0.3 1.0 0.7 Difficult to get pregnant 11.5 27.3 20.2 Menopausal, had hysterectomy 0.1 19.4 10.7 Inconvenient 0.9 1.1 1.0 Other 2.3 2.6 2.4 Don't know 3.1 1.0 1.9 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Number of women 763 930 1693 50 Nonusers who said that they did intend to use family planning in the fulurc were asked which method they preferred to use. The data arc presented in Table 4.12. Most of these women said they preferred to use the pill (59 percent), with female sterllisation the next most preferred method (8 percent). The same pattern of method preference is noted among women regardless of whether they intend to use in the next 12 months or later. There is a tendency for women who are unsure about the timing of future use to also be unsure of which method they might use. Table 4.12 Preferred method of contraception fox futom use Percent distribution of currently married women who are not using a con~aceptive method but who intend to use in the future by la'eferred method, according to whether they intend to use in the next 12 months or later. Zambia 1992 Intend to use In next After Unsure Preferred method 12 12 as to of contraception months months timing Total Pill 58.2 64.0 50.0 59.4 IUD 2.8 1.8 2.0 2.5 Injection 5,6 3.6 4.1 5.0 Diaphragm/Foam/Jelly 1.8 0.8 0.0 1.5 Condom 2.6 3.1 0.0 2.6 Female sterilisatinn 8.5 6.3 5,5 7.9 Periodic abstinence 2.4 3.3 0.0 2.7 Withdrawal 3.3 2.9 4.0 3.2 Other 7.2 5.1 6.1 6.6 Unsoxe 7.4 9.1 28.2 8.5 Total 100.0 I00.0 I00.0 100.0 Number of women 1304 459 54 1819 51 4.8 Exposure to Family Planning Messages on Radio and Television All respondents in the ZDHS were asked i f they had heard a message about family planning on radio or television in the month preceding the interview. Eight in ten women said they had not heard a message on either radio or television (see Table 4.13). Most of those who heard a message heard it on radio (18 percent), while 7 percent saw a message on television; only 5 percent had heard a message on both radio and television. The proportion of women who had heard family planning messages in the month prior to the survey varied widely by background characteristics. One-third of women resident in urban areas and in Copperbelt and Lusaka Provinces had heard messages, compared to only 7 percent of women living in rural areas or in Eastern and Western Provinces. Women with higher education are much more likely to have heard a family planning message on radio or television than those with primary or no education. Table 4.13 Family planning messages on radio and television Percent distribution of all women by whether they have heard a family planning message on radio or on television in the month preceding the survey, according to selected background characteristics, Zambia 1992 Heard family plauning message on radio or on television Number Background Radio Television of char aeterlstic Neither only only Both Miss'rag Total women Residence Urban 67.8 20.0 2.9 9.0 0.3 100.0 3636 Rural 92.8 5.8 0.4 0.9 0.1 100.0 3424 Province Cenural 85.4 10.1 1.6 3.0 0.0 100.0 622 Copperbelt 65,7 21.3 2.2 10.5 0.3 100.0 1743 Eastern 93.2 4.8 0.3 1.5 0.2 100.0 729 Luapula 86.0 10.1 0.4 3.5 0.0 100.0 431 Lusaka 68.1 18.6 4.4 8.5 0.4 100.0 1234 Northern 89.7 9.3 0.5 0.3 0.2 100.0 652 North-We.stem 86.1 10.3 1.8 1.4 0.4 100.0 183 Southern 90.4 7.5 0.5 1.6 0.0 100.0 1045 Westem 92.6 5.8 0.6 1.0 0.0 100.0 422 Education No education 93.8 4.9 0.3 1.0 0.0 100.0 1161 Primary 82.0 13.2 1.0 3.6 0.3 100.0 4213 Secondary 65.7 18.8 4.1 11.2 0.1 100.0 1561 Higher 57.0 16.7 9.6 16.7 0.0 100.0 124 Total 79.9 13.1 1.7 5.1 0.2 100.0 7060 52 Table 4.14 presents results from a question on whether women believe it is acceptable or not acceptable to air family planning messages over radio or television. Nearly t/nee-quarters of the women interviewed said that such messages are acceptable to them. The proportion of women who think family planning messages are acceptable is highest among women in their 20s and 30s and falls off among older women. Women living in urban areas or in Western, Central, Luapula, and Copperbelt Provinces, as well as more educated women are much more likely to accept family planning messages on radio or television than other women. Women in Eastern and Southern Provinces are particularly likely to oppose family planning messages on the media. Table 4.14 Acceptability of the use of mass media for diasamiunting family planning messages Percent distribution of women by acceptability of having messages about family planning on radio or television, according to age end selected background characteristics, Zambia 1992 Not Number Background Accept- ar, cept- Unsure/ of characteristic able able Mi~s'mg Total women Age 15-19 68.3 31.1 0.6 100.0 1984 20-24 78.1 21.5 0.4 100.0 1441 25-29 80.0 19.5 0.4 100.0 1179 30-34 76.9 22.5 0.6 100.0 915 35-39 73.7 26.2 0.2 100.0 656 40~14 66.4 33.5 0.1 100.0 505 45-49 57.9 41.8 0.3 100.0 380 Residence Urban 78.9 20.7 0.4 100.0 3636 Rural 67.1 32.5 0.5 100.0 3424 Province Cen~al 87.7 12.3 0.0 100.0 622 Copperbelt 80.9 18.8 0.3 100.0 1743 Eastern 44.7 54.9 0.5 I00.0 729 Luapula 81.0 19.0 0.0 100.0 431 Lusaka 78.4 21.3 0.3 100.0 1234 Northern 64.5 35.5 0.0 100.0 652 North-Western 75.6 14.6 9,8 100.0 183 Southera 57.3 42.7 0.0 100.0 1045 Western 97.8 2.2 0.0 100.0 422 Educatlon No education 59.8 40.0 0.2 I00.0 1161 Primary 71.2 28.3 0,5 I00.0 4213 Second~+ 87.4 t2.3 0A 100.0 1685 Total 73.2 26.4 0.4 I00.0 7060 53 4.9 Approval of Family Planning An indication of the acceptability of family planning is the extent to which couples discuss the topic with each other. Table 4.15 indicates that 58 percent of married women who know a contraceptive method had discussed family planning with their husbands in the year prior to the survey. Most of these women had discussed the topic only once or twice with their husbands, but almost as many had discussed family planning more often. The tendency to discuss family planning with spouses is greater among women in their 20s and 30s than among older or younger women. Table 4.15 Discussion of family planning by couples Percent distribution of currently married non-sl~filiscd women who know a contraceptive method by the number of times family planning was discussed with husband in the year preceding the survey, according to current age, Zambia 1992 Age Never Number of times family planning discussed Num~r Once or Three Not of twice or more ascertained Total women 15-19 51.6 30.8 17.1 0.5 100.0 456 20-24 38.9 35.3 25.7 0.1 100.0 935 25-29 37.9 31.7 30.1 0.2 100.0 902 30-34 38.4 32.9 28.2 0.4 100.0 717 35-39 38.4 27.0 34.4 0.1 100.0 479 40-44 45.2 28.9 25.6 0.3 100.0 346 45-49 60.2 22.9 16.9 0.0 100.0 249 Total 41.8 31.3 26.6 0.2 100.0 4083 In order to obtain more direct information about the acceptability of family planning, respondents were asked if they approved or disapproved of couples using a method to avoid pregnancy. Although all women were asked this question, the data presented in Table 4.16 are confined to currently married, non- sterilised women and exclude those women who had never heard of a contraceptive method. Currently married, non-sterilised women were also asked if they thought that their husbands approved of the use of family planning. It should be noted that wives' opinions of their husbands' attitudes may be incorrect, either because they have misconstrued their husbands' true attitudes, or because of a tendency to report their husbands' attitudes as similar to their own. Overall, 81 percent of married women who know a contraceptive method approve of family planning. Just over half of the women say that their husbands also approve of family planning; 17 percent say that they approve of family planning and their husbands do not. Approval of family planning by married women does not vary much by age of the woman except that women age 45-49 are less likely to approve than younger cohorts. Married women who live in urban areas or in Westem, Central or Northern Provinces, and those who are better educated are more likely than other women to approve of the use of family planning. Among 54 husbands, the proportion who reportedly disapprove of family planning decreases with increasing level of education of their wives. A sizeable proportion of married women living in rural areas do not know their husbands' attitudes towards family planning, an indication of the extent to which family planning is discussed by rural couples. The proportion of wives who say they do not know their husbands' attitude toward family planning use is also high among women in Eastern and Western Provinces and among uneducated women. Table 4.16 Attitudes of couples toward family planning Among curr~fly married non-sterilised women who lmow a contraceptive method, the percentage who approve of family planning, by thdtr perception of their husband's attitude and selected baekgrotmd eharacterlsties, Zambia 1992 Respondent approves Respondent disapproves Unsme Uusurc Both Husband of Husband Husband of Respondent Characteristic approve disapproves husband approves disapproves husband unsure Percent Total Age 15-19 41.0 12.7 22.5 3.8 12.0 6.5 1.3 100.0 456 20-24 53.2 14.5 15.9 2.6 9.8 3.7 0.4 100.0 935 25-29 54.2 17,8 12.4 2.4 8.9 3.4 0.9 100.0 902 30-34 51.5 17.9 12.8 2.5 10,2 4.0 1.1 100.0 717 35-39 52.0 18.0 11.5 2.8 9.4 5.7 0.5 100.0 479 40-44 44.1 20.5 14.9 1.3 13.6 5.4 0.1 100.0 346 45-49 36.7 14.4 13.8 4.6 17.8 12.2 0.4 100.0 249 Residence Urban 57.7 17.9 8.5 2.6 10.0 2.1 1.1 100.0 1963 Rural 42,5 15.3 20.2 2.8 11.3 7.5 0.3 100.0 2120 Province CenU'al 51.4 20.8 13.7 1.8 9.0 1.4 1.8 100.0 306 Copperbelt 55.2 21.1 7.3 4.0 9.4 1.7 1.3 100.0 979 Eastern 33.3 10.2 27.3 3.4 9.5 16.1 0.2 100.0 488 Luapula 43.8 18.2 19.5 1.3 10.3 6.4 0.5 100.0 264 Lusaka 59.9 13.5 10.0 1.6 12.0 2.2 0.8 100.0 678 Northern 60.2 14.5 11.3 1.7 9.2 3.2 0.0 100.0 384 North-Western 47.6 22.3 5.1 4.4 14.5 5.7 0.4 100.0 110 Southern 40,5 15.6 19.0 3.4 14.9 6.5 0.2 100.0 646 Western 47.6 15.9 25,9 0,6 5.9 3.6 0.5 100.0 228 Education No education 37.0 15.8 20.3 2.7 14.1 10.0 0.2 100.0 719 Primary 46.8 17.7 15.1 3.0 12.0 4.7 0.7 100.0 2577 Secondary 69.9 14.0 8.3 1.8 3.5 1.1 1.4 100.0 705 Higher 87.0 8.9 2.8 0.0 1.4 0.0 0.0 100.0 80 Total 49.8 16.5 14.6 2.7 10.7 4.9 0.7 100.0 4083 55 CHAPTER 5 OTHER PROXIMATE DETERMINANTS OF FERTILITY This chapter addresses the principal factors, other than contraception, which affect a woman's risk of becoming pregnant: nuptiality and sexual intercourse, postpartum amenorrhoea and abstinence from sexual relations, and secondary infertility. While it is by no means exact, marriage is an indicator of exposure of women to the risk of pregnancy, and is therefore important for the understanding of reality. Populations in which age at marriage is low also tend to experience early childbearing and high feltility; hence the motivation to examine trends in age at marriage. This chapter also includes more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Measures of other proximate determinants of fertility are the durations of postpartum amenorrhoea and postpartum abstinence and the level of secondary infertility. 5.1 Marital Status Data on the marital status of respondents at the time of the survey are shown in Table 5.1. The term "married" refers to legal or formal marriage, while "living together" refers to informal unions. In subsequent tables, these two categories are combined and referred to collectively as "currently married" or "currently in union." Women who are widowed, divorced, and no longer living together (separated) make up the remainder of the "ever-married or "ever in union" category. Table 5.1 Current marital status Percent distribution of women by current marital status, according to age, Zambia 1992 Age Marital status No longer Number Never Living living of married Married together Widowed Divorced together Total women 15-19 70.4 26.0 0.5 0.2 1.8 1.1 100.0 1984 20-24 21,2 66.5 2.1 1.1 6.2 2.9 100.0 1441 25-29 5,7 76.7 3.2 2.1 8.7 3.6 100.0 1179 30-34 Z0 79.5 3,0 3,8 10,3 1,5 100,0 915 35-39 0,7 79.7 2.2 3.5 11.8 2.2 100.0 656 40-44 0,1 79.3 2.3 5.7 9.8 2.8 100.0 505 45-49 0.0 75,2 2.5 8.5 11.6 2.2 100.0 380 Total 25,4 61,1 2.0 2.3 7.0 2.2 100.0 7060 57 Most Zambian women of reproductive age are currently in a marital union (63 percent). The 1980 census which also defined marriage to include unions "where no ceremony has been performed but the man and woman are living as husband and wife," reported a slightly higher figure (67 percent of women). Some of the decrease in the proportion married is probably due to a rising age at first marriage (see section 5.3), though some is no doubt due to the relatively larger proportion of teenagers surveyed in the ZDHS, most of whom have not yet married. Consequently, the proportion never married appears to have increased slightly from 24 percent in 1980 to 25 percent in 1992. The proportion who have never married drops precipitously among women in their late 20s. The proportion divorced or separated (no longer living together) rises steeply after age group 15-19 until age 25-29, after which it stays relatively constant at about 12-14 percent of women. The proportion widowed rises more gradually, reaching about 9 percent of women age 45-49. 5.2 Polygyny Since polygyny is practiced in Zambia, married women were asked in the ZDHS whether their husbands had other wives, and if so, how many. Overall, 18 percent of currently married women are in a polygynous union. The figures presented in Table 5.2 indicate that polygyny exists in aU provinces and among all socioeconomic groups, although prevalence varies. Rural women are about three times more likely than urban women to be in such unions. One-third of married women in Southern Province and one-quarter Table 5.2 Polygyny Percentage of currently married women in a polygynous union, by age and selected background characteristics, Zambia 1992 Age of woman Background All characteristic 15-19 20,24 25-29 30-34 35-39 40-44 45-49 ages Residence Urban 1.7 4.8 9.1 12.2 11.5 13.6 19.6 9.3 Rural 13.4 15.6 25.8 34.9 33.5 29.4 35.6 25.1 Province Central (4.5) 14.6 11.8 17.0 (20.6) (22.8) (44.4) 16.6 Col)perMit 3.4 3.3 8.5 11,3 10.4 11.1 13.8 8.2 Eastern 13.4 14.4 19.6 30.4 (27.6) (31.1) (36,8) 22.3 Luapula 9.5 10.8 24.0 24.1 (16.2) (22.5) * 17.3 Lusaka 3.5 6.6 6.6 12.5 6.6 12.4 (21.3) 8,7 Northern 10.0 15.7 26.8 (36.2) (37.6) (34.3) (39.0) 25.7 North-Western (0.0) 6.7 12.1 (24.1) (36.9) * * 15.6 Southern 19.0 18.4 35.2 44.7 45.9 35.3 (36,8) 32.8 Western * 10.6 16.5 32.1 (26.3) (24.4) (36.2) 22.1 Education No education 12.4 17.9 21.8 33.9 30.3 22.3 32.2 24.8 Primary 8.9 10.9 18.8 22.7 22.5 24.9 29.0 17.7 Secondary (4.3) 5.2 12.2 14.2 17.5 (19,9) * 11.3 Total 9.1 10.6 17.2 22.6 22.3 22.6 30.2 17.7 Note: Rates shown in parentheses are based on 25 to 49 women, while an asterisk means the rate is based on fewer than 25 women and has been suppressed. 58 in the Nolthem Province are in polygynous unions, compared to 22 percent of women in Eastern and Western Provinces, between 16 and 18 percent in Luapula, North-Western and Central Provinces and between 8 and 9 percent in Copperbelt and Lusaka Provinces. Nearly one-quarter of the women with no formal schooling are in a polygynous union, compared to 11 percent of those with secondary education. Most women in polygynous unions have only one co-wife, however, one-third of the women (6 percent of all married women) have two or more co-wives (see Table 5.3). In fact, in Southern and North- Western Provinces, though a majority of women are in monogamous unions (67 and 84 percent, respectively), more women have two or more co-wives (20 percent and 11 percent) than have one co-wife (13 percent and 4 percent, respectively). Table 5.3 Number of co-wives Percent distribution of currently married women by number of co-wive*, according to selected background characteristics, Zambia 1992 Number of co-wive* Number Background of characteristic 0 1 2+ Missing Total women Age 15-19 90.9 6.9 2.2 0.0 100.0 526 20-24 89.4 7.1 3.3 0.1 100.0 989 25-29 82.8 10.8 6.4 0.0 100.0 943 30-34 77.4 13.8 8.7 0.1 100.0 755 35-39 77.7 13.5 8.8 0.1 100.0 537 40-44 77.4 13.7 9.0 0.0 100.0 412 45-49 69.8 19.4 10.8 0.0 100.0 295 Residence Urban 90.7 6.6 2.6 0.1 100.0 2091 Rural 74.9 15.3 9.8 0.0 100.0 2366 Province Central 83.4 10.3 6.1 0.3 1(30.0 418 Copperbeh 91.8 6.5 1.6 0.1 I00.0 1023 Eastern 77.7 16.5 5.8 0.0 100.0 536 Luapula 82.7 14.8 2.5 0,0 100.0 281 Lusaka 91,3 5.2 3.6 0.0 100.0 738 Northern 74.3 20.5 5.2 0.0 100.0 423 North-Western 84.4 3.9 11.4 0.3 100.0 124 Southern 67.2 12.7 20.1 0.0 100.0 673 Western 77.9 18.5 3.6 0.0 100.0 241 Educatlon No education 75.2 17.2 7.6 0.0 I00.0 864 Primary 82.3 10.8 6.9 0.I 100,0 2754 Secondary 88,7 7.2 4.1 0.1 I00.0 745 Higher 97.7 1.2 1.2 0.0 100.0 93 Total 82.3 11.2 6.4 0.1 100,0 4457 59 The tendency to have another wife (either one or two or more co-wives) increases with age, a reflection of changes in the marital status as widowed and divorced women are remarried. Whilst a rural woman is twice as likely as an urban woman to have one co-wife, she is four times more likely than her urban counterpart to have two or more co-wives. More educated women are less likely to have a co-wife: 17 percent of women with no education have one co-wife, compared to 11 percent and 7 percent of those who have primary and secondary education, respectively. Women with no education are also nearly twice as likely as those with secondary education to have two or more co-wives. 5.3 Age at First Marriage ZDHS data show that half the women in Zambia marry before they reach age 18. The reported mean age at first union is 18.5 years; the 1980 census reported a mean age at first marriage of 18.3 years (Central Statistical Office, 1985a). The data presented in Table 5.4 indicate a median age at first marriage of 17.4 for women age 25-49 and 17.7 among the 20-49 year olds; the pattern shows a trend toward later age at marriage for younger women. Table 5.4 Age at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage, according to current age, Zambia 1992 Percentage of women who were Percentage Median first married by exact age: who had age at Number never first of Current age 15 18 20 22 25 married marriage women 15-19 4.2 NA NA NA NA 70.4 a 1984 20-24 9.0 43.3 63.6 NA NA 21.2 18.6 1441 25-29 12.0 50.4 69.5 81.9 91.6 5.7 18.0 1179 30-34 17.7 60.6 78.4 87.8 94.6 2.0 17.2 915 35-39 19.3 63.8 82.7 90.8 96,2 0.7 17.2 656 40-44 22.6 62.9 81.2 91.6 95,8 0.1 17.0 505 45-49 31.1 64.8 79.3 90.0 96.1 0.0 16.6 380 20-49 15.6 54.3 73.0 83.7 89.9 7.8 17.7 5076 25-49 18.2 58.6 76.8 87.2 94.2 2.5 17.4 3635 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 were first married by age x Cohort trends in age at marriage can also be described by comparing the cumulative distribution for successive age groups, as shown in Table 5.4. ~ The age at marriage appears to have increased over time. The proportion of women married by age 15 has decreased systematically from 31 percent among those age For each cohort the accumulated percentages stop at the lower age boundary of the cohort to avoid censoring problems. For instance, for the cohort currently aged 20-24, accumulation stops with the percentage married by exact age 20. 60 45-49 to 4 percent among the 15-19 year-olds. The median age at marriage has increased from 17 years or less among women now in their 30s and 40s to 18 and over among women in their 20s. Thus, the median age at marriage has increased by between one to one and a half years. The national picture masks large differentials in marriage behaviour patterns; Table 5.5 presents a more detailed picture of the trends in the median age at marriage. It can be seen that the changes observed at the national level have been achieved primarily through changes in the behaviour of women in urban areas, where the median age at marriage has increased by more than 3 years between cohorts of women age 20-24 and 45-49. Increases of 2 years or more have taken place among women in Copperbelt, Central and Luapula Provinces, whilst the median age at marriage among women in North-Western, Eastern and Southern Provinces has risen by over one year. Level of education attended is closely related to age at first marriage. The median age at first marriage for women 25-49 increases steadily with education, from 16.7 among women with no education to 19.9 for women with secondary or higher schooling. Table 5.5 Median age at first marriage Median age at first marriage among women age 20-49 years, by current age and selected background characteristics, Zambia 1992 Current age Woman Woman Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 19.7 18,4 17.2 17,2 17.1 16.4 18.0 17.5 Rural 17.9 17.6 17.2 17.1 17.0 16.7 17.4 17.2 Province Central 18.0 18.0 17.5 (16.6) (16.4) (15.8) 17.5 17.2 Copperbelt 18,9 18.3 16.9 16.8 16.8 16.5 17.6 17.2 Eastern 17.6 17.7 17.4 18.0 17.0 (16.3) 17.5 17.4 Luapula 17.6 17.3 16.7 17.0 16.4 (15.6) 17.0 16.8 Lusaka a 18.5 17.5 17.1 17.5 (18.0) 18.4 17.8 Northern 17.8 17.5 16.6 (17.3) (18.1) (17.2) 17.4 17.3 North-Western 17.6 17.8 17.8 (15.7) (15.6) * 17.1 17.0 Southern 18.8 18.0 17.0 17.5 16.8 (17.6) 17.8 17.5 Western a 18.1 18.4 17,4 (17,8) 16.8 18.2 17.8 Education No education 17.7 17.4 16.4 16.3 16.6 16.5 16.9 16.7 Primary 17.8 17.3 16.7 16.8 16.8 16,7 17.1 16.9 Secondary+ a 20.8 20.0 18.7 19.6 * a 19.9 Total 18.6 18.0 17.2 17.2 17.0 16.6 17.7 17.4 Note: Rates shown in parentheses are based on 25 to 49 women, while art asterisk means the rate is based on fewer than 25 women and has been suppressed. Medians are not shown for women 15-19 because less thma 50 percent of these women bad married by age 15. aomitted because less than 50 percent of the woman in the age group were first married by age 20. 61 5.4 Age at First Sexual Intercourse While age at first marriage is often used as a proxy for exposure to intercourse, the two events do not necessarily occur at the same time. Women may engage in sexual relations prior to marriage, especially if they are postponing the age at which they marry. The ZDHS asked women the age at which they first had sexual intercourse (see Tables 5.6 and 5.7). (Note that the information on age at first sexual intercourse in Tables 5.6 and 5.7 parallels the information on age at first marriage in Tables 5.4 and 5.5). In many cases sexual activity precedes marriage (see Table 5.6). For instance, by age 18, 72 percent of the women age 20-49 had had sexual intercourse, whereas only 54 percent had married; similarly, by age 20, 88 percent had had intercourse, while 73 percent had married. Overall, the median age at first sexual intercourse is 16.3 years, which is about 1.4 years earlier than the median age at first marriage of 17.7. Analysis of cohorts indicates that there has been little change in the median age at first sexual intercourse over time. Table 5.6 Age at first sexual intercourse Percentage of women who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at first intercourse, according to current age, Zambia 1992 Percentage of women who had first intercourse by exact age: Current age 15 18 20 22 Median Percentage age at who fast Number never had inter- of 25 intercourse course women 15-19 19.2 NA NA NA NA 39.5 a 1984 20-24 20.2 68.9 86.9 NA NA 4.3 16,6 1441 25-29 23.3 70.9 87.2 93.8 98.1 0.6 16.4 1179 30-34 28.1 77.1 90.7 96.1 98.4 0.2 16.0 915 35-39 27.5 75.8 90.8 95.7 98.4 0.0 16.2 656 40-44 28.9 72.5 88.8 95.6 97.4 0.0 16.3 505 45-49 36.8 71.4 86.6 92.7 98.1 0.0 16.0 380 20-49 25.4 72.3 88.3 94.6 97.3 1.4 16.3 5076 25-49 27.5 73.6 88.9 94.8 98.1 0.3 16.2 3635 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 had had intercourse by age x I f women do not wait for marriage to become sexually active, has the increasing age at marriage among women in urban areas and in Central, Copperbelt and Luapula Provinces had any effect on delaying exposure to intercourse? Table 5.7 indicates some trend toward later initiation of sexual intercourse among younger urban women; however, it is nowhere near as strong as the trend toward later age at marriage. While age at marriage has been increasing, the age of initiating sexual activity has remained unchanged in Lusaka and Northem Provinces where it has been relatively high. 62 More educated women tend to delay initiating sexual relations longer than uneducated women (median age at first intercourse for those with secondary or higher education is 2 years more than for those with no education), but they postpone marriage even longer (the median age at first marriage for the most educated women is three years greater than that of women with no education). On the other hand, the differentials between the urban and the rural women in respect of age at marriage and age at first sexual intercourse are virtually the same: urban women have a median age at marriage of 0.6 years later than rural women (20-49 age group); their median age at first intercourse is also 0.6 years later. Even among the younger women (20-24 years), while the median age at marriage in urban areas is about 2 years later than in the rural areas, the median age at first intercourse is less than one year later in urban than in rural areas. Table 5.7 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 years, by current age and selected backgmtmd characteristics, Zambia 1992 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 17.0 16.8 16.2 16.4 16.4 16.1 16.6 16.5 Rural 16.2 16.0 15.8 15.9 16.1 16.0 16.0 16.0 Province Cen~al 16.4 16.3 16.0 (15.5) (15.8) (15.0) 16.0 15.9 Copperbelt 16.8 16.8 16.1 16.1 15.9 16.3 16.5 16.3 Eastern 16.2 16.6 15.7 17.4 16.6 (15.4) 16.3 16.3 Luapula 16.1 15.8 16.0 16.5 15.6 (15.1) 15.9 15.8 Lusaka 17.2 16.9 16.3 16.6 17.0 (16.8) 16.8 16.7 Northern 16.7 16.6 16.3 (17.0) (17.3) (17.2) 16.7 16.7 North-Wastem 15.5 15.7 15.4 (15.3) (14.9) * 15.5 15.5 Southern 16.3 16.0 15.9 15.7 16.0 (16.3) 16,0 15.9 Western 16.4 16.3 16.3 15.8 (16.4) 16.3 16.2 16.2 Education No education 16.5 16.1 15.4 15.7 15.9 16.2 15.9 15.8 Primary 16.1 15.9 15.8 15.9 16.1 15.8 16.0 15.9 Secondary+ 18.1 18.0 17.6 17.6 17.8 * 17.9 17.8 Total 16.6 16.4 16.0 16.2 16.3 16.0 16.3 16.2 Note: Rates shown in parentheses are based on 25 to 49 women, while an asterisk means the rate is based on fewer than 25 women and has been suppressed. Medians are not shown for women 15-19 because loss than 50 percent of those women had had intorenurs~ by age 15. 5,5 Recent Sexual Activity In the absence of contraception, the probability of pregnancy is related to the frequency of intercourse. Thus, information on sexual activity can be used to refine measures of exposure to pregnancy. Only 12 percent of women interviewed in the ZDHS had never had sexual intercourse. But not all women who have ever had intercourse are currently sexually active. Table 5.8 presents data on levels of sexual activity by background characteristics; the distributions are shown for women who have ever had intercourse. 63 Table 5.8 Recent sexual activity Percent distribution of women who have ever had sexual intercourse by sexua/activity in the four weeks preceding the survey and the duration of abstinence by whether or not postpartum, according to selected background characteristics, Zambia 1992 Not sexually active in last 4 weeks SexuaHy Abstaining Abstaining active (postpartum) (not postpartum) Number Background in last , of characteristic 4weeks 0-1 years 2+ years 0-1 years 2* years Total women Age 15-19 55.7 16.3 1.0 25,0 2.0 100.0 1200 20-24 60.9 16.6 2.2 19.5 0.8 100.0 1378 25-29 65.3 12.3 1.8 18.5 1.8 100.0 1172 30-34 65,5 13.4 1.9 17.3 2.0 100.0 913 35-39 64.8 10.9 2.3 18.6 3.4 100.0 656 40-44 70,2 5.4 1.8 18.3 4.3 100.0 505 45~19 59.4 1.6 1.3 22.5 15.1 100.0 380 Duration of union 0 J, 69.3 15.4 0.7 14.5 0.1 100.0 1308 5-9 66.5 15.1 1.4 15.8 1.3 100.0 1095 10-14 68,4 12,2 2,2 15,4 1,6 100,0 857 15-19 67.5 12.7 1.2 16.6 2.0 100.0 769 20-24 64.7 9,6 2.1 19.9 3.6 100.0 574 25+ 64.3 2,6 1.7 21.4 10,1 100,0 664 Never in union 36.2 16.5 3.6 38.9 4.6 100,0 936 Residence Urban 62.1 11.7 1.5 21.7 2.9 100,0 3109 Rural 62.9 13.9 2.0 18.3 2.8 100.0 3096 Province Central 66.4 11.2 0.4 19,1 2.7 100.0 559 Copperbelt 62.0 10.7 1.8 22.3 3.2 100.0 1471 Eastern 60.1 12.7 2.5 19,8 4.9 100.0 672 Luapula 65.4 11,4 1.8 19,0 2.4 100.0 372 Lusaka 63.0 11.7 1.1 21,8 2.3 100.0 1078 Northern 53.3 19.9 3.2 19~6 4.0 100.0 546 Nor th-Westem 59.6 18.3 1.5 18.0 2.6 100.0 165 Southern 70.6 11.5 1.2 15.7 0.9 100.0 945 Western 53.4 18.9 3.8 21.4 2.5 100.0 395 Education No education 63.1 13,0 1.9 17.4 4.7 100.0 1083 Primary 64.1 13.6 1.6 18.7 2.0 100.0 3716 Secondary 57.0 11.0 2.3 26.2 3.5 100.0 1281 Higher 65.3 6.2 0.9 21.3 6.2 100.0 123 Current contraceptive method No method 60.5 13.8 1.9 20.7 3.0 100.0 5388 Pill 83.8 2.6 0.3 13.3 0.0 100.0 245 IUD (72.0) (4.0) (0.0) (12.0) (12.0) 100.0 27 Stetilisation 69.6 5.2 0.4 20.3 4.5 100.0 106 Periodic abstinence 78.8 6.1 0.0 15.1 0.0 100.0 55 Other 72.6 9.2 1.0 I6.2 1.0 100.0 375 Total 62.5 12.8 1.8 20.0 2.8 100.0 6205 Note: Figures in parentheses are based on 25 to 49 women 64 Women are considered to be sexually active if they had intercourse at least once in the four weeks prior to the survey. Women who are not sexually active may be abstaining in the period following a birth, or may be abstaining for various other reasons. Among women who have had sexual intercourse, 63 percent were sexually active in the month prior to the interview, while 15 percent were abstaining postpartum and 23 percent were abstaining for other reasons. Women who have never been in a union are less likely to be sexually active than those who are in a union. As expected, women who are using a method of family planning are more likely to be sexually active than those who are not. 5.6 Postpartum Amenorrhoea , Abst inence, and Insusceptibi l i ty Postpartum protection from conception can be prolonged by broastfeeding, which can lengthen the duration of amenorrhoea (the period foUowing a birth, but prior to the return of menses). Protection can also be prolonged by delaying the resumption of sexual relations. Table 5.9 presents the percentage of births whose mothers are postpartum amenorrhoeic and abstaining, as well as the percentage of births whose mothers are classified as still postpartum insusceptible to pregnancy for either mason; data are presented by months since the birth. Table 5.9 Postpartum amanorrhooa r abstinence and insusceptibility Percentage of births whose mothers are postpartttm arnanorthceic, abstaining and insusceptible, by number of months since birth, and median and moan durations, Zambia 1992 Number Months Amenur- Inans- of since birth rhoeic Abstaining eeptible births < 2 97.5 95.3 99.1 192 2-3 87.1 68.2 91.3 257 4-5 80.0 47.9 86.3 254 6-7 72.4 30.6 77.4 265 8-9 65.2 27.4 73.2 227 10-11 55.5 21.4 62.5 221 12-13 47.0 17.4 54.0 225 14-15 36.6 16.2 45.5 237 16-17 24.8 13.9 32.4 200 18-I9 17.5 12.3 24.3 217 20-21 15.1 10.7 22.7 219 22-23 8,0 8.9 13.7 209 24-25 4.9 5.9 9.6 201 26-27 4.3 3.8 7.2 223 28-29 1.7 3.6 5.0 237 30-31 0.3 5.8 5.8 198 32-33 1.1 5.2 6.3 210 34-35 0.9 6.4 7.3 196 Total 36.0 22.8 41.8 3987 Median 11.7 4.4 13.3 Mean 12.7 8.3 14.7 Prevalence/Incidence mean 12.8 8.1 14.8 65 Nearly three-quarters of Zambian women remain amenorrhoeic for at least six months following a birth; only one-third abstain from sexual intercourse during this period. The proportion remaining amenorrhoeic 18 months after birth drops significantly to 18 percent and those still abstaining to 12 percent. Overall, three-quarters of women become susceptible to pregnancy within 18-19 months of giving birth. The average duration of the postpartum insusceptible period is 15 months. The median durations of postpartum amenorrhoea, abstinence and insusceptibility are presented in Table 5.10 by background characteristics of the mothers. Postpartum amenorrhoea generally lasts slightly longer among older (age 30 and above) than younger mothers. The duration is also longer among rural (14 months) than urban mothers (9 months), a possible indication of shorter duration of breastfeeding among urban women. Mothers in Northern Province show a particularly long median duration of amenorrhoea, while those in Westem and Nonla-Westem Province tend to abstain for considerably longer periods (10-12 months) after birth than the 3-5 months that mothers in other provinces report. The long abstinence in the latter two provinces may account in part for their relatively low fertility (see Chapter 3). With regard to educational level, the higher the level of education of the mother, the shorter the median duration of amenorrhoea, The median duration of amenorrhoea decreases from 14 months for women with no education to 12 months for those with primary schooling and to only 8 months for women with secondary education. Table 5.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Zambia 1992 Postpartum Number Background Postpartum Postpartum insuscep- of characteristic amenorrhoea abstinence tibility births Age <30 11.0 4.3 12.9 2687 30+ (13.9) 4.5 14.9 1301 Residence Urban 9.4 4.6 11.3 1878 RurN 13.5 4.2 14.6 2109 Education No education * (4.4) (15.3) 654 Primary 11.7 4.5 13.1 2544 Secondary (8.3) * (11.9) 725 Total 11.7 4.4 13.3 3987 Note: Medians are based on current status. Rates shown in parentheses are based on 25 to 49 women, while an asterisk means the rate is based on fewer than 25 women and has been suppressed. 66 5.7 Termination of Exposure to Pregnancy Later in life, the risk of pregnancy begins to decline with age, typically beginning around age 30. While the onset of infecundity is difficult to determine for any individual woman, there are ways of estimating it for a population. Table 5.11 presents indicators of decreasing exposure to the risk of pregnancy for women age 30 and above. The first, an indicator of menopause, includes women who are neither pregnant nor postpartum amenorrhoeic, but have not had a menstrual period in the six months preceding the survey. Forty-two percent of the oldest women interviewed are menopausal according to this indicator. The other indicator is long-term abstinence which is the percentage of currently married women who did not have intercourse in the last three years. This percentage is very low even among the oldest women. Table 5.11 Termination of exposure to the risk of pre~nane,/ Indicators of menopause and long-term abstinence among eurronfly married women age 30-49, by age, Zambia 1992 Long-teaxn Monopause I abstinene~ Age Percent N Percent N 30-34 3.8 388 0.1 755 35-39 2.6 334 0.7 537 40-41 6.6 87 0.8 134 42-43 11.7 161 1.1 193 44-45 25.6 138 2.8 157 46-47 28.1 104 1.8 109 48-49 41.7 109 1.9 114 Total 12.0 1321 0.8 1999 IPercentage of non-pregnam, non-amenorrhonic currc~tiy married women whose last menstrual period occurred six or more months preceding the survey or who report that they are menopausal. 2Percentage of currently married women who did not have int~course in the three years preceding the survey. 67 CHAPTER 6 FERTILITY PREFERENCES Several questions were asked in the ZDHS concerning women's fertility preferences. These questions dealt with: 1) whether the respondent wanted another child, 2) if so, how long she would like to wait to have the next child, and 3) how many children she would want in total if she could start afresh. The answers to these questions allow the estimation of levels of unmet need for family planning services either to limit or space births and of levels of unwanted fertility. The value of the data on fertility preferences as a vehicle for predicting future fertility is questionable. Women's attitudes towards childbearing may not be fully formed and may change over time. Moreover, the data do not reflect the effects of social pressures or the attitudes of other family members, particularly the husband, who may have a major influence on reproductive decisions. Also, women need the means to fulfill their desires. However, on a macro level, data on fertility preferences can be useful as an indicator of the direction that future fertility may take. 6.1 Desire for More Children In the ZDHS, currently married women were asked "Would you like to have (a/another) child or would you prefer not to have any (more) children?" Interviewers were instructed to alter the wording depending on whether the respondent already had children or not. If the woman was pregnant, she was asked Figure 6,1 Fertility Preferences among Currently Married Women 15-49 Want no more 22% Undec ided 5~ I n feeund 4% Ster i l i sed 2% Want a ch i ld soon 26% (within 2 yrs) Want a ch i ld la ter 41% (a f ter 2 or more yrs) ZDHS 1992 69 if she wanted another child after the one she was expecting. Women who said they did want to have another child were then asked how long they would like to wait before the birth of the next child. As Figure 6.1 shows, two-thirds of married women in Zambia want to have another child; however, most of these women (41 percent of all married women) want to wait two or more years before having their next birth. Over one-fifth (22 percent) of women do not want to have any more children. Thus, a majority of married women want to either space their next birth (want a child later) or limit childbearing altogether (want no more). These women can be considered to be potentially in need of family planning services. Not surprisingly, the desire for more children declines noticeably as the number of living children increases (Table 6.1 and Figure 6.2). Thus, 77 percent of married women with no children want to have a child soon (within two years), whereas only 7 percent of women with six or more children want to have another soon, Table 6,1 Fertility preferences by number of living children Percent distribution of currently married women by desire for more children, according to number of living children, Zambia 1992 Number of living children I Desire ~or children 0 1 2 3 4 5 6+ Total Have another soon 2 76.9 36.4 28.3 29.1 21.1 16.1 6.9 26.3 Have another later 3 8.8 56.3 58.1 55,0 44.5 38.5 17.3 40.6 Have another, undecided when 3.0 1.1 0.8 0.6 0.5 0.8 0.7 0.9 Undecided 2.0 1.4 3.2 2.8 6.6 7.1 7.1 4.4 Wants no more 1.0 2.4 6.2 10,0 22.7 32.0 56.3 22.0 Sterilised 0.0 0.5 1.5 0.5 1.7 1.6 5.5 2.1 Declared infecund 8.2 1.3 1.6 2.0 3.0 3,4 6.0 3.5 Missing 0.0 0.4 0.3 0.0 0.0 0.4 0,2 0.2 Total 100.0 100.0 100.0 100.0 I00.0 100.0 100,0 I00,0 Number of women 321 822 712 614 481 428 1078 4457 tlncludes current pregnancy 2Wants next birth within 2 years 3Wants to delay next birth for 2 or more years 70 Figure 6.2 Fertility Preferences among Currently Married Women by Number of Living Children Percent 100 80 60 40 20 0 0 1 2 3 4 5 6+ No. of Living Children ZDHS 1992 Table 6.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, according to age, Zambia I992 Age of woman Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon I 32.2 31.6 29.1 27.4 21.4 16.9 8.3 26.3 Have another later ~ 59.8 60.3 50.7 36.6 18.6 8.5 2.6 40.6 Have another, undecided when 1.9 1.2 0.5 0.4 0.6 1.5 1.0 0.9 Undecided 2.5 2.0 6.1 6.7 6.1 2.8 4.2 4.4 Wants no more 2.0 4.2 12.3 24.7 42.8 52.3 61.4 22.0 Sterilised 0.0 0.1 0.2 1.3 6.3 7.3 5.3 2.1 Declared infeeund l . l 0.4 0.9 2.8 4.2 10.4 16.9 3.5 Missing 0.4 0.1 0.2 0.1 0.1 0.3 0.4 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 526 989 943 755 537 412 295 4457 1Wants next birth within 2 years awants to delay next birth for 2 or more years Table 6.2 shows similar data according to the age of the woman instead of the number of children. The desire to limit births rises rapidly with age, from two percent of married women age 15-19 to 61 percent of those age 45-49. Conversely, the desire to space births declines with age. In other words, the potential need for family planning services is greatest among older women for limiting childbearing and among 71 younger women for spacing births. The net effect of these two opposing patterns is that the proportion of women falling into one of these two groups is almost constant at about 60-64 percent of women. The desire to stop childbearing shows little variation according to background characteristics of the respondents (see Table 6.3). Urban women are more likely than rural women to want to stop childbearing, especially those women with four or more children. Women in Copperbelt, North-Western and Lusaka Provinces are slightly more likely than women in other provinces to want to stop childbearing, while women in Western and Luapula Provinces appear to be somewhat more pmnatalist. Women with either no education or secondary education are more likely than women with only primary education to want no more children; in other words, the data exhibit a U-shaped pattern of relationship. The positive effect of some primary education on fertility has been widely noted and may be due to enhanced means of support for more children. In any case, the differences in Zambia are small. Table 6.3 Desire to limit (stop) childbearing Percentage of currently married women who want no more children, by number of living children and selected background characteristics, Zambia 1992 Number of living children I Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 1.6 2.9 11.8 10.2 28.8 39.7 66.3 27.2 Rural 0.6 3.1 4.0 10.7 19.8 28.0 57.7 21.3 Province Centra/ (0.0) 2.9 4.6 10.9 (28.1) 01.1) 66.0 24.3 Copperbelt 1.8 1.9 5.9 9.2 26.4 38.4 67.7 28.0 Eastern 2.0 4.6 9.8 21.2 (30.5) (40.4) 62.8 24.4 Luapula (0.0) 1.2 2.4 4.4 (10.7) (27.9) 48.2 16.2 Lusaka (2.6) 2.3 17.0 11.3 32.3 41.0 61.0 26.6 Northern * 1.2 3.0 5.7 (20.6) (29.0) 61.1 21.7 Nor th-Westem * (12.2) (3.7) (23.7) (27.4) (56.0) 61.4 26.9 Southern 0.0 4.6 7.2 7.7 16.8 21.2 59.7 23.0 Western (0.0) 3.0 (2.0) 3.5 (15.6) (11.7) 46.5 14.0 Education No education Primary Secondary+ 2.0 6.0 7.1 13.0 24.3 31.6 58.9 29.3 0.5 2.1 4.0 8.0 18.0 28.2 61.0 21.5 1.8 3.1 16.2 16.7 43.0 56.7 72.6 27.1 Total 1.0 3.0 7.7 10.5 24.3 33.6 61.8 24.1 Note: Figures in parentheses are based on 25 to 49 women, while an asterisk means the figure is based on fewer than 25 women and h~ been suppressed. Women who have been sterilised are considered to want no more children. 1Includes current pregnancy 6.2 Demand for Family Planning Services Women who are currently married and who say either that they do not want any more children or that they want to wait two or more years before having another child, but are not using contraception, are considered to have an unmet need for family planning, t Women who are using family planning methods are 1 For an exact description of the calculation, see feomote 1, Table 6.4. 72 said to have a met need for family planning. Women with unmet and met need constitute the total demand for family planning. Table 6.4 presents data on unmet need, met need and total demand for family planning, according to whether the need is for spacing or limiting birtha. One-third of married Zambian women have an unmet need for family planning services, 21 percent for spacing purposes and 12 percent for limiting births. Combined with the 15 percent of married women who arc currently using a contraceptive method, the total demand for family planning comprises almost half of the married women in Zambia. Thus, if all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 15 percent to 49 percent of married women. Presently, only one-third of the potential demand for family planning is being met (last column in Table 6.4). Table 6.4 Need for family planning services Percentage of currently married women with unmct need far family planning, mot need for family planning, and the total demand for family planning services, by selected background charnctcaistics, Zambia 1992 Met need for Unroof need for family planning Total domaod for Percentage family planning I (cm-rcntiy using) 2 family planning of demand Number For For For For For For saris- of spacing limiting Total spacing limiting Total spacing linfiting Total fled wormn Background charnct~dstic Age 15-19 23.9 3.9 27.8 8.5 0.2 8.7 32.3 4.2 36.5 23.8 526 20-24 25.9 3.0 28.9 12.2 0.9 13.1 3g.1 3.9 42.0 31.2 989 2.5-29 26.1 5.4 31.5 12.5 2.8 15.3 38.6 8.2 46.8 32.6 943 30-34 23.0 10.2 33.2 10.9 7.5 18.3 33.9 17.7 51.5 35.6 755 35-39 16,9 22.6 39,5 4,8 17,7 22.5 2L7 40,3 62.0 36,3 537 40-44 9.9 32.4 42.4 1.8 15.6 17.4 11.8 48,0 59.8 29.1 412 45-49 6.6 35.5 42.1 0.4 8.6 9.0 6.9 44.1 51.1 17.6 295 Residence Urban 22.3 12.1 34.4 11.5 9.2 20.8 33.9 21.3 55.2 37.7 2091 Rural 20.5 12.1 32,6 6.7 3.6 10.3 27.2 15.7 42.9 23.9 2366 PrOVinCe (Mnmd 14.4 12.I 26.6 5.5 3.7 9.2 20.0 15.8 35.8 25.7 418 Copperbclt 26.2 13.1 39.3 11.2 7.7 19.0 37.4 20.9 58.3 32,5 1023 Eastern 23.6 t l .6 35,1 6.0 3.7 9.7 29.5 15.3 44.8 21.6 536 Luapnia 17.1 8.4 25.6 5.3 4.2 9.5 22.4 12.6 35.1 27.1 281 Lusaka 18.3 12.2 30,5 11.9 12.3 24.2 30.1 24.5 54.7 44.3 738 Nort~ra 24.1 11.0 35.1 12.8 4.7 17.5 36.9 15.7 52.6 33.3 423 North-Western 20.3 14.1 34.5 5.7 4.7 10.4 26.1 18,8 44.9 23.1 124 Southern 25.0 12.2 37.1 4.7 3.8 8.5 29.7 15.9 45.6 18.6 673 Western 8.2 13.0 21.2 14.1 3.7 17.8 22.3 16.7 39.0 45.7 241 Education No education 17.3 17.3 34.6 3.8 4.2 8.0 21.1 21.4 42.6 18.7 864 Primary 22.9 11.9 34.7 8.5 4.2 12.8 31.4 16.1 47.5 26.9 2754 Secondary 22.4 7.8 30.2 15.1 11.9 27.1 37.5 19.8 57.2 47.3 745 Higher 6.5 4.7 11.2 20.5 37.9 58.5 27.0 42.6 69.6 83.9 93 Total 21.4 12.1 33.4 9.0 6.2 15.2 30.3 18.3 48.6 31.2 4457 1Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhonic women whose last birth was mistimed, and women who are neither pregnant nor arncnorrho~c and who are not using any method of family planning and say they want to wait 2 or more years for their next birth. Also included in unmet need for spa~mg arc women who arc unsure whether they want another ch

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