Zambia -Demographic and Health Survey - 1997

Publication date: 1997

Zambia Demographic and Health Survey 1996 Central Statistical Office Ministry of Health ~I)HS / Demographic and Health Surveys Macro International Inc. World Summit for Children Indicators: Zambia 1996 Value BASIC INDICATORS Childhood mortality Maternal mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Basic education Children in especially difficult situations Infant mortality rate Under-five mortality rate Maternal mortality ratio Percent stunted Percent wasted Percent underweight Percent of households within 15 minutes of a safe water supply l Percent of households with flush toilets or VIP latrines Percent of women 15-49 with completed primary education Percent of men 15-49 with completed primary education Percent of girls 6-12 attending school Percent of boys 6-12 attending school Percent of women 15-49 who are literate Percent of children who are orphans (both parents dead) Percent of children who do not live with their natural mother Percent of children who live in single adult households 109 per 1,000 197 per 1,000 649 per 100,000 42.4 4.2 23.5 46.8 18.0 48.1 65.7 57.1 55.8 66.5 1.5 20.2 4.4 SUPPORTING INDICATORS Women's Health Birth spacing Safe motherhood Percent of births within 24 months of a previous birth 2 Percent of births with medical antenatal care Percent of births with antenatal care in first trimester Percent of births with medical assistance at delivery Percent of births in a medical facility Percent of births at high risk 19.3 95.6 11.4 46.5 46.5 59.5 Family planning Contraceptive prevalence rate (any method, married women) 25.9 Percent of currently roamed women with an unmet demand for family planning Percent of currently married women with an unmet need for family planning to avoid a high-risk bffth 26.5 21.7 Nutrit ion Maternal nutrition Percent of mothers with low BMI 9.1 Low birth weight Percent of births at low birth weight (of those reporting numeric weight) 11.1 Breastfeeding Percent of children under 4 months who are exclusively breastfed 24.9 Child Health Vaccinations Percent of children whose mothers received tetanus toxoid vaccination during pregnancy Percent of children age 12-23 months with measles vaccination Percent of children age 12-23 months fully vaccinated Diarrhoea control Acute respiratory infection Percent of children with diarrhoea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution or ORS) 84.5 86.5 78.3 56.5 Percent of children with acute respiratory infection in preceding 2 weeks who were taken to a health facihty or provider 70.7 x Piped, well, and bottled water 2 First births are excluded. Zambia Demographic and Health Survey 1996 Central Statistical Office Lusaka, Zambia Ministry of Health Lusaka, Zambia Macro International Inc. Calverton, Maryland USA September 1997 This report summarises the findings of the 1996 Zambia Demographic and Health Survey (ZDHS) conducted by the Central Statistical Office at the request of the Ministry of Health. Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the Swedish International Development Agency (SIDA), 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 Central Statistical Office, P.O. Box 31908, Lusaka, Zambia (telephone: 251- 377/80/81/85,252-575, 250-195; fax: 253-528). Additional information about the DHS programme may be obtained from Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 USA (telephone: 301-572-0200 and fax: 301-572-0999). Recommended citation: Central Statistical Office [Zambia] and Ministry of Health and Macro International Inc. 1997. Zambia Demographic and Health Survey, 1996. Calverton, Maryland: Central Statistical Office and Macro International Inc. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Zambia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 1.1 1.2 1.3 1.4 1.5 History, Geography, and the Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The Population Policy and National Population and Development Programme of Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Objectives and Organization of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2 CHARACTERIST ICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.1 2.2 2.3 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Background Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . 18 CHAPTER 3 FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.1 3.2 3.3 3.4 3.5 Fertility Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Teenage Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 CHAPTER 4 FERT IL ITY REGULAT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Knowledge of Methods by Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Current Use by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Knowledge of Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Contraceptive Effects of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Source of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Future Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Reasons for Nonuse of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Preferred Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Family Planning Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Contact of Nonusers with Family Planning Providers . . . . . . . . . . . . . . . . . . . . . . . . . 64 Discussion of Family Planning with Husband . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Attitudes of Couples Toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 iii CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 CHAPTER 6 6.1 6.2 6.3 6.4 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 CHAPTER 9 9.1 9.2 9.3 CHAPTER 10 10.1 10.2 10.3 Page OTHER PROXIMATE DETERMINANTS OF FERT IL ITY . . . . . . . . . . 69 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Age at First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . . . . . . 77 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Fertility Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Socioeconomic Differentials in Infant and Childhood Mortality . . . . . . . . . . . . . . . . 96 Demographic Differentials in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . 98 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Antenatal Care and Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Childhood Immunisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 INFANT FEEDING, CHILDHOOD AND MATERNAL NUTRIT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Nutritional Status of Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 MATERNAL MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 The Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Direct Estimates of Adult Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Estimates of Maternal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 iv Page CHAPTER 11 SEXUAL ACT IV ITY AND KNOWLEDGE OF A IDS . . . . . . . . . . . . . . . 137 11.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 11.2 Sexual Behaviours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 11.3 Knowledge About Sexually Transmitted Diseases (STDs) . . . . . . . . . . . . . . . . . . . . 140 11.4 Health Seeking Behaviour for Treatment of STDs . . . . . . . . . . . . . . . . . . . . . . . . . . 141 11.5 Knowledge About AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 11.6 Knowledge of Ways to Avoid AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 11.7 Perceptions of Risks of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 11.8 Perceptions of the Risk of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 11.9 Reasons for Perceptions of AIDS Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 11.10 AIDS Prevention Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 APPENDIX A SURVEY DES IGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 APPENDIX B EST IMATES OF SAMPL ING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 APPENDIX C DATA QUAL ITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 APPENDIX D PERSONS INVOLVED IN THE ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . 205 APPENDIX E QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 V Table 1.1 Table 1.2 Tatle 2.1 Table 2.2 Tatle 2.3 Tal~ le 2.4 Table 2.5.1 Table 2.5.2 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16.1 Table 2.16.2 Table 2.17 Table 2.18 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 Table 4.1 Table 4.2 Table 4.3.1 Table 4.3.2 Table 4.4.1 Table 4.4.2 Talcle 4.5 Table 4.6.1 Table 4.6.2 Table 4.7 Table 4.8 Table 4.9 Table 4.10 TABLES Page Demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Household population by age, residence, and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . 14 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . 15 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Age distribution of women 1980, 1990, 1992, 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Differential of characteristics between spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Level of education by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Occupation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Decisions on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Age-specific fertility rates over time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Current fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Trends in fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Adolescent pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Children born to adolescent women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Knowledge of contraceptive methods among couples . . . . . . . . . . . . . . . . . . . . . . . . 45 Ever use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Ever use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Current use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Current use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Trends in family planning use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Current use of contraception by background characteristics: women . . . . . . . . . . . . . 52 Current use of contraception by background characteristics: men . . . . . . . . . . . . . . . 53 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Perceived contraceptive effect of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . 58 vii Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7.1 Table 5.7.2 Table 5.8 Table 5.9 Table 5.10 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Page Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Exposure to family planning messages through the media . . . . . . . . . . . . . . . . . . . . . 62 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . 63 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Wives' perceptions of their husbands' attitudes toward family planning . . . . . . . . . . 67 Spouses' perception of spouse's approval of family planning . . . . . . . . . . . . . . . . . . 68 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . . . . . . . 80 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . . . . . . 86 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . 91 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Trends in childhood mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . 96 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . 98 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . 105 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . . . . 110 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Vaccinations in first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Prevalence and treatment of acute respiratory infection and prevalence of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 viii Table 8.13 Table 8.14 Table 9. l Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 10.1 Table 10.2 Table 10.3 Table 11.1.1 Table 11.1.2 Table 11.2 Table 11.3 Table 11 +4 Table 11.5 Table l 1.6.1 Table 11.6.2 Table 11.7.1 Table 11.7.2 Table 11.8.1 Table 11.8.1 Table 11.9 Table 11.10.1 Table 1 I. 10.2 Table 11.11 Table 11.12.1 Table I I. 12.2 Table 11.13.1 Table 11.13.2 Table A, 1 Table A,2 Table A,3 Table A.4 Table A.5 Table A.6 Table A.7 Table A,8 Table A.9 Table A.10.1 Table A.10.2 Table B. 1 Table B.2 Table B.3 Table B.4 Table B.5 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Breastfeediug status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Median duration and frequency of breastfeeding by background variables . . . . . . . 124 Types of food received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . 126 Nutritional status of children by demographic characteristics . . . . . . . . . . . . . . . . . . 128 Nutritional status of children by background characteristics . . . . . . . . . . . . . . . . . . . 129 Nutritional status of mothers by background characteristics . . . . . . . . . . . . . . . . . . . 131 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Adult mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Number of recent sexual partners: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Number of recent sexual partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Payment for sexual relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Self-reporting of sexually transmitted diseases in the past year . . . . . . . . . . . . . . . . 142 Knowledge of sexually transmitted diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Actieo taken by respondents who reported a sexually transmitted diseases in the past year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Knowledge of A1DS and sources of AIDS information: women . . . . . . . . . . . . . . . 145 Knowledge of AIDS and sources of AIDS information: men . . . . . . . . . . . . . . . . . . 146 Knowledge of ways to avoid AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Knowledge of ways to avoid AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Awareness of AIDS-related health issues: women . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Awareness of AIDS-related health issues: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Perception of risk of getting AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Reasons for perception of small/no risk of getting AIDS: women . . . . . . . . . . . . . . 153 Reasons for perception of small/no risk of getting AIDS: men . . . . . . . . . . . . . . . . . 153 Knowledge of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 AIDS prevention behaviour: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 AIDS prevention behaviour: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Projected population to 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Population distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Population sample allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Proposed non-proportional sample allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Number of households to yield target of women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Number o f sample points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Proposed number of sample points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Number of households to be selected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Expected number of women with completed interviews . . . . . . . . . . . . . . . . . . . . . . 168 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 List of selected variables for sampling errors, Zamiba 1996 . . . . . . . . . . . . . . . . . . . 180 Sampling errors - National sample: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Sampling errors - Urban sample: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Sampling errors - Rural sample: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Sampling errors - Central province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . 184 ix Table B.6 Table B.7 Table B.8 Table B.9 Table B.10 Table B.I 1 Table B.12 Table B. 13 Table B.14 Table C. 1 Table C.2 Table C.3 Table CA Table C.5 Table C.6 Page Sampling errors - Copperbelt province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . 185 Sampling errors - Eastern province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Sampling errors - Luapula province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Sampling errors - Lusaka province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Sampling errors - Northern province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . 189 Sampling errors - North-Western province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . 190 Sampling errors - Southern province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . 191 Sampling errors - Western province: Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Sampling errors - Sampling errors of differences . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Age distribution of eligible and interviewed women and men . . . . . . . . . . . . . . . . . 200 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Births by calendar year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 FIGURES Page Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 5.1 Figure 5.2 Figure 6.1 Figure 6.2 Figure 6.3 Figure 7.1 Figure 7.2 Figure 7.3 Figure 7.4 Figure 8.1 Figure 8.2 Figure 8.3 Figure 9.1 Figure 9.2 Figure 10.1 Figu~ 10.2 Distribution of de facto household population by single year and age and sex . . . . . . 10 Population pyramid, Zambia 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Percentage of males and females with no education by age group . . . . . . . . . . . . . . . 16 Age-specific fertility rates, Zamiba 1990, 1992 and 1996 . . . . . . . . . . . . . . . . . . . . . 32 Age-specific fertility rates by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Total fertility rates by province . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Percentage of currently married women who know specific contraceptive methods . 44 Percentage of currently married women age 15-49 using specific contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Percentage of currently married women using a contraceptive method by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 54 Distribution of current users of contraception by source of supply . . . . . . . . . . . . . . . 59 Percentage of currently married women in a polygynous union . . . . . . . . . . . . . . . . . 71 Median age at marriage by current age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Fertility preferences among currently married women 15-49 . . . . . . . . . . . . . . . . . . . 84 Percentage of currently married women and currently married men who want no more children by number of living children . . . . . . . . . . . . . . . . . . . . . 85 Percentage of currently married women by status of family planning needs . . . . . . . . 89 Trends in infant and child mortality, Zambia 1982-86, 1992-1996 . . . . . . . . . . . . . . 94 Infant and under-five mortality rates, from selected sources, Zambia, 1969-1996 . . . 95 Under-five mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Under-five mortality by selected demographic characteristics . . . . . . . . . . . . . . . . . . 99 Percent distribution of births by antenatal care and delivery characteristics . . . . . . . 105 Percentage of children age 12-23 months who have received all vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Trends in vaccination coverage among children age 12-23 months . . . . . . . . . . . . . 114 Median duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Percentage of children under five who are stunted . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Female adult mortality in Zambia for the period 0-6 years before the survey, by age, from various sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Male adult mortality in Zambia for the period 0-6 years before the survey, by age, from various sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 xi PREFACE The 1996 Zambia Demographic and Health Survey (ZDHS) is a nationwide sample survey of men and women of reproductive age designed to provide information on background characteristics of respondents, reproduction, contraceptive knowledge and use, and nutrition of children. Also collected was information on marriage, fertility, AIDS and other sexually-transmitted diseases, and maternal, child, and infant mortality rates. Zambia carried out the same type of survey in 1992; however, the 1996 ZDHS was more comprehensive than the 1992 ZDHS, as it covered additional information. The survey was conducted by the Central Statistical Office on behalf of the Ministry of Health and with substantial financial assistance from the U.S. Agency for International Development (USAID) through Macro International Inc+ of Calverton, Maryland and the United Nations Population Fund (UNFPA). The major objective of the 1996 ZDHS was to provide the country with data useful for policy formulation, and monitoring, implementation, and evaluation of some major government programmes and projects. ZDHS data are also useful to researchers, non-governmental organisations and the public for advocacy in the areas of social progress. Background work on the 1996 ZDHS commenced in August 1995. The exercise of mapping and listing households followed in March, 1996. Fieldwork began in July of the same year and went on until January 1997. Data entry and verification began in August 1996 and continued until January 1997. This was followed by tabulation production and drafting of the preliminary report, which was published in February 1997. The success of the survey accrues to the dedicated support and involvement of a large number of institutions and individuals. I extend my thanks to Mr Emmanuel Silanda, Assistant Director in charge of Social Statistics at the Central Statistical Office, Mr Kumbutso Dzekedzeke, Survey Director, Ms Margaret Tembo, Assistant Survey Director, Rev. Charles Banda, Head of the Population and Demography Branch, Ms Samantha Mulendema, Data Processing Supervisor, all the Provincial Statistical Officers, the Provincial Medical Officers of Lusaka, Southern, and Western Provinces, and other field and office staff whose efforts were instrumental in the successful implementation of this survey and the finalisation of this report. The survey would not have been implemented without the financial support of collaborating partners in the health reforms programmes in Zambia. The U. S. Agency for International Development (USAID) office in Zambia provided the bulk of financial support to carry out the survey through Macro International Inc. The United Nations Population Fund (UNFPA) financed the men's survey, while the Swedish International Development Agency (SIDA) contributed to financing the training of field staff. The United Nations Children's Fund (UNICEF) provided the kits for testing iodine levels in salt as well as the services of its procurement unit to expeditiously procure the weighing scales. In this regard, I highly appreciate the keen interest and active support throughout this survey of Mr Paul Hartenberger, Director, Office of Population and Health (USAID), Mr Kemal Mustafa, UNFPA Resident Representative, Dr Anders Nordstrom, Project Officer (SIDA), and other staff of USAID, UNFPA, UNICEF and SIDA who supported this survey. My sincere appreciation also goes to the members of the National Health Survey Management Committee and the ZDHS Technical Committee. Many thanks go to the authors of the various chapters of this report for their effort in its production. xJiJ I would like to extend my deepest gratitude to Ms Annie Cross, Ms Sri Pocdjastoeti, Mr Martin Wulfe, Ms Thanh L~ and Ms Andrea Piani of Macro International Inc. for their technical support and advice in the successful implementation of the survey, as well as to Dr Sidney Moore, Ms Kaye Mitchell, Ms Celia Siebenmann, and Dr George Bicego for their help in the production and review of this report. I would like to thank Ms Batista Chilopa, Mr Patrick Mumba Chewe, Mr. Webster Chileshe, Mr. George Namasiku, Mr Makoselo C. Bowa and Mr Anthony Nkole of the Central Statistical Office for their active involvement in various phases of the survey. Last but not least, I would like to thank Mr Record Malungo, Lecturer, University of Zambia; Mr Sikwanda Makono, Health Education Specialist, Ministry of Health; Ms Chipo Sikazwe, Nutritionist, Kabwe General Hospital and Wingrey Michelo, Programme Officer, Planned Parenthood Association of Zambia for participating in training the field staff and supervising the fieldwork. This report presents results of the 1996 ZDHS. The data will be particularly useful to planners, policy makers and the community at large. David S. Diangamo Director of Census and Statistics xiv ACKNOWLEDGMENTS This following people contributed to the preparation of this report: Kumbutso Dzekedzeke, CSO/UNFPA Margaret Tembo, CSO Emmanuel M. Silanda, CSO Charles Banda, CSO Modesto F.C. Banda, CSO Patrick Mumba Chewe, CSO Record J.S. Malungo, University of Zambia (UNZA) Paul Chishimba, Ministry of Health Mutinta Nseluke-Hambayi, Food, Security, Health and Nutrition Information System (FHANIS) Robie Siamwiza, University of Zambia (UNZA/SIDA) Batista M. Chilopa, CSO Sri Poedjastoeti, Macro International Inc. Martin Wulfe, Macro International Inc. Anne R. Cross, Macro International Inc. Sidney Moore, Macro International Inc. George Bicego, Macro International Inc. XV SUMMARY OF FINDINGS The 1996 Zambia Demographic and Health Survey (ZDHS) is a nationally representative survey conducted by the Central Statistical Office at the request of the Ministry of Health, with the aim of gathering reliable information on fertility, childhood and maternal mortality rates, maternal and child health indicators, contraceptive knowledge and use, and knowledge and prevalence of sexually transmitted diseases (STDs) including AIDS. The survey is a follow-up to the Zambia DHS survey carried out in 1992. FERTILITY Fertility Trends. The 1996 ZDHS survey results indicate that the level of fertility in Zambia is continuing to decline. At current fertility levels, a Zambian woman will give birth to an average of 6.1 children during her reproductive period, a decline from the level of 6.5 prevailing during the late 1980s and early 1990s. Despite the decline, fertility in Zambia remains one of the highest in sub-Saharan Africa. Results from DHS surveys in neighbouring countries show that the fertility level in Botswana is 4.9 births per woman, in Namibia 5.4, in Tanzania 5.8 and in Zimbabwe 4.3 births per woman. Fertility Differentials. Some women are apparently leading the fertility decline. For example, fertility levels are substantially lower among urban women (5.1 children per woman on average) than among rural women (6.9 children). Moreover, women who have received some secondary education have the lowest level of fertility, with a total fertility rate of 4.5, compared to a rate of 6.8 children per woman for those with no education, a difference of more than two children. Age at First Birth. Childbearing begins early in Zambia, with over one-third of women becoming mothers by the time they reach age 18 and around two-thirds having had a child by the time they reach age 20. The median age at first birth falls between 18 and 19 years. Moreover, 31 percent of teenage women (age 15-19) have begun childbearing, with 24 percent having had a child already and 7 percent carrying their first child. Adolescent childbearing seems to be declining somewhat--in 1992, 34 percent of teenagers either had already given birth or were pregnant with their first child. Birth Intervals. The majority of Zambian children (81 percent) are born after a "safe" birth interval (24 or more months apart), with 36 percent born at least 36 months after a prior birth. Nevertheless, 19 percent of non-first births occur less than 24 months after the preceding birth. The overall median birth interval is 32 months. Fertility Preferences. Survey data indicate that there is a strong desire for children and a preference for large families in Zambian society. They also indicate that men are considerably more pronatalist than women. Among those with six or more children, 22 percent of married women want to have more children, compared to 44 percent of married men. Both men and women desire large families. More than half (56 percent) of all women report five or more children as ideal and another 23 percent want to have four children. Only 7 percent of women report a two-child family as ideal. Overall, women report a mean ideal number of children of 5.3, compared to 5.9 for men. Despite the high fertility preferences, the data indicate that there has been a decline in ideal family size among women in Zambia, from an average of 5.8 children in 1992 to 5.3 in 1996. Women's desire for additional children has also declined somewhat over the past 5 years. The proportion of women who want no more children increased from 24 percent in 1992 to 29 percent in 1996. xvii Unplanned Fertility. Despite the increasing level of contraceptive use, ZDHS data indicate that unplanned pregnancies are still common. Overall, more than one-third of births in the five years prior to the survey were reported to be unplanned 29 percent were mistimed (wanted later) and 7 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in Zambia would be 5.2 births per woman instead of the actual level of 6.1. FAMILY PLANNING Increasing Use of Contraception. The contraceptive prevalence rate in Zambia has increased significantly over the past five years, rising from 15 percent in 1992 to 26 percent in 1996. Use of modern methods has increased from 9 percent of married women in 1992 to 14 percent in 1996. Use of traditional methods increased from 6 to 12 percent. The pill is the most widely used method (7 percent of married women), followed by withdrawal (5 percent) and condoms (4 percent). Differentials in Family Planning Use. Differentials in current use of family planning by province are large. Forty-two percent of married women in North-Western Province are currently using a contraceptive method, compared to only 11 percent of those in Luapula Province. However, most users in North-Western Province are using traditional methods; Lusaka and Copperbelt Provinces have the highest levels of use of modern methods. There are large differentials in current use by level of education. Only 17 percent of currently married women with no formal education are currently using a method, compared with 55 percent of those with higher than secondary education. Source of Contraception. Six in ten users obtain their methods from public sources, while 24 percent use non-governmental medical sources and shops and friends account for the remaining 13 percent. Government health centres (41 percent) and government hospitals (16 percent) are the most common sources of contraceptive methods. Knowledge of Contraceptive Methods. Knowledge of contraceptive methods is nearly universal, with 96 percent of all women and men knowing at least one method of family planning. Knowledge of at least one contraceptive method has increased since 1992, from 89 to 96 percent of all women. There has also been an increase over the last five years in the proportion of women who know specific family planning methods. For example, the proportion of women who have heard of condoms has increased from 72 percent in 1992 to 92 percent in 1996 and the proportion who have heard of injectables increased from 38 percent to 53 percent during the same period. Family Planning Messages. One reason for the increase in level of contraceptive awareness is that family planning messages are prevalent. Over 40 percent of the women and over half of the men interviewed reported that they had heard a family planning message in the months prior to the survey, mostly on radio. Unmet Need for Family Planning. ZDHS data show that there is a considerable unmet need for family planning services in Zambia. Overall, 27 percent of married women are in need of services--I 9 percent for spacing their next birth and 8 percent for limiting births. If all women who say they want to space or limit their children were to use methods, the contraceptive use rate would be increased from 26 to 52 percent of married women. Currently, less than half of this "total demand" for family planning is being met. MATERNAL AND CHILD HEALTH Maternal Health Care. ZDHS data show some encouraging results regarding maternal health care, as well as to some areas in which improvements could be made. Results show that most Zambian mothers receive antenatal care, 3 percent from a doctor and 93 percent from a nurse or trained midwife. Similarly, tetanus toxoid coverage is relatively widespread in Zambia; for 85 percent of births in the five years preceding xviii the survey, the mothers received at least one tetanus toxoid injection during pregnancy. Less encouraging is the fact that more than half of births still occur at home and, consequently, less than half are assisted by trained medical personnel. Proper medical attention during pregnancy and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness for either the mother or the newborn. There has been little change in these maternal health indicators since 1992. The survey results indicate that maternal mortality in Zambia is h igh~649 maternal deaths per 100,000 births. High Childhood Mortality. One of the more disturbing findings from the survey is that child survival has not improved over the past few years. Currently, the infant mortality rate is 109 deaths per 1,000 births and under-five mortality is 197 per 1,000 births, a slight increase from the rates of 107 and 191, respectively, that were derived from the 1992 ZDHS. Under-five mortality rates are highest in Luapula and Eastern Provinces, where approximately one in four children does not live to the fifth birthday. Childhood Vaccination Coverage. Vaccination coverage against the most common childhood illnesses has increased recently. The proportion of children age 12-23 months who are considered to be fully immunised has increased from 67 in 1992 to 78 percent in 1996. Only 2 percent of children 12-23 months have not received any vaccinations. Childhood Health. ZDHS data indicate that Zambian mothers are reasonably well-informed about childhood illnesses and that a high proportion are treated appropriately. For example, 71 percent of children with symptoms of respiratory illness during the two weeks before the survey were taken to a health facility or health care provider for treatment. Over half of children with diarrhoea during the same period received some type of oral rehydration treatment (fluid made from an ORS packet, a homemade solution, or increased fluids). Ninety-four percent of mothers know about the use of sugar-salt-water solutions for treating diarrhoea; yet when asked about specific eating and drinking regimes for sick children, only three-quarters say that a child who is sick with diarrhoea should get more to drink. Breastfeeding Practices. The ZDHS results indicate that breastfeeding is almost universally practised in Zambia, with a median duration of 20 months. Since breastfeeding has beneficial effects on both the child and the mother, it is encouraging to note that supplementation of breast milk starts relatively late in Zambia. In the first two months, only 11 percent of children have received supplements other than water and breast milk. However, by 4-5 months, 77 percent of children are given some form of food supplementation. Also encouraging is the fact that there is negligible use of infant formula and bottlefeeding is not commonly practised. Childhood Nutritional Status. Overall, 42 percent of Zambian children under age five are classified as stunted (low height-for-age) and 18 percent as severely stunted. Four percent of children under five in Zambia are wasted (low weight-for-height). Comparison with the 1992 ZDHS shows little change in these measures over time. Knowledge and Behaviour Regarding AIDS. Survey results indicate that virtually all respondents had heard of AIDS. Common sources of information were friends/relatives, the radio, and health workers. The vast majority of respondents--80 percent of women and 94 percent of men--say they have changed their behaviour in order to avoid contracting AIDS, mostly by restricting themselves to one sexual partner. Although almost all respondents say they know about the condom, only one-quarter of women and about half of men used condoms at some time during the 12 months prior to the survey. Most respondents say they use condoms both for family planning and for disease prevention. The practice of giving money, gifts or favours in exchange for sex is not uncommon in Zambia--11 percent of women and 24 percent of men say they have engaged in this in the 12 months before the survey. xix ANGOLA • Urban Cluster • Rural Cluster •# b i WESTERN NAMIBIA DEMOCRATIC REPUBLIC OF CONGO NORTH WESTERN • • % SOUTHERN I I LAKE MWERU LAKE TANGANYIKA NORTHERN ,PPERBE3 ~ " " CENTRAL ":~ eAe~ • ~, • LUSAKA l USAKA • LAKE KARIBA ZIMBABWE TANZANIA : . A~, ,~" e~e EeASTER N MOZAMBIQUE MALAWI CHAPTER 1 INTRODUC~ON 1.1 History, Geography and Economy History Historical and archaeological evidence indicates that by the year 1500, much of modem 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 gained her political independence and adopted a multiparty system of govemment. In December 1972, Zambia became a one-party state until 1991 when a multi-party system was re-introduced. Geography Zambia is a land-locked country covering an area of 752,612 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 67 districts. Four of ten Zambians live in urban areas, most of which are located along the old line of rail. Zambia lies between 8 and 18 degrees south latitude and between 20 and 35 degrees east longitude. It has a tropical climate and vegetation with three distinct seasons: the cool dry winter from May to August, a hot dry season during September and October and warm wet season from November to April. Among the main river water sources in Zambia are the Zambezi, Kafue, Luangwa and Luapula. The country also has major lakes such as Tanganyika, Mwem, Bangweulu and the man-made Kariba. The northern part of the country receives the highest precipitation, with an annual average ranging from 1,100 mm to over 1,400 mm. The southern and eastern parts of the country have less rainfall, ranging from 600 mm to 1,100 mm annually, which often results in droughts. Economy Zambia has a mixed economy consisting of a modem and urban-oriented sector confined to the line of rail, and a rural agricultural sector. For a long time, the modem sector has been dominated by parastatal organisations, while private businesses have predominated in the construction and agricultural sectors. Since 1991, with the introduction of a liberalised market-oriented economy, the parastatals have been privatised and, in some cases, liquidated. Copper mining is the country's main economic activity, accounting for 95 percent of export earnings and contributing 45 percent of government 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. The prices rose in 1978 but only to drop sharply between 1981 and 1982. The combined effects of the fall in copper prices, a rise in oil prices, the slow pace of industrialisation and a heavy dependence on imports have put the country's economy under serious pressure. Copper production reached its peak at 713,000 tonnes in 1976 and has been fluctuating ever since; production fell to 607,000 tonnes in 1980 and continued falling to 459,000 tonnes in 1986 before the slight rise in 1987 to 483,100 tonnes. By 1996, copper production fell to between 300-400,000 metric tonnes (MoFED, 1996b). The decline in copper production can be attributed to many factors including increased cost of production as a result of the continued fall in the grade of ore and reduction in investment in advanced technology. The overvalued excbange rate that existed for a long time contributed to the high cost of copper production. Before the closure of the Kabwe mines in 1994 due to reduced ore levels, the production of zinc and lead had also been showing a downward trend. About 10,600 tonnes of zinc and 3,900 tonnes of lead were produced in 1990 compared with 32,700 tonnes of zinc and 10,000 tonnes of lead produced in 1980 (NCDP, 1984). Cobalt production also declined from 3,309 tonnes in 1980 to 2,407 tonnes in 1983, after which production levels began to increase to 5,055 tonnes in 1988, marking the highest production level during the 1980-90 period. The production of coal rose from 579,000 tonnes in 1980 to 604,000 tonnes in 1982, after which it started to decline to reach 330,000 tonnes in 1990 (NCDP,1989). Agriculture contributes 15 percent of Zambia's gross domestic product (GDP), and employs 75 percent of the labour force. The agricultural sector is expected to provide both food-stuffs and industrial raw materials to rural and urban consumers and producers. Ninety percent of the farming population consists of small-scale farmers, while less than 10 percent are medium-scale farmers, and less than 3 percent are part of the large-scale sector. Maize is the country's staple as well as a major cash crop, accounting for 75 percent of the land cropped and 85 percent of the crop output. Other crops include cotton, groundnuts, sunflower, millet, tobacco, cassava, and vegetables. In 1995, the government launched the Agricultural Sector Investment Programme (ASIP) aimed at boosting agricultural production and streamlining the marketing of agricultural inputs and produce. About 42 million hectares are potentially suitable for agriculture. However, only 2.5 million hectares (6 percent) of this land are cropped annually (MoFED, 1996a). Of all the cultivated land, only 50,000 hectares (2 percent) are irrigated. This implies heavy dependency on rainfall to sustain agricultural production. With erratic rainfall in the major agricultural production areas of Southern and Eastern Provinces, an appropriate irrigation policy needs to be put in place. More than 10 million hectares of land are also used for the raising of 2.2 million cattle, 500,000 goats, 70,000 sheep, 300,000 pigs and 20 million poultry (CSO, 1994). Under the structural adjustment programme being implemented in Zambia, the average annual inflation rate was reduced from 191 percent (December 1991-November 1992) to 53 percent and 45 percent in 1994 and 1995, respectively. Amidst the declining economic situation, the total long-term debt rose from $60 million in 1971 to $7.3 billion in 1991, representing an increase in per capita indebtedness from $160 to $900. By the end of October 1993, Zambia's debt burden was $6.8 billion. In the same year, Zambia's external debt service payments totaled $375 million net of debt relief, which represented 35 percent of exports (MoFED, 1996c). Currently, approximately 70 percent of the total external finance flow to Zambia is reallocated to debt service, principally to the international finance institutions. The poor economic performance since the mid-1970s has consequently led to lower GDP. For instance, GDP per capita (in constant 1977 prices) declined from $350 in 1980 to $264 in 1994, representing an average annual decline of 2 percent. In the interim periods, fluctuations were observed. In 1989, the GDP grew by a meagre 0.1 percent in contrast to 6.3 percent in 1988. Real output declined on average by about 1.0 percent annually between 1989 and 1991 (NCDP, 1994). 2 In an effort to halt the economic recession, the Movement for Multiparty Democracy (MMD) Government has launched an Economic Recovery Programme (ERP) to turn around the "protracted decline of the economy into sustained positive real growth, and consequent improvement in living standards and the quality of life of the people" (Republic of Zambia, 1992). 1.2 Popu lat ion The 1969, 1980 and 1990 national censuses reported total populations of 4.0 million, 5.7 million and 7.8 million respectively, with growth rate of 2.7 percent per annum in 1990 (see Table 1.1 ). The growth rates vary by province, ranging from 1.5 percent in Copperbelt Province to 4.2 - 4.4 percent in Central and Eastern Provinces during the 1980-90 intercensal period (data not shown). Table 1.1 Demo~raohiccharacteristics Selected demographic indicators, Zambia 1969, 1980 and 1990 Census year 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 38.0 Crude birth rate (per 1,000) 47.7 50.0 44.0 Crude death rate (per 1,000) 19.7 16.7 18.3 Growth rate (per 1,000) 28.0 33.3 25.7 Total fertility rate 7.1 7.2 6.7 Completed family size (women age 40-49) 5. I a 6.7 a 7.0 Infant mortality rate 141 97 123 Life expectancy at birth Male 41.8 50.4 46.1 Female 45.0 52.5 47.6 a Reported figures Sources: Central Statistical Office, 1974, 1985a,1985b, and 1995b. The population density in Zambia 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 50 people or more pr square kilometre in Lusaka and Copperbelt Provinces to 5 or fewer people per square kilometre in Wester and North-Western Provinces. In addition to being the most densely populated provinces, Lusaka and Copperbelt are also the most urbanised areas in the country. There has been a steady flow of people to mining towns and urban centres. As a result, the proportion of the population living in urban areas has increased steadily from 29 percent in 1969 to 38 percent in 1990. The proportion of urban population varies by province, from 91 percent in Copperbelt Province to 9 percent in Eastern Province. While the urban population has grown by 2.7 percent per annum during the 1980-90 decade, the rural population has increased by 3.5 percent in the same period. During 1969-80, the urban population grew much faster than the rural population (5.8 vs. 1.6 percent annually). Thus, the speed of migration to the urban areas has slowed considerably during the 1980-90 period, compared with the earlier period (CSO, 1995). The crude birth rate as estimated from the census data increased from 48 per 1,000 population in 1969 to 50 in 1980 and dropped to 44 in 1990. The crude death rate is estimated to have increased slightly from 17 per 1,000 during 1975-80 to 18 during 1985-90 (CSO, 1995). Total fertility rates estimated from the 1969 and 1980 censuses are in the neighbourhood of 7.0 births per woman. The rate declined to 6.7 births per woman in 1990. Life expectancy at birth for males increased from 42 years in 1969 to 50 years in 1980 and was estimated to have declined to 44 years by 1990. Zambian women live, on average, 2 to 3 years longer than men; however, the gap appears to have narrowed in 1990. 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 (data not shown). Life expectancy at birth ranged from 45 years in Eastern Province to 57 years in Copperbelt (CSO, 1985b). The overall infant mortality rate declined from 141 deaths per 1,000 live births in the mid-1960s (based on the 1969 census) to 97 in the late 1970s, after which it increased to 123 in the late 1980s. 1.3 The Population Policy and National Population and Development Programme of Action For the first decade and a half after independence, Zambia did not view the high rate of population growth as a development problem. The only concern then was with the high rate of migration from rural to urban areas and the 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 the government to reappraise the role of population in national development efforts. The government realised that the nation's development planning 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 then National Commission for Development Planning (NCDP) 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 accepted in May 1989. Since then, the country's population growth rate has remained high and continues to act as a serious impediment towards sustainable development. The original population policy was revised in December 1996 to redefine or clarify its objectives. Another important rationale for the revision of the population policy was to take account of new concerns which include HIV/AIDS, teenage pregnancy, poverty, and gender issues. The objectives of the revised policy are: . To ensure that population issues and other development concerns are mutually integrated in the planning and implementation processes so as to attain development; . To 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 in order to enhance the health of families; . To establish and continuously update a national population-related database and information system that will pool pertinent data and information from various sources with a view to ensure availability of timely, population-related data; 4 4. To enhance participation among opinion leaders and the general public in population and development issues in order to generate and sustain commitment; . To contribute to the reduction of maternal, infant and child mortality in order to increase life expectancy; . To contribute to the reduction of HIV/AIDS and other sexually transmitted diseases so as to improve the general health status of the population; 7. To promote fair distribution of the population between rural and urban areas so as to ensure balanced development; 8. To promote productive employment opportunities for women in order to promote gender equality; . To improve the population's access to appropriate, affordable and quality reproductive health services including family planning and sexual health in order to have a healthy nation; 10. To promote the incorporation of population and gender education into school curricula at all levels in order to increase the knowledge and understanding of population and gender issues; and 11. To promote and maintain equal access to education for both sexes at all levels in order to raise literacy levels. Donor and non-governmental agencies such as the United Nations Population Fund (UNFPA), International 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. One of the strategies 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 Health 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 National Population and Development Programme and Health Reforms establishes the government's commitment to improve the health of the population by progress towards the achievement of the following targets by the year 2000: 5 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 increase accessibility to and acceptability of family planning services and appropriate use of information in order to increase family planning use. To improve the quality of, access to and utilisation of maternal and child health ser,)ices in order to reduce maternal deaths and complications. To reduce the incidence of sexually transmitted diseases (STDs), AIDS, and reproductive tract infections. To reduce the incidence of induced abortions in order to reduce maternal complications and deaths. 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 (MOH, 1992). The implementation of all these aspects of the PHC programmes requires multi-sectoral action and close collaboration among the various government institutions. The government 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 Object ives 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 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 ZDHS was conducted by the Central Statistical Office. Macro International Inc. of Calverton, Maryland provided technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). Funding for the survey was supplied by Macro International (from USAID), the United Nations Population Fund (UNFPA), the Swedish International Development Agency (SIDA), and the government of Zambia (through the Central Statistical Office ). The UNICEF office in Zambia contributed to the survey by providing salt-testing kits for use in data collection. 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 tam divided into Standard Enumeration Areas (SEAs) of roughly equal size. The ZDHS sample was selected from this frame in three stages. First, 312 CSAs were selected from this frame with probability proportional to size. One SEA was then selected from each CSA, again with probability proportional to size. After a household listing operation in all selected SEAs, a systematic sample of households was then selected. Every fourth household was identified as selected for the men's survey, meaning that, in addition to interviewing women age 15-49, interviewers also interviewed men age 15-59. As a result of oversampling of households in Luapula, North-Western and Western Provinces in order to produce 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 Three types of questionnaires were used for the ZDHS: the Household Questionnaire, the Women's Questionnaire and the Men's 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 a number of institutions, including the Umversity of Zambia, the Ministry of Health, the Planned Parenthood Association of Zambia (PPAZ), and the National Commission for Development Planning. 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 and men 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 Women's 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; Marriage; Fertility preferences; Husband' s background and respondent' s work; Awareness of AIDS; and Maternal mortality. The Men's Questionnaire was used to collect information from men age 15-59 years in every fourth household about the following topics: Background characteristics (education, religion, etc.); Reproductive history; Knowledge and use of family planning methods; Marriage; Fertility preferences; and Awareness of AIDS. In addition, the 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 11 interviewing teams. In general, each team consisted of one supervisor, one field editor, five interviewers and one driver. In total, there were 11 supervisors, 11 field editors, 56 interviewers, and 11 drivers. Of the interviewers, 45 were women and 11 were men. Fieldwork commenced on 15 July 1996 and was completed on 6 January 1997. The persons involved in the survey are listed in Appendix D. Table 1.2 is a summary of response rates from the household and the individual interviews. A total of 8,016 households were selected; of these 7,286 were successfully interviewed. The shortfall is due primarily to dwellings being vacant at the time they were visited by the interviewing team. Of the 7,365 households that were occupied, 99 percent were successfully interviewed. In these households, 8,298 women were identified as eligible for the individual interview and 8,021 were successfully interviewed. The number of men eligible for individual interview was 2,043, among whom 1,849 were successfully interviewed, resulting in the eligible men's response rate of 91 percent. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, Zambia 1996 Residence Result Urban Rural Total Household interviews Households sampled 2,329 5,687 8,016 Households occupied 2,230 5,135 7,365 Households interviewed 2,205 5,081 7,286 Household response rate Individual interviews Number of eligible women Number of eligible women interviewed Number of eligible men Number of eligible men interviewed Eligible woman response rate Eligible man response rate 98.9 98.9 98.9 3,124 5,174 8,298 3,001 5,020 8,021 794 1,249 2,043 698 1,151 1,849 96.1 97.0 96.7 87.9 92.2 90.5 8 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 (ZDHS) collected information on all usual residents and visitors who spent the previous night in the household. In this survey, the household was defined as a person or group of people living 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 five-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 Figure 2.1 and Appendix C.1) indicates slight distortions 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. Table 2.1 Household oooulation by a~e. residence ~nd sex Percent distribution of the de facto household population by five-year age groups, according to urban-rural residence and sex. Zambia 1996 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 17.3 16.9 17.1 18.0 17.9 17.9 17,7 17.5 17,6 5-9 15.1 14,3 14.7 16.4 15.7 16,0 15,8 15.1 15,5 10-14 13.6 14.3 13,9 15.2 14.2 14.7 14.5 14.2 14,4 15-19 11.7 13.1 12.4 10.5 9.6 10,0 i1.0 11.0 11.0 20-24 10.7 11.5 11.1 8.5 9.2 8.8 9,4 10A 9.8 25-29 8.1 8,3 8.2 6,5 6.3 6.4 7.2 7.1 7.1 30-34 6.7 6.7 6.7 5.2 5,5 5.3 5.8 6,0 5,9 35-39 4.9 4,3 4,6 4,3 4.1 4.2 4.6 4.2 4.4 40-~ 4.0 3,6 3.8 2.6 2.8 2.7 3.1 3.1 3.1 45-49 2.7 2,3 2.5 2.1 2.9 2.5 2.4 2.7 2.5 50-54 2.0 1.9 2.0 2,0 3.5 2.7 2.0 2,8 2.4 55-59 1.2 1.1 1.1 2.0 3.0 2,5 1.7 2.3 2.0 60-64 0.9 0,8 0.9 2.5 2.1 2,3 1.9 1.6 1.7 65-69 0.5 0,5 0.5 1.8 1.7 1.7 1,3 1.2 1.2 70-74 0.4 0,3 0.4 1.2 0,7 0.9 0.9 0.5 0.7 75-79 0.2 0.1 0.1 0,8 0,5 0.6 0.5 0,3 0.4 80+ 0,I 0.0 0.1 0.6 0,3 0.5 0.4 0.2 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100,0 Number 7,524 7,743 15,267 ll,051 11,664 22,727 18,575 19,407 37,994 Note: Totals include a small number of persons whose sex was not stated. Figure 2.1 Distribution of De Facto Household Population by Single Year of Age and Sex 5 4 3 2 1 0 Percent I I I I I I 10 20 30 40 50 60 70+ Slngle YearofAge I--Female Male I ZDHS 1996 When population is distributed in five-year age groups, age misreporting is minimal (Figure 2.2). The relatively large number of women at age 50-54 and men age 60-64 is suggestive of transfer of some women from age group 45-49 to 50-54 and men from age group 55-59 to 60-64, presumably a deliberate attempt on the part of interviewers to reduce their workload. This pattern has been observed in other DHS surveys (Rutstein and Bicego, 1990). However, the impact of this phenomenon on the quality of the data is minimal because the shifting is not pronounced. Table 2.2 shows that the de jure population structures derived from the 1969, 1980 and 1990 Population and Housing Censuses and the 1992 and 1996 ZDHS surveys have changed little over time. Dependency ratios are also shown. They are the ratio of the number of persons age 0-14 and 65 and over divided by the number of persons age 15-64. The ratio is an indication of the dependency responsibility of adults in their productive years. The ratio varies over time. After reaching 111 dependents per 100 population age 15-64 in 1980, the ratio dropped to 98 in 1992 and 1996. 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 Table 2.3 shows data on households by the sex of the head of household, household size and the mean household size by residence. The table shows that the vast majority of households in Zambia are headed by males (77 percent), with only 23 percent headed by females. This represents a decline in the proportion of male-headed households from 83 percent in 1990 (CSO, 1995). Female-headed households are more common in rural than in urban areas (25 compared to 20 percent). 10 Figure 2.2 Population Pyramid, Zambia 1996 80+ 75-70 70-74 05-59 00-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-,4 40 S 0 5 10 Percent ZDHS 1996 Table 2.2 Ponulation bv aee from selected sources Percent distribution of the de jure population by broad age group, 1969, 1980, 1990, 1992 and 1996, Zambia 1969 1980 1990 1992 1996 Age group Census Census Census ZDHS ZDHS <15 46.4 49.8 46.2 46.7 46.8 15-64 51.3 47.4 51.9 50.6 50.5 65+ 2.3 2.8 2.9 2.6 2.7 Missing 0.0 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 Median age 15.3 16.8 16.3 16.4 Dependency ratio 0.95 1.11 0.92 0.98 0.98 Sources: Central Statistical Office, 1985a and 1985b, Central Statistical Office, 1995 Household composition usually affects the allocation of resources (financial, emotional etc.) available to the household members. Financial resources are usually limited in situations where women are heads of households. The well-being of a household's members is also affected by its size. Where the size of the household is large, crowding is likely and can lead to health problems. In the 1996 ZDHS, the average size of households was 5.4 persons, compared to 5.6 in the 1992 ZDHS. Results from the survey further show that the average household size is larger in urban areas than in rural areas (5.7 compared to 5.1 persons). While households with one to six members are common in both rural and urban areas of Zambia, large households 11 Table 2.3 Household comoosition Percent distribution of households by sex of head of household, household size, and whether household includes foster children, according to urban-rural residence, Zambia 1996 Characteristic Residence Urban Rural Total Household headship Male 79.8 75.2 76.9 Female 20.2 24,8 23.1 Number of usual members 1 4.9 6.7 6.0 2 9.2 10.6 10.1 3 11.4 14.3 13.2 4 12.5 14.6 13.8 5 13.3 14.7 14.1 6 11.4 11.6 11.6 7 11.9 9.9 10,6 8 8.5 6.1 7.0 9+ 16.9 11.5 13.5 Total 100.0 100.0 100.0 Mean size 5.7 5.1 5.4 Percent with foster children 25. I 25.1 25. l Total 100.0 100.0 100.0 Note: Table is based on de jure members, Le., usual residents. with nine or more persons are more common in urban than rural areas (17 percent compared to 12 percent). One-quarter of Zambian households contain a foster child or children, that is, persons under 15 years of age who have neither parent in the household. Table 2.4 presents data on fosterhood and orphanhood for children under 15 years of age. Household structure has been influenced by the high rates of rural-urban migration experienced by the country over the past two decades, coupled with urban-rural migration in the recent past. Overall, 62 percent of children under age 15 are living with both parents, while 19 percent live with only their mothers, 5 percent live with only their fathers, and 14 percent are "fostered" or not living with either parent. Although parental mortality accounts for only a small proportion of children not living with both parents, it is a factor; 9 percent of children under 15 have a deceased father, 4 percent have a deceased mother, and 2 percent have neither father nor mother. Given the projected population below 15 years in 1996 of 4.2 million (CSO, 1995b), almost half a million are orphans, among whom 307,000 have a mother but no father, 122,000 have a father but no mother, and 63,000 do not have either a father or a mother. As expected, the percentage of children living with both parents decreases with age, mostly because older children are more likely than younger children to live with only their fathers or to be fostered. Almost one-quarter of children age 10-14 live without either parent. Of course, the likelihood that one or the other parent has died is also higher among older children; 14 percent of children age 10-14 have lost their fathers and 8 percent have lost their mothers. Differences in fosterhood and orphanhood by other background characteristics are minimal and may be due to differences in the age distribution of children. The one exception is Westem Province, where only 44 percent of children under 15 live with both parents and 30 percent live only with their mothers. 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 the social, economic and political sectors, as well as achieving national development and modernisation. 12 Table 2.4 Fosterhood and omhanhood Percent distribution of de jure children under age 15 by survival status of parents and child's l iving arrangements, according to selected background characteristics, Zambia 1996 Living Living with mother with father Not living with Missing/ but not father but not mother either parent Don't Living know if with Father Mother father/ Number both Father Father Mother Mother Both only only Both mother of Charactersstic parents alive dead alive dead alive alive alive dead alive Total children Age 0-2 75.3 18.9 2.5 0.8 0.1 1.6 0.3 0.1 0.0 0.3 100.0 4,157 3-5 66.6 14.6 4.2 2.5 0.8 7.7 1.3 1.2 0.7 0.4 100.0 3,732 6-9 58.9 12.0 5 6 4.0 1.5 10.8 2.0 2.9 1.6 0.7 100.0 4,826 10-14 50.2 9.5 7.4 5.2 2.0 13,3 2.7 4.0 3.0 2.8 100.0 5,596 Sex Male 61.6 13.0 5.8 3.5 1.3 8.1 1.7 2.3 1.6 1 0 100.0 9,072 Female 61.4 13.7 4.5 3.1 1.1 9.6 1.7 2.1 1.4 1 4 100.0 9,229 Residence Urban 61.6 12.4 6.3 4.3 1.4 7.1 1.7 1.9 2.0 1.2 100.0 7,040 Rural 61.5 13.9 4.4 2.7 1.0 10.0 1.7 2.4 1.2 1.2 1000 11,271 Province Central 60.2 12.2 4.0 4.0 1.2 10.4 1.5 2.7 2.6 1.2 100.0 1,695 Copperbelt 62.4 11.0 6 7 3.9 2.1 8.0 1.7 1.6 1.5 1. I 100.0 3,365 Eastern 68.6 12.3 3 9 1.4 1.0 7.6 1.0 1.7 0.7 1.7 100.0 2,670 Luapula 63.5 13.7 5 8 1.2 0.9 7.5 3.1 1.8 1.3 1.4 100.0 1,612 Lusaka 606 13.2 5.9 4.0 1.1 7.6 1.9 2,5 2.1 1.I 100.0 2,637 Northern 643 14.0 5.5 1.1 0.8 7.9 1.2 2.3 1.7 1.1 100.0 2,173 North-Western 57.4 14.6 3.1 4.4 0.6 15.2 1.6 1,9 0.9 0.5 100.0 755 Southern 61.0 12.2 3.3 4.2 1.1 10.5 1.7 3.4 1.2 1.4 100.0 2,113 Western 44.4 23.3 6.2 7.6 1.2 1 i. 1 2.1 2.5 1.0 0.7 100.0 1,290 Total 61.5 13.4 5.1 3.3 1.2 8.9 1.7 2.2 1.5 1.2 100.0 18,311 Note: By convention, foster children are those who are not living with either parent. This includes orphans, i.e., children whose parents are both dead. Total includes a few persons whose sex was not stated. Tables 2.5.1 and 2.5.2 show the educational level of the female and male household population by selected background characteristics. Three-quarters of females and 82 percent of males have at least some education, while 16 percent of females and 25 percent of males have attended secondary school or higher education. Educational coverage has deteriorated slightly since 1992; the proportion of females with no education increased from 24 percent in 1992 to 25 percent in 1996, while the proportion of males who have never been to school increased from 15 to 18 percent. There is evidence that the differential in educational attainment by sex is narrowing (Figure 2.3). For example, while among people in their early fifties the proportion of women with no education is about four times the proportion of men with no education (58 compared to 15 percent); among those age 15-19 the difference is considerably smaller (9 percent compared to 7 percent). For both males and females, the proportion of persons with no education is much higher in rural areas than in urban areas. Rural men are more than twice as likely to have never attended school (24 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 percentage. 13 Table 2.5.1 Edqcational level of the female household t~onulation Percent distribution of the de facto female household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Zambia 1996 Don't Median Background No edu- know/ years of characteristic cation Primary Secondary Higher missing Total Number schooling Age t 6-9 53.4 44.6 0.0 0.0 2.0 100.0 2,345 0.0 10-14 12.4 84.5 2.7 0.0 0.3 100.0 2,761 3.6 15-19 8.5 62.3 29.2 0.0 0.0 100.0 2,129 6.7 20-24 11.0 56.6 30.7 1,6 0.1 100.0 1,967 7.1 25-29 12.6 57.2 26.2 4.0 0.0 100.0 1,375 7.2 30-34 13.1 60.1 21.7 5.1 0.0 100.0 1,156 7.0 35-39 13.8 62.5 18.5 5.1 0.0 100.0 811 6.6 40-44 19.9 53.8 i9.6 6.5 0.2 100.0 609 6.6 45-49 38.4 53.4 7.3 0.6 0.3 100.0 520 2.2 50-54 58.2 38.8 1.8 0.6 0.6 100.0 549 0.0 55-59 61.6 35.6 1.8 0.7 0.3 100.0 440 0.0 60-64 64.3 33.1 0.8 0.9 0.9 100.0 311 0.0 65+ 74.9 21.9 0.0 0.9 2.3 100.0 451 0.0 Residence Urban 12.7 57.1 26.4 3.4 0.3 100.0 6,203 6.3 Rural 33.5 59.0 6 5 0.3 0.7 100.0 9,223 2.6 Province Central 21.3 62,2 14.1 2.0 0.4 100.0 1,390 4.4 Copperbelt 13.8 59.4 24.5 1.9 0.3 100.0 2,817 5.9 Eastern 43.9 50.1 5.0 0.0 0.9 100.0 2,138 1.0 Luapula 28.8 60.5 10.2 0.4 0.2 IO0.O 1,356 3.1 Lusaka 15.7 54.6 24.6 4.6 0.4 100.0 2,382 6.1 Northern 28.4 62.4 8.0 0.4 0.7 100.0 1,829 3.2 North-Western 33 2 54.7 11.2 0.3 0.6 100.0 599 2.6 Southern 22.6 64.8 10.9 1.2 0.5 100.0 1,675 4.0 Western 31.5 56.4 10.1 1.2 0.8 100.0 1,241 3.1 Total 25.1 58.2 14.5 1.6 0.5 100.0 15,426 4.0 I Excludes one woman with age missing Table 2.6 presents enrolment rates by age, sex and residence. Six in ten children aged 6-15 years are currently enrolled in school. Enrolment is substantially higher in urban areas than in rural areas. Boys and girls age 6-15 have a virtually equal chance of being enrolled (60 percent compared to 59 percent). Enrolment after age 15 drops substantially; only 33 percent of older teenagers and 6 percent of those in their early twenties are still in school. The proportions are higher in urban areas than in rural areas in all age groups. At age 16 and older, women are much less likely than men to be enrolled in school, presumably due to cultural norms which encourage girls to drop out of school, possibly to get married and start a family. Enrolment rates in 1996 are lower than those in 1992, probably because the data collection period encompassed school holidays (July-August) in which some children were reported as not enrolled in school. 14 Table 2.5.2 Educational level of the male household t~onulation Percent distribution of the de facto male household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Zambia 1996 Don't Median Background No edu- know/ years of characteristic cation Primary Secondary Higher missing Total Number schooling Age ~ 6-9 54.1 44.1 0.0 0.0 1.7 100.0 2,383 0.0 I0-14 12.5 85.9 1.2 0.0 0.4 100.0 2,702 3.4 15-19 7.2 64.0 28.4 0.1 0.2 100.0 2,045 6.6 20-24 7.1 48.2 42.3 2.0 0.3 100.0 1,740 7.7 25-29 5.8 45.5 42.9 5.5 0.2 100.0 1,329 7.9 30-34 6.2 44.9 41.3 7.5 0.1 100.0 1,072 7.9 35-39 4.8 44.3 40.2 10.7 0.0 100.0 845 8.0 40-44 6.1 43.8 38.2 11.9 0.0 100.0 583 8.0 45-49 9.6 50.6 31.5 7.7 0.5 100.0 438 7.5 50-54 15.3 61.8 15.9 6.3 0.7 100.0 369 5,9 55-59 19.8 65.7 8.7 5.0 0.8 100.0 307 4.4 60-64 31.0 59.5 6.1 2.3 1.1 100.0 345 3.3 65+ 38.4 54.5 5.1 0.9 1.1 100.0 567 2.3 Residence Urban 9.0 50.6 34.1 5.9 0.4 100.0 6,011 7.3 Rural 23,7 61.5 13.2 0.9 0.6 100.0 8,716 3.9 Province Central 16.7 57.0 23.9 2.0 0.5 100.0 1,438 5.5 Copperbelt 9.2 52.8 33.3 4.1 0.6 100.0 2,776 7.1 Eastern 32.8 53.9 11.7 0.5 1.0 100,0 2,075 2.8 Luapula 16.6 67.2 14.9 1.1 0.3 100.0 1,237 4.4 Lusaka 12.3 50,5 29.2 7.6 0.4 100.0 2,354 7.1 Northern 15.6 64.3 18.4 1.0 0.7 100,0 1,717 4.8 North-Western 23.1 58,5 15.3 2.1 0.9 100.0 490 3.9 Southern 18,5 61.9 17.0 2.3 0.3 100.0 1,568 4.9 Western 24.4 57.6 14.9 2,6 0.4 100.0 1,072 4.1 3,0 0.6 100.0 14,727 Total 17.7 57.1 21.7 5.2 I Excludes one man with education missing Table 2.6 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 1996 Male Female Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 6-10 61.2 40.3 48.3 63.2 41.2 49.3 62.2 40.7 48.8 11-15 83.9 67.6 73.9 81.3 63.9 71.2 82.6 65.8 72.5 6-15 71.7 52.8 60.1 72.0 51.2 59.4 71.9 52.0 59.7 16-20 50.6 35.7 42.4 32.9 14.7 23.3 41.3 25.1 32.6 21-24 13.5 5.5 9.2 4.2 1.4 2.6 8.5 3.3 5.7 15 Figure 2.3 Percentage of Males and Females With No Education by Age Group Percent BO 60 40 20 6-9 10 14 15 19 20.24 25 29 30-34 35-39 40-44 45-49 S0 54 55 59 60*64 65+ Age Group I-e-Male +Female ] ZDHS 1996 2.2 Housing Characteristics Socioeconomic conditions were assessed by asking respondents specific questions relating to their household environment. Table 2.7 presents housing characteristics such as type of drinking water, sanitation facilities, quality of the floor and crowding. This information is important in that it helps determine the health status and reflects wealth and disposable income of the members of the household. Electricity is available to only 17 percent of the households in Zambia. Moreover, most of those with electricity are urban households (44 percent) compared to 2 percent of rural households. Sources of drinking water differ considerably by area of residence. In urban areas, piped water is the primary source; 47 percent of households have water piped into the residence and 34 percent obtain water from a public tap. In mrul areas, public traditional wells (31 percent), public shallow wells (20 percent), and rivers and streams (22 percent) are the main sources of drinking water. More than half of households are within 15 minutes from their source for drinking water. The proportion of these households is 76 percent in urban areas, compared to 39 percent in rural areas. Eighteen percent of Zambian households have a flush toilet, 53 percent have traditional pit latrines, and 29 percent have no sanitation facilities at all. Modem sanitation facilities are absent from virtually all rural households. Traditional pit latrines are common in both urban and rural areas (49 percent and 55 percent, respectively). 16 Table 2.7 Housing charactgfi,~tics Percent distribution of households by housing characteristics, according to urban-rural residence, Zambia 1996 Residence Characteristic Urban Rural Total Electricity Yes 44.1 1.5 17.3 No 55.8 98.3 82.5 Missing/Don't know 0.1 0 2 0 2 Total 1(30.0 100.0 100,0 Source of drinking water Piped into residence 46.7 1.7 18.4 Pubhc tap 33.9 5.3 15.9 Well in residence 3.6 3,1 3.3 Public shallow well 2.2 20.1 13 4 Public traditional well 5.1 31.2 21.5 Borehole 4 7 12.5 9.6 Spring 0.2 1.6 1.1 River/stream 0.8 22.3 14.4 Pond/lake 0.3 1.6 1.1 Other 2.4 0.4 1.2 Missing/Don't know 0.2 0 1 0.1 Total 100.0 100.0 100.0 Time to water source (mlnut¢~) <15 minutes 75.8 39.2 52.7 Median nine to source 1.0 20.1 10.8 Sanitation facility Own flush toilet 41.2 1.0 15.9 Shared flush toilet 4.4 0.2 1.7 Traditional pit toilet 48.6 55.0 52.6 Ventdated improved pit latrine 0.3 0 4 0,4 No facihty/bush 4 8 42.9 28.8 Other 0 3 0 1 0.1 Missing/Don't know 0.4 0.4 0.4 Total 100.0 100.0 100.0 Floor material l~arth/sand 14.9 88.4 61.1 Wood planks 0.6 0.1 0.3 Parqueffpohshed wood 1.0 0.0 0.4 Terrazzo tde 3.3 0.1 1.3 Concrete/cement 79.9 11.2 36.7 Other 0.2 0,0 0 1 Missing 0.2 0 2 0.2 Total 100.0 1000 1000 Persons per sleeping room 1-2 56.6 53 4 54 6 3-4 35.9 35,9 35.9 5-6 5.5 7,2 6.6 7+ 1.3 3.0 2.4 Missing/Don't know 0.7 0.5 0.6 Total 1000 100.0 100.0 Mean persons per room 2.7 2.9 2.8 Iodine reading (parts per million) 1 Not iodlsed 9.8 6.6 7,7 lodlsed 80.6 76,5 78.1 Not tested/Missing 9 6 16.9 14.2 Total 100.0 I00.0 100,0 r-Not iodised includes households in which the respondent reported that the salt was not ledised, or the test indicated that the salt conhained less than 25 ppm (no colour change), lodised means that the salt contained 25 or more ppm, The majority of Zambian households live in residences with earthen (61 percent) floors and 37 percent occupy houses with cement floors. Concrete or cement flooring is most common for urban households (80 percent), whilst earthen floors are most common for rural households (88 percent). 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 (see Table 2.3), 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. One of the objectives of the 1996 ZDHS was to establish the prevalence of use of iodised salt. For this purpose, the interviewers were given kits developed by UNICEF which allow the identification of the iodine content by the change in the salt colour after the application of a special liquid. The content was measured in five levels, from 0-24, 25-49, 50-74, 75-99, and 100+ parts per million (ppm). However, according to UNICEF recommendation, the change in colour should be considered as an approximation of the iodine concentration and the test is most useful in determining whether the salt contains iodine or not. The salt is considered usefully iodised if it contains a minimum of about 20 ppm of iodine. Data from the 1996 ZDHS show that in 14 percent of households, the test was not conducted, either because the respondent could not provide the salt or because of the interviewer's negligence. In the majority of the households (78 percent), the salt was usefully iodised (25 or more ppm) and in 8 percent of the households either the respondent reported that the salt was not iodised or the test indicated that the iodine content was less than 25 ppm. Urban households are more likely to have iodised salt than rural households. 17 Household Durable Goods Respondents were asked about ownership of particular household goods such as radios and televisions (to assess access to media), refrigerators (to assess food storage) and modes of transportation (bicycle, motorcycle, car). Ownership of these items is also indicative of the household's social and economic well-being. The results presented in Table 2.8 indicate that 44 percent of households own a radio (65 percent in urban areas and 31 percent in rural areas) and 17 percent own a television (43 percent in urban areas and 2 percent in rural areas). Seven percent of households own refrigerators (17 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 rural areas. Table 2.8 Household durable eoods Percentage of households possessing various durable consumer goods, according to urban-rural residence, Zambia 1996 Residence Durable good Urban Rural Total Radio 64.9 31.0 43.5 Television 43.4 2.1 17.4 Refrigerator 16.7 0.5 6.5 Bicycle 14.7 30.5 24.6 Motorcycle 0.9 0.5 0.6 Private car 5.7 0.9 2.7 None of the above 28.I 55.1 45.1 Number of households 2,702 4,584 7,286 Twenty-five percent of the households own a bicycle, while only 3 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 of households owning a private car is 6 percent in urban areas and 1 percent in rural areas. 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. Table 2.9 Aee distribution of women 1980. 1990. 1992 and 1996 Percent distribution of women of reproductive age, Zambia 1980, 1990, 1992 and 1996 1980 1990 1992 1996 Age group Census Census ZDHS ZDHS 15-19 24.6 27.4 28.1 25.0 20-24 20.0 21.5 20.4 22.8 25-29 16.3 16.1 16.7 16.0 30-34 13.3 12.4 13.0 13.5 35-39 10.5 8.5 9.3 9.5 40-44 8,6 7.9 7,2 7.1 45-49 6.7 6.2 5.4 6.2 Total 100,0 100.0 100.0 100.0 Sources: Central Stattstical Office, 1995 Table 2.9 presents the age distribution of women in the 1992 and 1996 ZDHS surveys compared with that of women enu- merated in the 1980 and 1990 censuses. Although the proportion of all women who are 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 1996 ZDHS is older than that for women 15-49 in the 1990 census. Specifi- cally, the proportion of women age 15-19 is lower in the 1996 ZDHS than in the 1990 census (25 percent compared with 27 percent). It is not clear whether this difference is real or whether it is the result of some pattern of age misreporting, or high mortality among women in the reproductive ages (15-49). 18 Table 2.10 reflects the high level of urbanisation in Zambia; 45 percent of women 15-49 and 46 percent of men 15-59 live in urban areas. The data show further that one in five respondents lives in Copperbelt Province, 17 percent in Lusaka Province, and 13 percent in Eastern Province. Northern and Southern Provinces each accounts for 10-11 percent of respondents, while Central, Luapula, and Western Provinces each accounts for about 8 percent of the respondents. North-Western Province has the smallest proportion of respondents (3 percent). The distribution of respondents by urban-rural residence and province differs somewhat from that recorded in 1992, because the sample for the 1996 survey was based on the actual population recorded in the 1990 Census of Population, Housing and Agriculture, while that in the 1992 ZDHS was based on pre-census estimates. The majority of respondents have had formal schooling. Only 13 percent of women and 7 percent of men have never attended school, more than half have gone to primary school, and more than 25 percent attended secondary or higher education. Nine in ten women and more than eight in ten men are not currently attending school Data in Table 2.10 show that 25 percent of women 15-49 and 44 percent of men 15-59 in the sample have never been married, 61 percent of women and 51 percent of men are currently married or living together, and 14 percent of women and 5 percent of men are no longer in union. The percentage of women in union declined from 67 percent in 1980 to 63 percent in 1992 and to 61 percent in 1996. One in four respondents reported themselves as Catholics, while seven in ten are Protestants. Bemba is the largest ethnic group, accounting for 36 percent of respondents. Nineteen percent of respondents belong to the Nyonja group, while 15 percent comprise the Tonja language group. The Northwestern group (comprising Luvale, some Lunda groups, Kaonde, and other smaller tribes in North- Western Province) is the fourth largest group with 9 percent of the respondents. The Baroste language group (including Lozi) comprises about 7 percent of respondents, with Mambwe and Tumbuka accounting for 6 percent each. Differentials in Characteristics Between Spouses Table 2.11 shows the age and educational differentials between female respondents and their husbands or partners. On average, husbands are almost 7 years older than their wives. For 80 percent of the couples, both husband and wife have attended formal schooling, while for 16 percent only one of the spouses is educated and for 4 percent of the couples, neither has gone to school. Differentials in Education Table 2.12 presents the distribution of respondents by education, according to selected characteristics. Education is inversely related to age; that is, older men and women are generally less educated than younger men and women. For instance, 37 percent of women age 45-49 years have had no formal schooling, compared to only 8 percent of the women age 15-19 years. In the case of men, 10 percent of men aged 45-49 have had no formal schooling, compared to 7 percent of men age 15-19 years. Rural residents are educationally disadvantaged compared to urban residents. One in five rural women of childbearing age has never been to school, compared to only 6 percent of urban women. The corresponding proportions for men are 10 percent and 3 percent, respectively. Conversely, four times as many urban women have gone beyond the primary level as rural women (46 percent compared to 13 percent). Data in Table 2.12 also indicate that women residing in Copperbelt and Lusaka Provinces are more likely to have received secondary education, followed by women in Central, Southern and North-Western Provinces. The same pattem is found among men age 15-59. The differences by province in the percentage of women and men who have had only primary schooling are minor. 19 Table 2.10 Background characteristics of respondents Percent distnbuaon of women and men by selected background characteristics, Zambia 1996 Women Men Number of women Number of men Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted wesghted Age 15-19 25.0 2,003 1,982 24.9 460 458 20-24 22.8 1,830 1,823 21 8 404 395 25-29 16.0 1,286 1,280 13.8 255 253 30-34 13.5 1,081 1,083 12 2 225 230 35-39 9.5 758 768 9.9 184 186 40-~4 7A 568 569 6 5 121 121 45 -49 6.2 494 516 4 5 83 84 50-54 NA NA NA 3.5 65 68 55-59 NA NA NA 2.8 52 54 Residence Urban 44.9 3,604 3,001 46 I 852 698 Rural 55.1 4,417 5,020 53.9 997 1,151 Province Central 8 1 653 748 8.5 157 185 Copperbelt 19.8 1,588 1,129 21 4 396 288 Eastern 13 4 1,075 1,118 13.7 254 276 Luapula 9 0 726 896 8.2 151 196 Lusaka 17.5 1,403 1,074 17.I 316 220 Northern 10 9 872 783 12.0 221 205 North-Western 3.6 288 567 2.6 48 94 Soutbem 10.2 816 846 9.4 173 189 Western 7.5 600 860 7.1 132 196 Education No education 13.3 1,067 I, 168 6.9 127 138 Primary 58.9 4,721 4,833 50.7 938 990 Secondary 25 0 2,007 1,828 37 1 686 634 Higher 2 8 226 191 5 3 98 87 Don't know/missing 0 0 1 I 0 0 0 0 Currently attending school Yes 8 8 703 673 15.1 279 265 No 90.7 7,278 7,310 83 6 1.545 1,562 Missing 0.5 40 38 1 3 25 22 Current marital status Never married 25 3 2,032 1,986 44.0 814 796 Married 60.3 4,839 4.888 51.0 943 962 Llvmg together 0 8 63 61 0.I 1 2 Widowed 4.1 327 313 1.1 21 19 Dworced 7 2 574 591 2.1 39 43 Not living together 2.3 184 180 1.7 31 27 Missing 0.0 2 2 0.0 0 0 Religion Cathohc 24 0 1,927 1,853 24.7 457 452 Protestant 74.4 5,965 6,029 71 6 1,324 1,321 Muslim 0 3 22 18 0.5 8 9 Other 0 3 27 25 0.6 11 12 Missing 0 3 25 25 0 1 3 2 Ethnicily Bemba 35.6 2,854 2,670 35.7 660 629 Tonga 15.4 1,232 1.242 14.8 273 286 Northwestern 9 2 737 1,016 8.5 157 204 Baroste 7.5 604 730 6.4 118 149 Nyanja 18 5 1,486 1,389 20.0 370 337 Mambwe 5 7 455 385 5.8 108 94 Tumbuka 5.5 441 396 5.8 107 100 Other 2.3 185 166 2.6 48 43 Don't know/missing 0 3 28 27 0.4 7 7 Total 100.0 8,021 8.021 100.0 1,849 1,849 20 Tahle 2.11 Differential characteristics between snouses Percent distribution of couples by differences between spouses in age and level of education, Zambia 1996 Number Differential Percent/ of characteristic Years couples Age difference (percent) (husband minus wife) Wife older 2.0 16 0-4 years 34.5 283 5-9 years 45.3 372 10-14 years 12.5 103 15 years + 5.8 48 Mean age difference (years) I st wife 6.5 805 2nd wife * 17 All wives 6.6 822 Education (percent) Both husband and wife not educated 3.8 31 Wife educated, husband not 3.2 27 Husband educated, wife not 13.2 108 Both husband and wife educated 79.8 656 Total 100.0 822 Note: An asterisk indicates the mean is based on less than 25 couples and has been suppressed. Access to Media Men and 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 men and women with family planning and health messages through the media. Table 2.13 shows that whilst 36 percent of the women and 44 percent of men interviewed listen to the radio daily, 25 percent of women and 45 percent of men read a newspaper on a weekly basis, and 29 percent of women and 38 percent of men watch television at least once a week. There are few variations in media access by age of the respondents, except among the oldest age groups for whom access is more limited. Urban residents are much more likely to have access to mass media than rural residents. Compared to data from the 1992 ZDHS, it appears as if women are reading newspapers and listening to the radio less often and watching television more often; however, comparisons are difficult since the wording of the questions differed. Employment Women were asked whether they were employed and if so, how often they worked. Table 2.14 gives this information according to different background characteristics. Overall, 54 percent of women were not working, 21 percent were working all year, 19 percent worked seasonally, and 6 percent worked occasionally. A high proportion of women aged 15-19 (76 percent) and 20-24 (57 percent) were not employed compared to those aged 25 years and older, in part due to their being at school. Over half of the women both in rural and urban areas were not currently employed. Rural women are more likely to have seasonal jobs than urban women; about 30 percent of women in rural areas work seasonally, compared to only 6 percent in urban areas. However, the reverse is true for women working throughout the year. Twenty-nine percent of women in urban areas worked all year, while in rural areas the proportion is only about 9 percent. The reason for this could be that most of the women in rural areas are engaged in farming which is seasonal, while women in urban areas are more likely to be involved in full- time, formal employment or in businesses such as sale of second-hand clothes and vegetables at the market. Women with secondary or higher education are more likely to work all year than women with less education. Table 2.15 shows data on employed women by type of employment and whether the woman earns cash, according to age, residence, and level of education acquired. Younger women are more likely to be employed by a relative, while women age 25-39 tend to be self-employed and receive cash earnings. Urban women have a better chance of receiving cash payment for their work than rural women; while 95 percent of urban women work for cash, only 73 percent of rural women receive cash for their work. Among women in urban areas, six in ten are self-employed with cash payment, and 29 percent are employed by a non-relative and receive cash payment. In rural areas, the corresponding proportions are 58 percent and 5 percent, respectively. 21 Table 2.12 Level of education by back,,round characteristics Percent distribution of respondents by highest level of education attended, according to selected background characteristics, Zambia 1996 Level of education Number Background No of women/ characteristic educauon Primary Secondary Higher Total men WOMEN Age 15-19 8.4 61.6 30.0 0.1 100.0 2,003 20-24 10.9 57.3 29.9 1.9 100.0 1,830 25-29 I 1.7 57.1 27.0 4.2 100.0 1,286 30-34 13.1 60.6 21.2 5.0 100.0 1,081 35-39 14.1 62.9 17.8 5.2 100.0 758 40-44 20.6 53.5 19.1 6.8 100.0 568 45-49 37.3 54.3 7.8 0.6 100.0 494 Residence Urban 5.6 48.1 40.7 5.6 100.0 3,604 Rural 19.6 67.6 12.2 0.6 100.0 4,417 Province Central 7.9 61.4 26.8 3.8 100.0 653 Copperbelt 5.8 50.8 40.0 3.4 100.0 1,588 Eastern 32.7 58.4 8.9 0.0 100.0 1,075 Luapula 15.6 66.3 17.4 0.7 100.0 726 Lusaka 7.8 48.1 36.8 7.3 1130.0 1,403 Northern 11.8 71.9 15.5 0.8 100.0 872 North-Western 18.5 60.7 20.1 0.7 100.0 288 Southern 10.0 68.5 19.2 2.3 100.0 816 Western 18.6 61.3 18.1 2.0 100.0 600 Total 13.3 58.9 25.0 2.8 100.0 8,021 MEN Age 15-19 6.9 62.7 30.5 0.0 100.0 460 20-24 6.8 50.4 40.9 2.0 1130.0 404 25-29 6.2 40.1 46.6 7.1 100.0 255 30-34 8.5 42.7 42.0 6.8 100.0 225 35-39 1.4 44.1 42.5 12.0 100.0 184 40-44 6.5 42.4 36.3 14.9 100.0 121 45-49 9.7 51.7 32.4 6.1 100.0 83 50-54 7.6 60.8 20.0 I 1.6 100.0 65 55-59 18.2 62.7 11.2 7.9 100.0 52 Residence Urban 2.7 34.9 53.2 9.2 100.0 852 Rural 10.4 64.2 23.4 2.0 100.0 997 Province Central 7.2 43.5 44.7 4.6 100.0 157 Copperbelt 2.8 37.6 53.7 5.9 100.0 396 Eastern 19.2 58.7 21.3 0.8 100.0 254 Luapula 5.1 64.7 26.6 3.6 100.0 151 Lusaka 5.2 38.1 43.6 13.0 100.0 316 Northern 2.1 64.6 31.2 2.1 100.0 221 North-Western 3.1 63.6 27.5 5 8 100.0 48 Southern 5.6 60.8 32.4 1.2 100.0 173 Western 11.9 56.5 24.7 7.0 100.0 132 Total 6.9 50.7 37.1 5 3 100.0 1,849 22 Table 2.13 Access to mass media Percentage of women and men who usually read a newspaper once a week, watch television once a week, or listen to radio daily, by selected background characteristics, Zambia 1996 Women Men Mass media Mass media Read Watch Listen Read Watch Listen No news- tele- to All Number No news- tele- to All Number Background mass paper vision radio three of mass paper vision radio three of characteristic media weekly weekly daily media women media weekly weekly daily media men Age 15-19 47.9 26.5 32.3 34.7 11.7 2,003 39.3 42.1 38.7 34.4 18.2 460 20-24 48.5 24.2 29.5 36.3 11.2 1,830 36.6 42.1 41.4 46.8 24.8 404 25-29 46.5 25.5 30.6 40.7 13.9 1,286 28.8 50.6 38.5 49 5 24.2 255 30-34 44.9 26.1 28.8 41.2 13.3 1,081 32.6 45.7 37.0 46.0 19.0 225 35-39 48.8 24.2 27.2 36.9 11.1 758 29.3 50.1 40.8 51.3 24.6 184 40-44 55.7 24.5 24.7 31.2 11.4 568 29.5 47.3 35.1 52.0 22.2 121 45-49 65.0 13.5 14.2 25.4 4.6 494 31.3 39.4 39.6 52.1 18.5 83 50-54 NA NA NA NA NA NA 34.7 48.8 32.3 46.3 24.8 65 55-59 NA NA NA NA NA NA 58.9 29.9 8.7 24.3 4.9 52 Residence Urban 22.5 40.0 57.5 57.3 24.4 3,604 11.6 65.9 73.4 64.5 43. I 852 Rural 70.8 12.0 5.4 19.2 1.2 4,417 54.7 26.4 7.7 27.1 2.8 997 Province Central 47.3 11.4 26.9 39.7 4.4 653 38.2 33.1 27.6 45.5 14.4 157 Copperbelt 22.9 37.8 59.7 56.7 23.6 1,588 9.4 62.0 78.1 64.3 39.7 396 Eastern 67.5 17.8 3.6 19.6 1.0 1,075 35.7 40.8 7.3 41.5 1.9 254 Luapula 71 5 7.6 6.5 22.9 1.5 726 42.2 37.8 14.5 26.6 5.2 151 Lusaka 18.2 48.3 60.3 62.5 31.4 1,403 8.5 72.2 81.2 70.8 55.3 316 Northern 79.5 4.7 5.9 14.4 0.9 872 81.1 6.9 5.1 15.4 1.7 221 North-Western 72.8 12.9 8.2 16.9 1.8 288 53.3 25.6 14.1 34.7 8.3 48 Southern 50.1 31.7 15.7 25.6 5.2 816 58.2 34.0 12.5 18.6 6.5 173 Western 75.4 6.3 8.1 19.5 1.8 600 45.2 39.4 9.4 31.4 5.9 132 Education No education 81.1 1.0 6.9 15.2 0.1 1,067 71.1 2.9 8.3 23.5 0.0 127 Primary 56.6 16.6 18.7 30.1 4.8 4,721 46.6 31.0 24.2 33.6 10.4 938 Secondary 19.5 50.1 57.6 57.5 28.6 2,007 16.3 65.0 56.7 58.1 34.9 686 Higher 3.9 77.4 86.2 77.6 58.5 226 4.8 86.8 76.9 78.0 58.9 98 Total 49.1 24.6 28.8 36.3 11.6 8,021 34.8 44.6 38.0 44.4 21.3 1,849 NA=Not apphcable Virtually all women who are currently employed in Copperbelt, Eastern, Lusaka, North-Western and Southern Provinces earn cash, while in Western Province the majority of women who work do not receive cash payment. There is a considerable variation of employment status by the woman's level of education. Nine in ten women with higher than secondary education are employed by a non-relative with cash payment. On the other hand, eight in ten women with no education are self-employed. Among these women, 20 percent did not receive cash earnings. 23 Percent distribution of women by employment status and continuity of employment, according to background characteristics, Zambia 1996 Not currently employed Currently employed Did not work Worked All year in last in Background 12 last 12 5+ days <5 days Season- Occasion- characteristic months months per week per week ally ally Missing Total Number Age 15-19 74.3 1.9 5.7 1.5 11.8 4.7 0.1 100.0 2,003 20-24 54.7 2.6 14.8 3.0 19.1 5.8 0.1 100.0 1,830 25-29 42.9 3.7 23.3 2.6 20.8 6.6 0.1 100.0 1,286 30-34 38.8 2.2 24.4 4.6 22.5 7.4 0.1 100.0 1,081 35-39 38.7 2,4 29.1 2.2 22.2 5.4 0.1 100.0 758 40-44 36.2 1.9 31.2 3.9 22.2 4.5 0.0 100.0 568 45-49 41.8 1.7 18.8 1.5 28.9 7.2 0.0 1130.0 494 Residence Urban 52.1 3.6 29.4 2.7 5.9 6.2 0.1 100.0 3,604 Rural 51.8 1.5 8.6 2.6 29.9 5.5 0. I 100.0 4,417 Province Central 46.4 3.5 20.4 4.0 21.6 4,1 0.1 100.0 653 Copperbelt 57.5 4.3 24.9 3.3 4.0 5.8 0.1 100.0 1,588 Eastern 73.1 0.5 5.7 1.0 17.9 1.6 0.2 100.0 1,075 Luapula 34.5 0.6 9.3 2.1 48.1 5.4 0.0 100.0 726 Lusaka 54.9 3.2 33.4 1.0 3.8 3.8 0,0 100.0 1,403 Northern 34.4 3.7 11.6 4.5 36.2 9.6 0.0 100.0 872 North-Western 25.6 0.2 6.0 2.5 42,8 22.4 0.5 100.0 288 Southern 63.0 1.5 14.4 2.3 9.4 9.2 0.1 100.0 816 Western 42.3 1.1 12.9 4.9 36.3 2.6 0.0 100.0 600 Education No education 55.7 1.3 9.1 1.9 28.0 4.0 0.0 100.0 1,067 Primary 51,6 2.5 14.4 2.9 22.0 6.5 0.1 100,0 4,721 Secondary 54.9 2.9 24.5 2.9 8.9 5.9 0.0 100.0 2,007 Higher 15.1 1.8 75.5 0.0 6,4 1.2 0.0 100.0 226 Total I 51.9 2.4 18.0 2.7 19.1 5.8 0.1 100.0 8,021 t Total includes one woman with missing information on education Occupation Tables 2.16.1 and 2.16.2 show data on employed women and men by their current occupation. For those working in agriculture, the data are presented by type of land holding. The agriculture sector accounts for 36 percent of employed women 15-49. Four in ten women are engaged in sales and services, while 10-11 percent of women work in skilled manual jobs. 24 Table 2.15 Emolover and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to background characteristics, Zambia 1996 Employed by Employed by Self-employed a non-relative a relative Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women Age 15-19 47.8 12,1 11,9 1.2 16.0 10.9 20-24 55.3 14.0 15.4 0,8 9.7 4.8 25-29 63.2 10.2 16.0 0.0 7,5 3.0 30-34 67.1 8.3 14.7 0.0 6.2 3.8 35-39 59.7 11.8 17.9 0.8 5,3 4.3 40-44 54.7 12.7 22,5 0.8 4.5 4.8 45-49 61.0 19.3 8.2 0.2 6,2 5.1 Residence Urban 60.1 3.1 29.1 0.5 5.9 1.4 Rural 57,7 19.0 4.8 0.5 10,0 7.9 Province Central 48.9 23,6 15.3 1.4 8.9 1,9 Copperbelt 73.0 0.4 21.6 0.2 3.4 1.3 Eastern 89.3 0.3 5.0 0.0 5.4 0.0 Luapula 57.6 25.2 3.3 0.4 6.3 7.3 Lusaka 52.4 0.2 38.3 0.5 6.8 l.S Northern 47.1 18.1 5.2 1.1 18.2 10,3 North-Western 81.8 6.3 4.2 0.0 6.6 0.9 Southern 67.9 2.9 20 4 0.3 7.8 0,3 Western 26.6 35,4 8.9 0.6 8.6 19.9 Education No education 59.5 19.5 3,7 0.6 6.4 10.4 Primary 63.7 14.2 6.6 0.6 9.4 5.4 Secondary 56 5 5.1 28.3 0.4 7.5 2,2 Higher 10.8 0.4 86.6 0.0 1.8 0.4 Total I 58.8 12,1 15.4 0.5 8.2 5.1 0.0 100.0 475 0,1 100.0 780 0.0 100.0 685 0,0 100.0 637 0.2 100.0 447 0.0 IO0.O 351 0.0 lO0.O 279 0.0 100.0 1,596 0.0 100.0 2,059 0.0 100.0 327 0.0 100.0 604 0.0 100.0 283 0,0 100.0 471 0.0 100.0 588 0.0 100.0 540 0.2 100.0 212 0.3 100.0 290 0.0 100,0 340 0,0 100.0 459 0.0 100.0 2,161 0.1 100.0 847 0,0 100.0 188 0.0 100.0 3,655 l Total includes one woman with missing information on education Among men, 28 percent are not working, while 36 percent (or half of those who are employed) work in agricultural jobs. A large proportion of men age 15-19 are not working because most of them are in school. Men in their 30s and 40s are more likely to be engaged in professional, technical and management services, while sales and services are popular among women at all ages. As expected, rural respondents are more likely to be employed in agriculture, whilst the majority of urban women and men who are employed are involved in the professional, technical and management sector, the sales and services sector, and skilled manual jobs. One's education is associated with the type of occupation one does; those with no education are more likely to be engaged in agriculture, while women and men with higher than secondary education tend to work in professional, technical and management positions. 25 Table2.16.1 Occurmtion: women Percent distribution of currently employed women by occupation and type of agricultural land worked or type of non-agricultural employment, according to background characteristics, Zambia 1996 Agricultural Non-agricultural Prof. Household Number Background Own Family Rented Other's tech./ Sales/ SkiUed Unskilled and of characteristic land land land land manag, services manual manual domestic Missing Total women Age 15-19 14.4 23,7 0.2 2.1 1.5 44.3 8.0 1.2 4.4 0.2 100.0 475 20-24 20.1 15.9 0.0 2.1 5.6 42.8 8.8 1.7 3.1 0.0 100.0 780 25-29 18.7 9.7 0.6 0.9 9,0 45.2 12.7 0.7 2.4 0.0 100.0 685 30-34 22.2 9.2 0.0 1.2 10.6 42.5 11.8 1.1 1.3 0.1 100.0 637 35-39 22.5 9.6 0.3 1.7 13.1 39.0 8.5 2.1 2.8 0.2 100.0 447 40-44 23,8 8.9 0.3 2.3 16.6 34.0 8.0 2.7 3.4 0.0 100.0 351 45-49 35.3 12.0 0.4 2.3 6.1 33.1 7.9 0.8 2.0 0.0 100.0 279 Residence Urban 2,7 1.7 0.1 0.6 17.1 61,1 9.0 2.1 5.7 0.0 100.0 1,596 Rural 35.7 21.5 0.4 2.6 2.0 26.0 10.4 0.9 0.5 0.1 100.0 2.059 Province Central 13.7 22.7 1.3 2.8 9.0 41.4 6.8 0.7 1.7 0.0 100.0 327 Copperbelt 2.2 0.4 0.3 0.2 14.2 68.9 8.3 2.5 2.9 0.0 100.0 604 Eastern 33.3 3.3 0.3 0.7 2.3 24.4 32.0 0.7 2.3 0.7 100.0 283 Luapula 57,3 16.2 0.0 1.0 1.7 20.5 1.9 0.9 0.5 0.0 100.0 471 Lusaka 0.7 2.1 0.0 0.8 20.1 55.3 8.6 2.4 10.0 0.0 100.0 588 Northern 26.1 33.4 0.2 1.1 2.8 29.9 6.0 0.2 0.4 0.0 100.0 540 North-Western 49.7 2.7 0.0 1.0 1.6 25.7 17.6 0.5 1.2 0.0 100.0 212 Southern 7.2 2.5 0.3 3.7 9.6 60.6 11.8 2.9 1.1 0.3 100.0 290 Western 24.8 29.9 0.0 6.5 5.6 22.6 9.0 1.0 0.6 0.0 100.0 340 Education No education 40.5 17.4 0.4 2.2 0.3 25.6 10.4 1.1 2.0 0.2 100.0 459 Primary 24.7 16.0 0.3 2.0 0.4 43.0 9.6 0.9 3.0 0.1 100.0 2,161 Secondary 6.3 5.2 0.0 1.0 16.3 53.6 11.7 2.8 3.1 0.0 100.0 847 Higher 2.5 0.0 0.0 0,6 88.7 5.4 1.4 1.4 0.0 0.0 100.0 188 Total t 21.3 12.8 0.3 1.7 8.6 41.3 9.8 1.4 2.7 0.1 100.0 3,655 Note: The "professional, technical, managerial" category includes professional, technical, clerical and managerial occupations. L Total includes one woman with missing information on education Decisionmaking On Use of Earnings Women in employment receiving cash earnings were asked who decides on the use of their earnings. More than half of women reported making the decision themselves, 16 percent involved their husband/partner, and for 21 percent of women the decision was made by their husband/partner (Table 2.17). There is little difference by age in decisionmaking regarding earnings, except that younger women are more likely to have someone other than a husband decide how their earnings are spent, presumably because a lower proportion of younger women are married. 26 Table 2.16 20ccut~ation: men Percent distribution of men by employment status, occupation and type of agricultural land worked or type of non-agricultural employment, according to background characteristics, Zambia 1996 Agricultural Non-agricultural Not ProL Household Number Background currently Own Family Rented Other's teeh / Sales/ Skilled Unskilled and of characteristic worlang land land land land manag, services manual manual domestic Missing Total men Age 15-19 70.4 1.4 13.5 0,0 3.4 0.0 5.7 1.4 2.1 2.1 0.0 100.0 460 20-24 28.2 8.5 20.4 0,0 9.7 3.4 15.0 5.8 3.0 5.6 0.4 100.0 404 25-29 9.9 18.9 13.9 0.3 5.2 6.1 17.0 19.5 4.0 5.1 0.0 100.0 255 30-34 7.4 24.0 7.7 0,0 8.3 13.1 13.1 19.3 5.2 2.0 0.0 100.0 225 35-39 6.0 25.5 5.8 0.4 10.6 20.3 10.2 14.8 4.5 1.9 0.0 100.0 184 40-44 4.2 27.6 6,8 0.7 6.6 10.6 20.6 17.2 4.9 0,9 0.0 100.0 121 45-49 7.2 24.8 8.0 0.0 6.8 8.9 12,7 22.0 3.8 5.7 0.0 100.0 83 50-54 10.3 40.3 7.4 0.0 1.0 9.1 7.8 17.0 6,0 1.1 0.0 100.0 65 55-59 14.0 61.3 1.5 0.0 7.8 2.2 7.0 2.1 4.1 0.0 0.0 100.0 52 Residence Urban 33.5 1.0 0.8 0.1 3.4 12.1 18.6 19.5 4.6 6.4 0.1 100.0 852 Rural 23.1 29.5 22.2 0.2 9.6 2.1 6.4 3.6 2.8 0.5 0.0 100.0 997 Province Central 34.3 11.1 10.9 0.0 6.9 7.2 13.0 8.4 5.7 2.4 0.0 100.0 157 Copperbelt 38.1 1.5 0.3 0.0 3.1 9.0 14.6 23.0 5.3 5.0 0.0 100.0 396 Eastern 13.7 39.7 30,5 0.4 2.5 2.3 6.9 2.8 0.9 0.0 0.4 100.0 254 Luapula 22.5 9.1 27,9 1.0 20.4 6.7 7.3 3.6 1.0 0.5 0.0 100.0 151 Lusaka 30.8 4.1 1.5 0.0 2.6 13.6 18.6 15.5 4.9 8.5 0.0 100.0 316 Northern 25.0 30.5 20.8 0.0 7.9 2.1 7.0 3.8 1.7 1.2 0.0 100.0 221 North-Western 19.5 38.2 0.0 0.0 6.3 4.6 12.1 6.3 10.8 1.0 1.0 100.0 48 Southern 25.2 26.2 13.8 0.0 12.6 1.7 8.9 7.9 1.7 2.0 0.0 100.0 173 Western 27.4 15.5 11.9 0.0 10.3 6.0 15.2 8.0 4.1 1.5 0.0 100.0 132 Education No education 19,0 30.7 23.5 0.7 10.6 0.0 7.4 3.6 3.3 1.2 0.0 100,0 127 Primary 26.7 21.0 16.9 0.2 8.6 0,6 10.3 7.8 4.4 3.3 0.2 100.0 938 Secondary 33.4 9,7 5,7 0,0 4.2 9,3 15.0 16,3 2,5 4,0 0,0 100,0 686 Higher 11.8 0.0 1.1 0.0 1.8 55.1 13.6 12.9 3.7 0.0 0.0 100.0 98 Total 27.9 16.4 12.4 0.1 6.7 6.7 12.0 10.9 3.6 3.2 0.1 100.0 1,849 Note: The "professional, technical, managerial" category includes professional, techmcal, clerical and managerial occupations. Urban women are more likely than their mral counterparts to have their say in the use of cash they earned. Rural women tend to have their husbands make this decision. Women in the most urbanised parts of the country, Copperbelt and Lusaka Provinces, are most likely to decide for themselves, as are women in Southern Province. In Eastern Province, 47 percent of respondents decide themselves how to spend their earnings, while 45 percent report that their husbands decide. As expected, unmarried women are more likely to make the decision regarding their cash earnings than married women (84 percent compared to 43 percent). Among married women, three in ten say their husbands make the decision, 43 percent make the decision themselves, and 24 percent share the decision with their husbands/partners. The likelihood of making a decision on cash earnings increases with the woman's level of education. The proportion of women who decide for themselves how to spend their cash earnings is 49 percent among women with no education compared to 67 percent for women who have higher than secondary level of education. 27 Table 2.17 Decisions on use of earnings Percent distribution of women receiving cash earnings by person who decides on use of earnings, according to background characteristics, Zambia 1996 Person who decides how earnings are used Jointly with Jointly Number Background Self Husband/ husband/ Someone with of characteristic only partner partner else someone Missing Total women Age 15-19 50.9 15.4 4.7 24.9 4.2 0.0 100.0 360 20-24 52.6 25.8 14.3 5.4 1.6 0.3 100.0 627 25-29 57.2 21.5 17.8 2.1 1.3 0.0 100.0 595 30-34 59.0 21.5 17.8 I.I 0.6 0.0 100.0 560 35-39 59.8 20.1 19.0 0.5 0.6 0.0 100,0 370 40-44 66.9 13.2 18.0 0.0 1.0 0.9 100.0 287 45-49 58.7 24.5 15.8 0.0 1.1 0.0 100.0 210 Residence Urban 69.2 10.7 14.9 3.3 1.6 0.3 I00.0 1,517 Rural 44.9 31,3 16.2 6.3 1.2 0.0 I00.0 1,493 Province Central 52.6 30.4 9.5 6.6 1.0 0.0 100.0 239 Copperbelt 65.0 9.4 20.2 1.8 3 2 0.5 100.0 592 Eastern 47.3 45.2 4.4 2.8 0.3 0.0 100,0 282 Luapula 43.9 33.8 17.6 4.1 0.5 0.0 100.0 317 Lusaka 73.0 9.6 11.8 4.1 1,5 0.0 100.0 573 Northern 44.3 28.5 13.3 12.5 1.3 0.0 100.0 38 I North-Western 43.9 16.3 37.2 1.5 1.0 0.0 100.0 197 Southern 63.3 14.5 17.1 3.7 1.0 0.5 100.0 278 Western 58.5 20.5 11.7 7.9 0.9 0.5 100.0 150 Education No education 49.4 32.0 13.3 4.5 0.8 0.0 100,0 319 Primary 52.7 25.0 15.3 5.6 1.4 0.2 100.0 1,722 Secondary 67.9 I 1.3 14.3 4.0 2.2 0.3 100.0 781 Higher 67.4 4.8 27.1 0.7 0.0 0.0 100.0 186 Marital status Currently married 42.9 32.1 23.9 0.5 0.2 0.2 100.0 1,953 Not married 83.5 0,2 0.0 12.6 3.7 0.0 100.0 1,057 Total I 57.2 20.9 15.5 4.8 1.4 0.2 100.0 3,010 I Includes one woman with missing information on education Child Care Working mothers with children under 5 were asked who took care of their children while they were at work. Table 2.18 shows that six in ten employed women have one or more children below the age of six living with them. Among these respondents who also work away from home, the most common caretaker of the children is the respondent herself, followed by other relatives and female children. The role of the husband or partner and male children in looking after children when the mother is away for work is minimal. This is true in all subgroups of employed women, except in urban areas and Lusaka, where a sizeable proportion of young children are taken care of by servants or hired help. Hired help is also common among children of women who work for someone else, most of whom are employed in the formal sector. 28 Table 2.18 Child care while workin~ Percentage of employed women (i.e., worked in the last 12 months) who have a child under six years of age, and the percent distribution of employed mothers who work away from home by person who cares for child while mother is at work, according to background characteristics, Zambia 1996 Background characteristic Employed women Child's caretaker, among employed women who work away from home and have children <6 years Child Not One or is in worked more Hus- Ser- school/ since Number ehd- Number Re- band/ Other Other Other Neigh- vanff insfi- birth of dren of spond- part- female male rela- bor/ hired tutlonal of employed <6 women ent net child child tire friend help care child Other Missing Total mothers Residence Urban 55.1 1,596 20.0 2.7 20.0 3.0 39.5 1.0 7.3 2.2 1.3 1.2 1 6 100 0 562 Rural 62 2 2,056 48.0 2 7 18.7 5.7 20.2 2.0 0.8 0 0 0.3 0.7 0.9 100.0 870 Province Central 62.8 327 28.8 3.9 18.8 4.2 33.8 1.7 3.0 3.3 0.0 1.1 1 4 100.0 136 Copperbelt 55.9 604 18.7 2.1 21.5 5.2 385 1.0 2.8 2.1 1.4 2.8 3.8 100.0 I93 Eastern 63.7 283 58.4 1 4 11 9 2.7 22.5 0.0 3.1 0.0 0.0 0.0 0.0 100.0 69 Luapula 64.0 471 33.1 1.6 24.1 6.8 295 2.7 0.9 0.0 0.6 0.0 0.6 100.0 261 Lusaka 53.4 588 17.6 2.8 12.4 1.3 44.3 1.5 13.7 2.2 1.5 1.3 1.3 100.0 183 Northern 62.7 540 60.8 2.2 17.8 3.1 12.0 1.4 1.3 0.0 0.5 0.9 00 100.0 253 North-Western 64.1 212 59.1 0.6 13 8 0.6 24.7 0.6 0.0 0.0 0.0 0.0 0.6 100.0 85 Southern 55.4 290 25.3 8.5 19 7 7.5 31.3 1.4 4.1 0.0 1.4 0.0 0 9 100.0 95 Western 54.8 340 43.1 3.1 24.6 8.8 14.6 2.7 0.9 0.0 0.5 0.4 1.3 100.0 158 Education No education 60.1 459 41.7 2.6 30 6 4.2 13.6 2 7 0.0 0.0 1.6 1.4 1.7 100.0 187 Primary 61.2 2,162 43.6 3 1 20 1 5.7 23.3 1.6 0.4 0.2 0 4 I 0 0.6 100.0 867 Secondary 56.3 847 24 3 2.0 I I 5 2.1 46.6 1 4 6.6 2.1 0.5 0.5 2.5 100.0 297 Higher 45.0 188 1 7 0.6 11.7 4.4 38.8 0.9 31 5 6.2 3 3 0.0 0.9 100.0 80 Work status For family member 55.4 484 45.8 2.7 21.8 4.5 21.9 0.3 1.2 0.0 0.8 0.6 0.3 100.0 202 For someone else 40.7 581 6.6 1.7 t2.7 2.3 49.6 2.1 17.0 4.5 1.2 0.6 1.6 100.0 220 SeIf-employad 63.9 2,589 41.9 2.9 20 2 5.2 24.2 1 8 0.8 0.3 0.6 1.0 1.2 100.0 1,010 Occupation Agricultural 65.2 1,319 53.1 1.5 20.3 5.6 16.4 1.8 0.3 0.0 04 04 0.3 100.0 704 Non-agricultural 55.7 2,334 21.6 3.9 18.2 3 8 38.8 1.5 6.3 1.7 1.0 1.3 1.9 100.0 727 Employment status All year, full-time 54.6 1,440 19.2 2.2 20.9 3.5 37.0 2.1 9.2 1.7 1.1 1.1 2.0 1000 506 All year, part-time 66.2 214 35.1 6.3 15.6 5.7 28.0 2.0 0.0 2.0 0.0 5.4 0.0 100.0 68 Seasonal 63.3 1,532 499 1.8 19.5 5.6 19.9 1.5 0.2 0.2 0.5 05 0.6 100.0 734 Occasional 55.7 467 35.1 7.8 13.0 3.3 37.1 0.4 0.0 1.1 1.1 0.0 1.1 100.0 123 Total 59.1 3,655 37.0 2.7 19.2 4.7 27.8 1 6 3.3 0 9 0 7 0 9 1.2 100.0 1,432 Note: Totals include one woman with work status missing, two women with occupation missing, and two women with employment status missing Figures may not add to lO0.0 due to rounding. 29 CHAPTER 3 FERTILITY Fertility measures presented in this chapter are based on the reported reproductive histories of women in the age range of 15 to 49 years who were interviewed in the ZDHS. Each woman was asked to report the number of sons and daughters she had ever given birth to who were living with her, the number living away, and the number who had died. For each live birth, she was asked to report the name, sex, and date of birth. For living children, the children's ages and whether or not they were living with her were recorded. For deceased children, the age at death was also collected. This information allows for the calculation of completed fertility (number of children ever born) and current fertility. This chapter also analyses levels of fertility by selected background characteristics of women which include age, residence, and education level. Factors related to fertility, including age at first birth, birth intervals, and teenage childbearing are also analysed. 3.1 Fertility Levels and Trends Age-specific fertility rates for the three-year period preceding the survey are shown in Table 3.1, along with data from the 1980 and 1990 censuses and the 1992 ZDHS for comparison. The census estimates refer to the single years preceding the censuses (i.e., 1979 and 1989), while the DHS estimates refer to the three-year periods preceding the surveys. 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 children a woman would have by the end of her childbearing years if she were to pass through those years beating children at the currently observed rates. If fertility were to remain constant at the levels measured in the 1996 ZDHS, a Zambian woman would bear 6.1 children in her lifetime. This is lower than the rates from the previous sources, implying a decline of about 15 percent over the past 16 years. The pace of the fertility decline is slightly faster during the 1990 to 1996 period (9 percent) than during the 1980-90 period (7 percent). Figure 3.1 shows that the most of the decline in fertility from 1990 is due to lower age-specific fertility rates for women 30 years and older. At the same time, while the peak of the age-specific fertility rates in 1990 is in the 25-29 age group, in the last two surveys the peak had shifted to age 20-24. Age-specific fertility rates for the three-year period prior to the survey by urban and rural residence are presented in Table 3.2. In general, women in rural areas have about two more children than those in urban areas (6.9 births compared to 5.1 births). The most significant differences are found in women under age 30. Figure 3.2 shows that in urban areas, age-specific fertility rates peak at age 25-29, while in rural areas the peak is at age 20-24. Table 3.1 Ace-specific fertility rates over time Age-specific fertility rates as adjusted in the 1980 and 1990 censuses and as reported in the 1992 and 1996 ZDHS Census Census ZDHS ZDHS Age group 1980 1990 1992 1996 15-19 153 94 156 158 20-24 318 267 294 280 25-29 323 294 271 274 30-34 289 272 242 229 35-39 225 226 194 175 40-44 115 129 105 77 45-49 17 59 31 24 TFR 15-49 7.2 6.7 6.5 6.1 Note: The ZDHS rates refer to the three-year period preceding the surveys. The census figures were estimated using the Gompertz function, and refer to the year preceding the census. Source: Gaisie et al., 1993; Central Statistical Office, 1995 31 Figure 3.1 Age-Specific Fertility Rates Zambia, 1990, 1992 and 1996 Biflhs per 1,000 Women 35O 3OO 250 200 150 100 50 0 15-19 I i I I I 20 24 25-29 30-34 35 39 40~4 1~'1900 Census ")<-1992ZDHS m1996ZDHS I ZDHS19M Figure 3.2 Age-Specific Fertility Rates by Residence Births per 1,000 Women 350 300 250 200 150 I 100 5O 0 318 297 203 r ~ ] i I 1~1g 2~24 2~29 30-34 ~ 40-44 45-49 Ag, ZDHS 1996 32 Table 3.2 Current fertility rates Age-specific and cumulative fertility rotes and the crude birth rate for the three years preceding the survey, by urban-rural residence, Zambia 1996 Residence Age group Urban Rural Total 15-19 127 184 158 20-24 236 318 280 25-29 248 297 274 30-34 211 243 229 35-39 137 203 175 40-44 50 97 77 45-49 8 32 24 TFR15-49 5.08 6.86 6.08 INK 15-44 5.04 6.70 5.96 GFR 182 239 213 CBR 43.7 46.1 45.2 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate, expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Differences in fertility according to selected background characteristics of women are shown in Table 3.3. There is considerable variation in fertility among the provinces. The total fertility rate (TFR) is more than 7 births per woman in Northern and Eastern Provinces. On the other hand, the TFR is lowest in Lusaka Province, where women average more than two fewer births than women in Northern and Eastern Provinces (4.9 vs. more than 7 births per woman). Women in Copperbelt and Western Provinces also have relatively low TFR compared to women in other provinces (see Figure 3.3). Women's level of education appears to have an inverse relationship with their fertility. Women who have had no education have the highest TFR, while those who have completed higher levels of education tend to have fewer children. The 1996 ZDHS data show that 12 percent of women in reproductive age are currently pregnant. Lusaka Province, which has the lowest TFR, also has the smallest percentage of currently pregnant women (10 percent). Eastern and Central Provinces, on the other hand, have the largest percentage of currently pregnant women (13 percent). Another measure of trends in fertility is comparing the TFR with the mean number of children ever born to women at the end of their childbearing period, age 40-49. While the total fertility rate is a measure of current fertility, the latter measures past or completed fertility. Overall, women age 40-49 report having given birth to an average of 7.3 children. Comparing this with the TFR of 6.1 is another indication that there has been a decline in fertility of about one child over the last 20 years or so. 33 Table 3.3 Fertihtv bv background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and mean number of children ever born to women age 40-49, by selected background characteristics, Zambia 1996 Mean number of children Total Percentage ever born Background fertililty currentl~ to women characteristic rate pregnant age 40-49 Residence Urban 5.08 9.9 7.11 Rural 6.86 12.7 7.45 Province Central 6.25 13.3 7.24 Copperbelt 5.59 10.9 7.57 Eastern 7.06 13.5 7.49 Luapula 6.83 l 1.6 7.87 Lusaka 4.87 9.8 6.79 Northern 7.23 11.7 7.91 North-Western 6.23 10.8 7.36 Southern 6.16 12.1 6.84 Western 5.53 9.9 6.70 Education No education 6.82 13.2 7.72 Primary 6.66 12.4 7.48 Secondary+ 4.53 8.7 6.16 Total 6.08 11.5 7.31 i Women age 15-49 years Table 3.4 shows fertility trends in the four five-year periods before the survey. These data were derived from the respondents' birth histories. Figures in brackets represent partial fertility rates due to "truncation"--the fact that women age 50 years and older were not included in the survey--and the further back into time rates are calculated, the more severe is the truncation. For example, rates cannot be calculated for women in age group 45-49 for the period 5-9 years before the survey because those women would have been age 50- 60 at the time of the survey and were not interviewed. The data show that fertility has been declining in all age groups, except at ages 20-24, where fertility remained at the same level in the periods 5-9 and 0-4 years prior to the survey. Table 3.5 presents fertility rates for ever-married women by duration since first marriage for four five-year periods preceding the survey. The table is similar to Table 3.4 except that it is confined to ever-married women, and the woman's age is replaced by marriage duration at the birth of the child. Data in this table confirm the findings presented in Table 3.4: fertility has declined at all marriage durations. 3.2 Chi ldren Ever Born The distribution of women and men in different age categories by the number of children ever born is shown in Table 3.6 for all women and for currently married women, and for all men and currently married men. The mean number of children ever born and the mean number of living children in each five-year age group are also shown in the table. On average, women have given birth to three children by their late twenties, six children by their late thirties, and almost eight children at the end of their reproductive years. The most significant difference between all women and currently married women is found in the youngest age group, because many women have not been married. 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 births 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). 34 Figure 3.3 Total Fertility Rates by Province Bblhs per Wommn Central Eastern CopperbeR Luapuls Lusaka North-Western W~tem Northern Southern ZDHS 1996 Table 3.4 Trends in a~e-sDecific fertilitv rates Age-specific fertility rates for five-year periods preceding the survey, by woman's age at the time of birth, Zambia 1996 Number of years preceding the survey Woman's age at birth 0-4 5-9 10-14 15-19 15-19 156 166 179 198 20-24 285 284 303 322 25 -29 270 280 304 319 30-34 231 257 277 [292] 35-39 174 188 [269] 40-44 76 [137] 45-49 [26] Note: Age-specific fertility rates are per 1.000 women. Estimates in brackets are truncated. The distribution of women by number of children ever born shows that one-quarter of women 15-19 have had at least one child, two- thirds of women 30-34 have four or more children, and one in three women 45-49 have ten or more children. A comparison between currently married women and currently married men shows that for all age groups, men have fewer children than women. This is to be expected, since men marry and have children later than women. However, the gap narrows at older ages (eight children for both women and men age 45- 49). 35 Table 3.5 Trends in fertility bv marital duration Fertility rates for ever-married women by number of years since first marriage, for five-year periods preceding the survey, Zambia 1996 Marriage Number of years preceding the survey duration at birth (years) 0-4 5-9 10-14 15-19 0-4 348 345 356 365 5-9 296 306 319 340 10-14 261 267 297 325 15-19 202 240 295 [282] 20-24 150 189 [243] 25-29 67 [113] Note: Duration-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 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 two years. The percent distribution of births in the five years before survey by the number of months since the previous birth is shown in Table 3.7 by demographic and socioeconomic character- istics. First births have been excluded from the table. The median birth interval is 32 months, 8 months longer than the minimum length considered safe. One in five births in the five- year period preceding the survey occurred less than two years after a previous birth, 45 percent between two to three years, and 36 percent three years or more after a previous birth. The age of the mother and birth order have a direct relationship with the length of the birth interval; younger women tend to have shorter birth intervals than older women. There is no significant variation in birth intervals by the sex of the child or urban-rural residence. As expected, children whose preceding sibling died have a shorter birth interval than those whose older sibling survived (33 months compared to 27 months), presumably because parents are eager to "replace" the child who died. The median interval between births varies by province, ranging between 31 and 36 months. The interval is significantly higher in Western Province (36 months). Birth intervals also vary by mother's level of education. The median ranges between 32 and 33 months for children whose mothers had up to secondary education; however, for children whose mothers had attended higher education, the interval is 6 months longer (39 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. From the demographic point of view, 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. From the health perspective, bearing children at a young age involves substantial risks to the health of both the mother and child. For instance, high maternal mortality rates are associated with frequent births and young and old age of mother. Early childbearing also tends to restrict educational and economic opportunities for women. The distribution of women by age at first birth and current age is shown in Table 3.8. The majority of women in Zambia become mothers before reaching age 20. Older women started childbearing earlier than younger women, at a median age of 18.2 years among women 45-49 compared to 19.0 years among women 20-24. While about 45 percent of women age 35 years and over had their first child before age 18, the corresponding percentage among women 20-24 years is 35 percent, indicating a trend towards delayed childbearing. Differentials in age at first birth by background characteristics are shown in Table 3.9. The median age at first birth for women aged 20-49 is 18.7 years. Generally speaking, variation in age at first birth is not pronounced in Zambia, except that urban women have a slightly higher median age at first birth than rural women (19.1 years compared to 18.5 years). 36 Table 3.6 Children ever born and livin~ Percent distribution of all women and currently married women age 15-49 and all men and currently married men age 15-59 by number of children ever 10ore (CEB) and mean number ever born and living, according to five-year age groups, Zambia 1996 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 CEE children ALl. WOMEN 15-19 76 1 19.8 3.8 0.3 0.1 0.0 0.0 0.0 00 0.0 00 100.0 2,003 0.28 0.24 20-24 21.2 28.0 28.1 162 5.2 1.2 0.1 0.0 0.0 0.0 00 100.0 1,830 1.60 130 25-29 8.1 14,1 16.4 22.0 20.9 127 4.5 1.2 00 0.1 00 100.0 1,286 2.96 2.44 30-34 3.8 6.8 10.5 12 7 14.0 17.5 16.1 11.9 4 3 1.8 0 5 100.0 1,081 4.46 3.61 35-39 1.4 6.5 6.3 6.6 9.6 11.7 14 5 11.4 13.7 9.8 8.6 100 0 758 5.90 4.86 40-44 1.3 3.4 3.2 5.3 7.4 11.4 •2.5 11.4 12 .9 125 18.6 1000 568 6.85 5.63 45-49 0.9 2.2 3.2 3 2 5.8 6.7 9.3 10.5 14.2 12.7 31.4 100 0 494 7.84 6.05 Total 26.0 15.5 12.4 10.2 82 7.0 5.7 4.3 3.7 2.9 4.1 100.0 8,021 3.04 2.46 CURRENTLY MARRIED WOMEN 15-19 35.2 51.4 12.4 1.0 0.0 0.0 0 0 0 0 0.0 0 0 0 0 100.0 498 0.79 0.66 20-24 10.5 254 33.9 21.4 6.9 1.8 0.1 0.0 0.0 O0 0.0 100.0 1,207 1.95 1.59 25-29 4.4 9.3 15.8 23.6 24.0 15.7 5.8 I 5 0.0 0.0 00 100.0 969 3.31 274 30-34 2.6 5.1 8.7 11.6 14 .0 18 .9 17.4 13.7 5.1 2.2 0.7 100.0 857 4.76 388 35-39 0.6 4.9 5 6 5.8 7.8 11.3 13 8 12.5 15 .4 12.0 10 2 100.0 586 6.29 5 22 40-44 1.5 1.9 3.3 4.4 5.2 11.3 10.7 11.6 13 .6 15.0 21.6 100.0 419 723 5.96 45-49 1.1 2.1 3.1 2.6 5.5 5.5 9.0 9.6 12 9 12.9 35.7 100.0 367 8 06 6.28 Total 7.8 15.1 15.4 133 10.7 9.6 7.4 5.9 49 4.1 5.9 100.0 4,902 402 3.28 ALL MEN 15-19 98.6 1.2 0.0 02 0.0 0.0 0.0 0.0 O0 0.0 0.0 I00.0 460 0.02 0.01 20-24 68.1 18.1 10.8 2.1 0.6 0.3 0.0 0.0 0.0 0.0 0.0 100.0 404 0.50 0.41 25-29 27.1 22.7 22.2 13.2 lO 1 2.2 2.6 0.0 0.0 0.0 0.0 100.0 255 1.73 1.40 30-34 12.2 9.7 14.6 16.6 168 14.2 8.3 4.4 2.4 0.4 0.4 1000 225 3.35 2.69 35-39 2.9 4.1 7.0 14.7 16.1 17.4 15.5 8.5 4.8 2.3 6.7 100.0 184 5.11 421 40-44 1.6 4.9 4.6 7.7 105 11.4 15.6 12.8 10.5 67 13.5 1000 121 6.23 5.24 45-49 0.9 1.0 2.7 1.0 73 11.1 12.6 12.1 12.0 114 28.0 100.0 83 7.78 6.22 50-54 00 1 0 1.4 3.8 1.2 3.2 8.9 6.6 14.0 11 2 48.7 1000 65 9.50 7.89 55-59 0.0 0.0 00 4.5 2.8 5.1 135 5 1 15.7 4.4 48.8 100.0 52 9.72 7.57 Total 45 0 9.4 8.4 6.6 6.3 5 3 5.2 3.1 2.9 1 7 6.0 100.0 1,849 2.64 2.15 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * 100.0 3 * * 20-24 15.2 43.9 31.8 6.0 2.1 1.0 0.0 0.0 0.0 0.0 0.0 1000 115 1.39 1.10 25-29 8.8 24 4 28.5 17.4 14.3 3.3 3 3 0.0 0.0 00 0.0 1000 174 2.27 1.85 30-34 6.1 7.0 15.2 18.3 18.9 15.8 9.9 5 2 2 8 0.4 0.4 100.0 190 3.74 3 01 35-39 0.7 2.2 5 7 16 1 14.8 18.8 16.5 9.3 5 5 2.6 7.7 100.0 161 5.44 4 51 40-44 0.0 4.6 5.0 5.4 10.7 116 167 13.7 11.3 66 144 100.0 113 6.47 5.48 45-49 1.0 1.1 1.7 00 6.5 9.3 11.8 13.1 130 12.3 303 100.0 77 8.07 638 50-54 0.0 1.1 1.5 40 00 34 70 7.1 14.0 12.0 499 100.0 61 9.64 792 55-59 0.0 0.0 0.0 4.8 3.0 5 5 14.4 5.5 16.8 1.7 48 3 100.0 49 9.73 7 63 Total 5.1 12.4 14.0 11.7 11.2 98 9.6 6.1 5.7 32 11 3 100.0 944 4.84 3.94 Note: An astensk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed 37 Table 3.7 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Zambia 1996 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-47 48+ Median number of Number months since of Total previous birth births Age of mother 15-19 14.3 34.5 39.9 9.0 2.4 100.0 24.2 88 20-29 8.2 14.4 48.7 17.8 10.9 100.0 30.4 2,924 30-39 4.4 10.6 41.7 22.2 21 1 100.0 33.8 2,106 40 + 4.9 7 3 32.4 22.1 33.3 100.0 38.5 460 Birth order 2-3 7.7 13.6 44.9 18.0 159 100.0 31.3 2,422 4-6 6 1 127 45.6 20.2 15.3 1000 31.7 2,010 7+ 5.1 10.7 41.9 22.4 199 100.0 33.9 1,145 Sex of prior birth Male 7.1 13.2 41 7 20.4 17.5 100.0 32 3 2,710 Female 6.1 12.1 47 2 19.0 15.5 100.0 31.6 2,868 Survival of prior birth Living 3.5 11 3 47.0 21.1 17.2 1000 32.7 4,485 Dead 19.5 183 34.6 14.1 135 1000 26.7 1,093 Residence Urban 6.9 12 9 43.8 19.2 17.2 100 0 32.0 2,165 Rural 64 12.6 45.0 20.0 16.1 100.0 31.8 3,413 Province Central 7.0 99 45 1 20.1 17.8 1000 32.1 457 Copperbelt 7.4 15.6 450 15.9 16.2 100.0 31.0 1,042 Eastern 5.8 12.5 46.2 18 7 16.8 100.0 32.0 885 Luapula 8.3 13.3 46 0 16.5 15.9 100.0 30.8 540 Lusaka 6.4 12.0 43.3 20.8 17.6 100.0 32.2 808 Northern 7 0 15.3 40.2 22 9 14.7 100.0 32.3 684 North-Western 6.1 7.9 46.1 21 5 18.4 100.0 32.5 225 Southern 5.5 12.4 48.9 20 7 12 5 100.0 31.8 607 Western 4.9 7 0 38.6 26.6 22 9 100.0 35.8 329 Education No education 61 12.3 425 20.1 19.1 1000 32.6 806 Primary 6.7 13 0 46.0 19.1 15 2 100.0 31.5 3,674 Secondary 6 3 12.5 42.7 21.5 17.0 100.0 32.8 1,003 Higher 9.1 6.5 26 1 19.1 39.3 100.0 39.2 94 Total 6.6 12.7 44.5 19.7 16.5 100.0 31.9 5,578 Note: Ftrst births are excluded The interval for multiple births is the number of months since the preceding pregnancy that ended in a live bxrth 3.5 Teenage Fertility Fertility among teenagers (women under age 20) has received increasing attention from various institutions concerned with their welfare. Table 3.10 shows the percentage of women aged 15-19 years who have become mothers or are pregnant with their first child. The sum of these two percentages represents the proportion of young women who have begun childbearing. 38 Table 3.8 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Zambia 1996 Women Median with Age at first birth Number age at no of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 76.1 1.5 16.4 5.9 NA NA NA 100.0 2,003 a 20-24 21.2 4.5 30.8 28.1 12.4 3.1 NA 100.0 1,830 19.0 25-29 8.1 5.2 30.1 27.0 15.9 10.1 3.4 100.0 1,286 19.0 30-34 3.8 6.1 35.0 23.9 16.2 8.5 6.6 100.0 1,081 18.7 35-39 1.4 8.8 36.9 26.4 14.0 6.8 5.8 100.0 758 18.3 40-44 1.3 7.0 36.6 27.4 14.2 8.8 4.6 100.0 568 18.4 45-49 0.9 10.5 36.9 21.1 15.0 9.0 6.6 100.0 494 18.2 ~qA -- Not applicable Omitted because less than 50 percent of the women in the age group x to x+4 have had a birth by age x Table 3.9 Median a~e at first birth Median age at first birth among women age 20-49 years, by current age and selected background characteristics, Zambia 1996 Current age Background Age Age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 19.4 19.6 19.3 18.5 18.8 17.7 19.1 19.0 Rural 18.7 18.6 18.4 18.2 18.2 18.5 18.5 18.4 Province Central 19.4 18.9 18.8 (18.3) (I8.5) (18.6) 18.9 18.7 Copperhelt 19.2 19.2 19.1 18.3 (17.7) (17.1) 18.7 18.5 Eastern 18.6 18.5 18.1 18.3 19.0 (18.9) 18.5 18.4 Luapula 19.1 18.8 18.0 18.2 (17.8) (17.8) 18.4 18.2 Lusaka 19.3 19.7 19.7 18.5 (19.3) (17.9) 19.3 19.3 Northern 18.8 19.2 18.8 (18.2) (18.9) (18.8) 18.8 18.8 North-Western 19.0 18.8 18.2 (16.7) * * 18.4 18.1 Southern 18.6 18.8 18.0 18.1 (18.2) * 18.5 18.4 Western 18.8 19.3 19.2 18.8 (18.2) (18.0) 18.8 18.7 Education No education 18.6 18.4 17.9 17.7 18.3 18.5 18.3 18.2 Primary 18.5 18.5 18,2 17.9 18.1 17.9 18,3 18.2 Secondary+ a 20.8 * * 19.7 * a 20.4 Total 19.0 19.0 18.7 18.3 18.4 18.2 18.7 18,6 Note: Fxgures in parentheses are based on 25-49 women, while an asterisk indicates that a figure is based on fewer than ~5 unweighted cases and has been suppressed. Omitted because less than 50 percent of the women m the age group x to x+4 have had a birth by age x 39 Table 3.10 Adolescent t~re~nancv and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Zambia 1996 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 1.9 2.6 4.5 398 16 10.7 4.6 15.3 419 17 20.3 8.0 28.3 379 18 34.4 11.8 46.1 406 19 52.1 7.4 59.4 401 Residence Urban 20.4 6.2 26.6 956 Rural 27.0 7.5 34.4 1,048 Province Central 24.3 8.0 32.3 151 Copperbelt 22.9 7.0 29.9 430 Eastern 28.1 6.9 35.0 235 Luapula 16.8 5.8 22.6 196 Lusaka 20.4 8.3 28.6 358 Northern 25.1 6.3 31.4 227 North-Western 30.9 7.2 38.0 58 Southern 27.1 6.4 33.5 195 Western 28.2 4.5 32.7 154 Education No education 36.9 11.1 48.1 168 Primary 25.9 7.1 33.1 1,234 Secondary+ 15.9 5,2 21.1 601 Total 23.9 6.8 30.7 2,003 Three often teenagers in Zambia have either already had a child (24 percent) or are pregnant with their first child (7 percent). Urban and better educated women tend to start childbearing later than rural women and women with less education. There is some variation between provinces. While in most provinces, one in four teenagers has become a mother, the proportion in Luapula is 17 percent and in North-Western almost twice as high (31 percent). Whereas most teenage women who have begun childbearing have given birth 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, three in four have not given birth, one in five has had one child, and 4 percent have two or more children. 40 Table 3.11 Children born to adolescent women Percent distribution of women 15-19 by number of children ever born (CEB), according to single years of age, Zambia 1996 Age 0 1 2+ Number of Mean children ever bom number Number of of Total CEB women 15 98.1 1.9 0.0 100.0 0.02 398 16 89.3 10.4 0.3 100.0 0.11 419 17 79.7 19.4 0.9 100.0 0.21 379 18 65.6 30.3 4.1 100.0 0.39 406 19 47.9 36.9 15.1 100.0 0.69 401 Total 76.1 19.8 4.1 t00.0 0.28 2,003 41 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Contraception Determining the level of knowledge of contraceptive methods and services was a major objective of the Zambia Demographic and Health Survey (ZDHS), since knowledge of specific methods, places where they can be obtained and the general accessibility of the methods and services is a precondition for their use. Information about knowledge of contraceptive methods was collected by asking both women and men to name ways or methods by which a couple or an individual could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked if he/she recognised it. Eight modem methods--the pill, 1UCD, injectables, implants, vaginal methods (foaming tablets, jelly, sponge, and diaphragm), condom, 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, strings, beads, roots, or breastfeeding, were also recorded. Data in Table 4.1 indicate that knowledge of any contraceptive method among women age 15 -49 and men age 15-59 is almost universal; only 4 percent of women and men reported that they did not know any method of family planning. Except for condom, male sterilisation, and natural family planning, knowledge of individual methods is slightly higher among women than men. It is also higher among currently married women and men than among all women and men. Since it is currently married women and men who are at greatest risk of pregnancy, this chapter focuses primarily on them. Table 4.1 Knowledee of contracentive methods Percentage of all women 15-49, of currently married women, of sexually active unmarried women, and of women with no sexual experience, and the percentage of all men 15-59, of cnrrenfiy married men, and of sexually active unmarried men who know specific contraceptive methods, by specific methods, Zambia 1996 Women who know method Currently Contraceptive All married method women women Men who know method Sexually Sexually active No Currently active unmarried sexual All married unmarried women experience men men men Any method 95.8 98.4 Any modern method 95.1 97.7 Pdl 86.4 92.6 IUCD 42.4 47.9 Injectables 53.2 60.1 Implants 10.3 11.5 Diaphragm/foam/jelly 26.2 29.9 Condom 91.5 93.8 Female sterilisation 66.1 72.9 Male sterilisatJon 18.4 20.3 Any traditional method 64.8 74.6 Natural family planning 43.8 48.2 Withdrawal 53.8 64.9 Other 38.2 47.2 Number of women/men 8,021 4,902 Mean number of methods 5.3 5.9 96.9 80.7 96.2 99.0 99.2 96.6 80.3 96.0 98.6 99.0 84.5 52.2 75.0 88.9 71.1 41.0 13.1 27.5 33,8 24.2 47.4 20.0 46.0 54.3 43.5 10.6 3.3 8.8 I 1.7 9.0 27.8 7.8 22.8 25.6 23.1 93.3 77.1 95.3 97.6 99.0 59.1 31.7 63.5 75.2 58.4 15.4 7.8 27.2 31.9 25.9 59.4 21.6 70.7 83.6 67.2 43.9 18.5 60.3 70.7 58.9 47.5 6.7 53.6 68.5 45,7 32.0 5.1 22.1 35.8 11.0 492 944 1,849 944. 303 5.0 2.4 5.0 5.9 4.7 43 In general, women and men are more knowledgable about modem contraceptives than about traditional methods. Three in four married women and four in five married men indicated that they have some knowledge about a traditional method. The most widely known methods by both women and men are the pill and condoms, known by about 90 percent or more of married women and men, female sterilisation, known by more than seven in ten women and men, and injectables, known by 60 percent of married women and 54 percent of married men (see Figure 4.1). The IUCD is known by about half of married women and one-third of married men. Much less widely known among the modem methods are diaphragm/foam jelly (known by 30 percent of married women and 26 percent of married men) and male sterilisation, known by one-fifth of women and one-third of men. The least known method is implants (12 percent). Men are more likely to know about traditional methods than women; knowledge of withdrawal is 65 percent among married women and 69 percent among married men, while 48 percent of women and 71 percent of men know about natural family planning. Knowledge of many methods--the condom in particular--is almost as high among sexually active unmarried people as among married women and men. -" Figure 4.1 Percentage of Currently Married Women Who Know Specific Contraceptive Methods Pill IUCD In~ectable= Implant8 Diaphragm/Foam/Jelly Condom Female Sterlllsatlon Male Sterllisat ion Natural Family Plann Jng Withdrawal ~ g 3 ~ 1 2 30 73 65 20 40 60 80 100 Percent ZDHS 19~ Knowledge of contraceptive methods among women has increased over time. The proportion of all women who know at least one method has increased from 89 percent in 1992 to 96 percent in 1996, while the proportion of currently married women who know a method has increased from 94 to 98 over the same time frame. Knowledge of some specific methods shows a more dramatic increase. For example, knowledge of injectables increased from 43 percent of married women in 1992 to 60 percent in 1996 and knowledge of condoms increased from 73 to 94 percent of married women over the same period (Gaisie et al., 1993:37). 44 4.2 Knowledge of Methods by Couples Because the ZDHS involved interviewing men living in a subsample of the households in which individual women were interviewed, it is possible to match women and men who were married or living together. Table 4.2 shows the distribution of these 822 couples according to the correspondence between husbands and wives about contraceptive knowledge. In 72 percent of the couples, both the husband and wife know at least one method of contraception; in 16 percent of couples, only the husband knows a method, in 10 percent, only the wife knows a method; and in 2 percent, neither the wife nor the husband knows a method of contraception. The pill and condom are commonly known among couples (85 percent or more) as opposed to implant, diaphragm/foam/jelly and male sterilisation (11 percent or less). Injectables and the IUCD are more commonly known to wives than their husbands, while male sterilisation and natural family planning are more known among husbands than their wives. Table 4.9 Knowledge of contracentive methg~l ~ amon~ couoles Percent distribution of couples by contraceptive knowledge, according to specific methods, Zambia 1996 Only Only Both husband wife Neither Contraceptive know knows knows knows method method method method method Total Any method 71.7 16.1 9.6 2.5 100.0 Any modern method 96.9 2.0 0.8 0.2 I00.0 Pill 84.9 5.5 8.0 1.6 100.0 IUCD 23.7 10.2 24.9 41.2 I00.0 Injectables 35.2 18.7 25.4 20.7 I00.0 Implants 2.6 9.1 9.5 78.8 I00.0 Diaphragm/Foam/Jelly 10.8 14.9 19.3 55.0 100.0 Condom 93.5 4.6 1.5 0.5 100.0 Female sterilisation 58.3 18.2 15.4 8.1 100.0 Male sterilisation 8.4 23.3 11.1 57.2 100.0 Any traditional method 71.7 16.1 9.6 2.5 100.0 Natural family planning 37.6 33.2 10.5 18.8 100.0 Other 8.7 8.6 9.6 73.1 100.0 Note: Figures are based on 822 couples. 4.3 Ever Use of Contraception All women and men interviewed in the ZDHS who said that they had heard of a method of family planning were asked if they had ever used it. The results are presented in Table 4.3.1 for women and Table 4.3.2 for men. Overall, 49 percent of Zambian women of reproductive age have used a method of family planning at some time. This compares with 58 percent of men age 15-59. The majority of these women and men have used a modem method (33 percent of women and 46 percent of men). The proportions are higher for currently married women, 59 percent of whom have ever used a modem method of family planning. Among these women, the pill was the most widely used method (26 percent), followed by condom (19 percent). A large proportion of married women have used traditional family planning methods, including natural family planning (13 percent), withdrawal (26 percent), and other methods (16 percent). Forty percent of sexually active unmarried women have used a modem method, and 23 percent have used a traditional method. 45 4~ Table 4.~. 1 Ever use of contraceotton: women Percentage of all women, currently mamed women, and sexually active unmarried women who have ever used any contraceptive method, by specific method and age, Zambia 1996 Modem method Traditional method Any Diaplwagm/ Female Male Any Natural Number Any modem Foam/ sterili- stetili- tralitional family Wah- Other of Age method method pall IUCD lnjectables Implant Jelly Condom satioa sation method planning drawal methods women ALL WOMEN 15-19 18 9 13.7 2.6 0.0 0. I 0 0 0.2 11.7 0.0 0.0 8.3 3.5 4.6 2.8 2.003 20-24 51.7 36.3 18.9 0.3 0.8 0.0 0.5 24 9 0.0 0.1 28.6 10.4 19.8 8 5 1,830 25-29 63 7 45.6 31 6 0.9 2A 0.0 2.1 25.9 0.2 0.0 38.2 16.1 25.7 12.5 1,286 30-34 63.8 41.7 32.1 2.2 2.2 0.0 3.9 17.2 1.1 0.0 40.2 16.2 29.2 17.0 1,081 35-39 61.6 37.3 29.5 2 8 3.6 0.1 3 3 12.8 2.8 0.3 37.8 13.8 27.0 19.6 758 40-44 65.3 41.6 33.2 6 3 5.5 0.2 2.8 7.1 8.5 0.2 35.9 13.7 23.0 24.0 568 45~19 51.2 24.1 18.9 1 6 2.9 0.0 2.1 3.7 5.6 0.0 3 I. 1 9.2 21.2 22.2 494 Total 48.9 32.6 20.7 1.3 1.8 0.0 1.6 17.0 1.4 0.1 28.2 10.8 19.2 11.8 8.021 CURRENTLY MARRIED WOMEN 15-19 38 2 25.8 6 5 0.0 0.3 0.0 0 4 20.8 0.0 0.0 19.6 4.3 13.9 7.8 498 20-24 58.3 40.6 22.7 0.2 0.8 0.0 0.7 27 0 0.0 0.1 33.6 10.5 24 3 10.4 1,207 25-29 64.3 45.0 32 8 I 0 2.4 0.0 1.6 24.5 0.2 0.0 40.7 15.6 28.4 13.5 969 30-34 66.2 42.5 33.0 2.2 1.8 0.0 3.9 16.4 1.4 0.0 43.0 16.8 31.8 18.8 857 35-39 63.1 37.4 29.5 2.7 3.8 0.1 3.6 11.5 3.6 0.4 39.7 14.3 28.5 19.6 586 40~14 65.1 39 6 30.8 6 1 5.5 0.0 2.8 5.7 10.1 0.3 34.7 12.1 22.5 27.6 419 45-19 51.0 23.3 17.8 1.0 2.0 0 0 2.0 3.1 6.2 0.0 31.4 9.5 21.8 22 9 367 Total 59.4 38.5 26.0 1.5 2.1 0.0 2.0 18.6 2.0 0.1 35.9 12.5 25.5 15.7 4,902 SEXUALLY ACTIVE UNMARRIED WOMEN Tolal 51.1 40.0 18.8 1.5 2.3 0.0 2.9 29.5 0.0 0.0 23.3 11.8 13.2 8.2 492 4x Table 4.3.2 Ever use ofcontraceotion: men Percentage of all men, currently married men, and sexually active unmamed men who have ever used any contraceptive method, by specific method and age, Zambia 1996 Mod~n mclhod Tr~lido~d m~hod Any Diaphragm/ Feanale Male Any Natural Number Any modern Foam/ ~ - stefili- U-adifioual family With- Othex of Age method method Pill IUCD lnjectables Jelly Condom salioa satioa me~od planning drawal methods men ALL MEN 15-19 26.2 23.9 1.2 0.4 0.0 0.0 23.9 0.0 0.0 8.5 4.8 4.9 0.8 460 20-24 61.3 54.8 8.5 0.0 0.2 1.4 51.5 0.2 0.0 2.8.4 19.3 I 1.4 4.4 404 25-29 73.6 60.9 18.7 0.6 0.9 1.5 57.3 0.3 0.5 48.4 27.2 28.6 8.0 255 30-34 72.6 51.6 25.0 1.3 0.8 1.2 45.4 1.0 0.0 46.6 33.7 30.4 I0.6 225 35-39 76.6 58.9 36.6 0.7 2.9 5.8 42.9 1.9 0.0 54.7 37.4 33.8 13.2 184 4044 73.2 51.3 33.6 1.1 3.4 5.7 29.5 2.0 0.0 49.4 35.3 32.9 16.7 121 45~.9 72.5 42.8 27.0 5-2 0.0 1.8 18.9 5A 0.0 52.5 29A 35.6 16.8 83 50-54 66.8 38.0 24.4 4.2 2.0 0.0 11.9 5-2 0.0 47.0 30.0 20.9 23.7 65 55-59 45.2 16.0 10.7 0.0 0.0 0.0 6.8 1.6 0.0 37.3 28.6 9.6 153 52 Total 58.2 45.5 16.0 0.9 0.9 1.7 38.3 1.0 0.1 34.4 22.5 19.5 8.0 1,849 CURRENTLY MARRH~ 15-19 9* " * " o* ' 2". o" o* ,0" ,* 9" " 3 20-24 6 4 58.9 17.0 0.0 0 1.3 5 3 0 0 3 2 4 I 6 7.4 115 25-29 77.7 61.8 21.5 0.0 1.0 0.0 56.9 0.0 0.0 52.3 27.1 33.0 10.4 174 30-34 74.2 52.7 27.1 1.6 1.0 0.7 46.0 0.8 0.0 49.0 34.4 32.5 12.1 190 35-39 76.2 56.7 37.1 0.8 3.3 5.3 39.5 2-2 0.0 53.3 35.0 34.2 13.7 161 75.0 52.1 35.3 1.2 3.6 6.1 29_5 2.1 0.0 51.5 37.7 34.5 17.2 113 45-49 73.6 43.3 29-2 3.7 0.0 1.9 19.2 5.8 0.0 53.1 31.0 36.7 16.3 77 50-54 65.4 35.9 21.4 4.5 2.2 0.0 12.7 5.6 0.0 44.3 28.6 18.7 23-2 61 55-59 44.5 17.1 11.4 0.0 0.0 0.0 7.3 1.7 0.0 36.0 26.7 10.3 12.7 49 Total 72.5 52.1 26.4 1.2 1.5 2.1 39A 1.7 0.0 48.8 31.2 29.7 13.2 944 SEXUALLY ACTIVE UNMARRIED MEN Total 70.3 66.3 8.8 1.1 0.0 2.7 64.0 0.5 0.0 26.6 17.6 12.3 3.9 303 Note: An asterisk indicates the rate is based on fewer than 25 men and has been suppressed. Among married men, 39 percent have ever used condoms, 26 percent reported having a partner who used the pill, and 49 percent have used a traditional method. Seven in ten sexually active unmarried men have used a method of family planning. The most commonly used method among this group is condom (64 percent), followed by natural family planning (18 percent) and withdrawal (12 percent). Trends in levels of ever use among women can be obtained by comparing the 1992 and 1996 ZDHS surveys. In 1992, 49 percent of married women said they had used a method of family planning at some time; by 1996, this figure had increased to 59 percent. Since the 1992 survey did not interview men, there are no comparable trends for men. 4.4 Current Use of Contraception The level of current use of contraception is the most widely used and valuable measure of the success of a family planning programme. Furthermore, it can be used to estimate the reduction in fertility attributable to contraceptive use. Current use of contraception is shown in Tables 4.4.1 and 4.4.2 for women and men, respectively. Although 98 percent of married women in Zambia have heard of family planning and nearly 60 percent have used a family planning method, only 26 percent reported that they were using a method at the time of the survey. Fourteen percent of married women are using modem methods, while 12 percent are using traditional methods. The most popular contraceptive methods are the pill (7 percent), withdrawal (5 percent), and condom (4 percent) (see Figure 4.2). Nineteen percent of all women interviewed and 24 percent of sexually active unmarried women are using some method of contraception. Contraceptive use among men is more widespread than among women. Overall, 37 percent of married men are currently using a family planning method. The majority of these men use modem contraception, mainly the pill (11 percent) and condoms (8 percent). The latter method is by far the most widely used method among sexually active unmarried men (36 percent). An inverted U-shaped pattern of prevalence by age is observed for all women and men and those who are currently married. Use is lower among younger persons, who tend to be in an early stage of family building, and among older persons, some of whom are no longer fecund and/or sexually active. The mix of methods used also varies according to the person's age. As expected, younger women are more likely to use non-permanent methods such as condoms, while older women tend to use permanent methods such as female sterilisation. Almost one in four unmarried sexually active women uses some family planning method; 18 percent are using modem methods and 6 percent traditional methods. Sexually active unmarried men are more likely to use contraception than women. Four in ten of these men use modem methods, most often condoms (36 percent). There has been a marked increase in contraceptive use since 1992. The contraceptive prevalence rate has increased from 15 to 26 percent of married women, a rise of 70 percent in 4 years (see Table 4.5). Most of the increase is the result of increased use of the pill and condoms; use of the pill jumped from 4 to 7 percent of married women, while use of condoms increased from 2 to 4 percent of married women. 48 4~ Table4.d.I Currentuseofcontracentlon" women Percent distribution of all women, currently married women, and sexually active unmarried women who are currently using a contraceptive method by specific method, according to age. Zambia 1996 Modem method Tradtt~onal method Any Diaphragm/ Female Male Any Natural Not Number Any modem Foam/ stefili- sterili- traditional family With- currently of Age method method Pill IUCD lnjectables Jelly Condom sation sation method planning drawal Other using Total women ALL WOMEN 15-19 7,4 4 7 LI 0.0 0,1 0.1 3.5 0.0 0.0 2.7 0.3 1.0 1,4 92.6 1O0.0 2,003 20-24 20.3 12.3 64 0.1 0.7 0.0 5.1 0.0 0.0 80 1.7 2.8 3.5 79.7 100.0 1.830 25-29 25.7 15.5 9.1 0.4 1.2 0.0 4.6 0.2 0.0 10.2 1.8 4.0 4.4 74.3 100.0 1.286 30-34 24.4 12.7 77 0.1 1.1 0.3 2.5 1.1 0.0 11.7 2.1 50 4.6 75.6 100.0 1.081 35-39 26.6 15.2 6.7 1.0 1.3 0.0 3.2 2.8 0.3 11.3 2.1 4 1 5.1 73.4 100.0 758 40~14 26.0 15.8 3.2 1.6 1 6 0.0 1.1 8.5 0.0 10.2 3.5 2.4 4.4 74.0 100.0 568 45-49 15.2 8.0 1.6 0.5 0 0 0.0 0.2 5.6 0.0 7.2 1.0 1.6 4.7 84.8 100.0 494 Total 19.2 11.2 5.2 0 3 0.7 0 1 3.5 1.4 0.0 7.9 1.5 2.9 3.5 80.8 100.0 8.021 CURRENTLY MARRIED WOMEN 15-19 16.9 8 8 2.8 0 0 0.3 0.0 5.7 0.0 0.0 8 1 0 0 4.0 4 1 83.1 100.0 498 20-24 24.6 t4.7 8.7 0.1 0.7 0.0 5.1 0.0 0.0 10.0 1.7 3.7 4.6 75.4 100.0 1.207 25-29 28.3 16.0 10.2 0.6 1.4 0.0 3.7 0.2 0.0 12.3 1 8 5.2 5.4 71.7 IG0.0 969 30-34 27.9 14.2 8 7 0.1 0.9 0.4 2.7 1.4 0.0 13.8 2 3 6.1 5.4 72.1 100.0 857 35-39 31.2 17.2 7.2 1.0 1.7 0.0 3.3 3.6 0.4 14.0 2.7 5.4 5.9 68.8 100 0 586 40~4 30.0 18.1 3 6 1.5 2.1 0.0 0.$ |0.1 0.0 1~ 9 3 5 2.9 5.5 70,0 100.0 4t9 45-49 17.8 8.5 1.6 0.4 0.0 0.0 0.3 6.2 0.0 9.3 1.3 2.1 5.9 8Z2 100 0 367 Total 25.9 14.4 7.2 0.4 1.0 0.1 3.5 2.0 0.0 11.5 1.9 4.5 5.2 74.1 100,0 4,902 SEXUALLY ACTIVE UNMARRIED WOMEN Total 24.0 17.9 5.1 0 0 0.8 0.3 I 1.6 0.0 0.0 6.1 3.9 1.1 I. I 76,0 100 0 492 Table 4.4.2 Current use ofcontracetth0n: men Percctu distribution of all men, currently married men, and sexually active unmarried men who arc currently using a contraceptive method by specific method, according to age, Zambia 1996 Modem method Traditional method Any Diaphragm/ Female Male Any Natural Not Number Any modem Foam/ sterili- sterili- traditional family With- currently of Age method method Pill IUCD lnjectubles Jelly Condom sation sation method planning drawal Other using Total men ALL MEN 15-19 13.9 12.2 0.0 0.0 0.0 0.0 12.2 0.0 0 0 1.7 1 0 0 7 0.0 86.1 100.0 460 20-24 30.4 23 6 2.5 0.0 0.0 0 3 20.8 0.0 0.0 6.g 3 4 1.8 1 6 69.6 100.0 404 25-29 38.7 24 7 10.5 0 0 0.0 0.0 13.7 0.0 0.5 14.0 6.2 4.8 3.0 61.3 100.0 255 30-34 38.9 22.5 10.9 0.7 0.5 00 10.5 0.0 0.0 16.4 7.4 4.5 4.5 61.1 100.0 225 35-39 37.9 25.7 14.0 0.0 0.7 0.8 8.6 1.5 0.0 12.2 5.8 2.7 3.7 62.1 100.0 184 40-44 40.7 26.0 15.7 1.1 1.2 0.0 6.0 2.0 0.0 14 7 8.2 2.3 4.2 59.3 I00.0 121 45-49 41.3 25.0 10.2 3.4 O0 0.0 6.0 5.4 0.0 16.3 3.8 %9 4.6 58.7 I00.0 83 50-54 24.4 12.8 4.0 0.0 0.0 0.0 3.6 5.2 0.0 11.6 3.4 1.1 7.0 75.6 100.0 65 55-59 13.4 3.3 1.7 0.0 0.0 0.0 1.6 0.0 O0 I0.I 7.1 0.9 2.1 86.6 100.0 52 Total 29.7 20.2 6.4 0.3 0.2 0 2 12.4 0.7 0.1 9.4 4.3 2.6 2 5 70.3 100.0 1,849 CURRENTLY MARRIED MEN 15.19 ; ; ; • o" 0" " o" " " ' " ," ' lOO.0 3 20-24 2 7 1 5 3 0.0 0 0 11.2 0 0.0 16.2 6.7 51 4 70.3 100.0 115 25-29 40.8 207 13.3 0.0 0.0 00 7.5 00 0.0 20.1 8.6 7.0 4.4 59.2 100.0 174 30-34 41.6 23.0 11 5 0.8 0.6 0.0 10.2 0.0 0.0 18.6 g.0 5.3 53 58.4 100.0 190 35-39 38.0 266 15.3 0.0 0.g 09 7.8 1.8 0.0 11.4 4.9 3.1 3.3 62.0 100.0 161 40-44 42.9 27.2 16.8 1.2 1.3 0.0 5 7 2.1 0.0 15 7 g.7 2.4 4.5 57.1 100.0 113 45-49 42.8 25.1 II.I 1.7 0.0 0.0 6.5 5.8 0.0 17.7 4.1 8.6 5.0 57.2 I00.0 77 50-54 26.1 13.7 4.3 0.0 0 0 0.0 3.8 5.6 0.0 12.4 3.7 1 2 7.5 73.9 100.0 61 55-59 14.3 3.5 1.8 0.0 0 0 0.0 1.7 0 0 0.0 10.$ 7.5 1.0 2.2 85.7 100.0 49 Total 37 1 21.0 10.9 0.4 0.4 0.2 7.7 1 4 0.0 16.1 6.9 4.7 4.5 62.9 100.0 944 SEXUALLY ACTIVE UNMARR/ED MEN Total 43.3 39.9 3.6 0.0 0.0 0.4 35.9 0.0 0.0 3.4 2.5 0 4 0.5 56.7 I00.0 303 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figure 4.2 Percentage of Currently Married Women Age 15-49 Using Specific Contraceptive Methods Pill InJectables Condom Female Sterlllutlon Natural F~mlly Planning Withdrawal ~ 7 l, WImiittttW 4 1 2 3 4 5 6 7 Percent ZDHS 1996 Table 4.5 Trends in family olannin~ use Percentage of currently married women age 15-49 who are currently using specific family planning methods, Zambia 1992 and 1996 ZDHS ZDHS Method 1992 1996 Any method 15.2 25.9 Any modern method 8.9 14.4 Pill 4.3 7.2 IUCD 0.5 0.4 lnjectables 0.1 1.0 Diaphragm/foam/jelly 0.1 0.1 Condom 1.8 3.5 Female Sterilisation 2.1 2,0 Any traditional method 6.3 11,5 Natural family planning 0.9 1.9 Withdrawal 3.0 4.5 Other 2.2 5.2 Number of women 4,457 4,902 4.5 Current Use by Background Characteristics While overall only about one in four married women is using contraception, the ZDHS data show that some women are more likely to be using than others (Table 4.6.1). Women most likely to be using contraception are those living in urban areas as well as those in North-Western, Lusaka, Northern and Copperbelt Provinces, women who have higher education, and women with three or more children. Urban women are three times more likely to use modern methods than their rural counterparts (24 percent and 8 percent, respectively) (Figure 4.3). Urban women are more likely to depend on methods such as the pill (12 percent), condom (5 percent), and female sterilisation, whilst rural women depend on withdrawal (6 percent) and the pill (4 percent). Contraceptive prevalence among married women also varies widely by province, from a low of 11 percent in Luapula Province to 42 percent in North-Western Province. In North- Western, Northern, Southern, and Westem Provinces, traditional methods predominate over modern methods and are used by 10 percent or more of women. In Lusaka, Copperbelt, and Central Provinces, on the other hand, modern methods are far more likely to be used than traditional methods. In Eastern and Luapula Provinces, use of modern and traditional methods is more or less the same. 51 Ld~ Table 4.6.1 Current use of contr-dr.eotion by backffound characteristics" women Percent distribution of currently mamod women by contraceptive method currently used, according to selected background characteristics, Zambia 1996 Modem method Traditional method Any Diaphragm/ Female Male Any Natural Background Any modem Foam/ stefili- stenli- trathuonal family With- characteristic method method Pill IUCD lnjeotables Jelly Condom sation sation method planning drawal Other R~ce U~ 33.3 23.6 12.2 0.9 2.2 0.1 47 3.3 0.1 97 3.0 3.0 Rural 20.9 8.2 3.9 01 0.3 0.0 2.7 1.2 00 127 1.1 5.5 Not currendy using Number of Total women Education No education Primary Secondaxy Higher Number of liviRg children 0 1 2 3 4+ Total 171 5.7 3.2 00 0.0 0.0 1.1 1.3 00 11.4 1.1 5.1 5.3 82.9 I~ .0 803 23.4 11.4 5.6 0.2 0.8 0A 32 1.6 0.0 12.0 1.5 4.7 5.8 76.6 1~.0 3,~3 37.9 27.1 14.4 10 2.0 0.1 60 3.4 01 107 3.3 3.7 3.7 62.1 1~.0 924 554 48.4 210 5.5 6.0 0.0 81 7.2 0.7 7.0 6.0 1.0 0.0 ~.6 1~.0 1~ 22 1.9 0.4 0.2 0.0 0.0 1.2 0.1 0.0 0.3 0.3 0.0 0.0 97.8 1~.0 536 2t.4 13.7 6.0 0.2 0.3 0.0 6.8 0.4 0.0 7.7 0.9 3.3 3.6 78.6 1~.0 870 266 16.8 9.6 0.2 0.8 0.2 5.4 0.6 0.1 9.8 1.8 4.2 3.7 73.4 1~.0 861 32.7 17.4 I0.5 06 2.1 0.0 3.0 1.2 0.0 15.3 1.9 6.4 7.0 67.3 I~.0 7~ 31.7 15.9 7.4 0.7 1.3 0.I 2.0 43 0.I 15.7 2.8 5.6 7.3 68.3 I~.0 1,925 ~.9 14.4 7.2 0.4 1.0 0.1 3.5 2.0 0.0 11.5 1.9 4.5 5.2 74.1 I~0 4,~2 Province Cenlral 17.4 13.0 6.7 0.2 0 0 0.0 5.1 1.0 0.0 4.4 0 7 1.7 2.0 82 6 100.0 419 CopI~thdit 29.8 20.1 9.3 0.3 1.3 0.0 3.8 5.3 0.0 9.7 2.6 3.2 4.0 70.2 100.0 910 Eastern 21.1 10.6 5.5 0.0 0.3 0.I 3.9 0.8 0.0 I0.5 1.0 5.7 3.8 78.9 I00.0 764 Luapula 10.9 6.7 3.9 0.0 0 0 0 2 1.2 1.4 0.0 4.1 1.5 0.7 2.0 89.1 100.0 448 Lusaka 35.3 27 4 13.9 2.0 3.9 0.2 5.3 2 0 0.2 8.0 3.5 2.1 2.3 64.7 100.0 796 Northern 33.0 8.0 4.9 0.0 0.5 0.0 2.0 0.6 0.0 25.0 0.8 12.6 11.5 67.0 I00.0 552 North-Western 41.7 11.3 3.1 0.0 0.0 00 3.6 4.7 0.0 30.4 1.8 7 1 21.5 58.3 100.0 197 Southern 21.9 9.0 4.8 0.2 0.5 0 0 2.9 0.4 0.2 12.9 2.3 3.9 6.8 78.1 100 0 518 Western 18.7 8.7 4.7 0 2 0.0 0 0 1 9 1.9 0.0 10.1 0.9 5 1 4 0 81.3 100.0 298 3.8 66.7 100.0 1,972 6.1 79.1 100.0 2,930 Table46.2 Current useofeomraeet~onbvbackt, roundcharaeterisacs: men Percent disUibulion of currently married men by contraceptive method currently used, according to selected backgnmnd characteristics. Zambia 1996 Modem method Traditional method Any Diaphragm/ Background Any modem Foam/ characteristic method method Pill IUCD Injectables Jelly Condom Female Any Natural Not Number stetili- traditional family With- currently of sation method planning drawal Other using Total men Res idence Urban 47.5 30.3 17.4 1.0 1.0 0.4 8.8 Rural 29.4 14.2 6.2 0.0 0.0 0.0 6.9 1.7 17.2 9.6 4.3 3.3 52.5 1~.0 ~1 1.2 15.2 4.9 4.9 54 ~.6 1~.0 ~3 Province Central 39.1 Copperbelt 39.6 Eastern 44.3 Luapula 26.8 Lusaka 50.5 Northern 17.6 North-Western 52.6 Southern 29.6 Western 25 0 Educat ion No educatmn 23.1 Primar/ 27.8 Secondary 49.6 Higher 49 3 Number of living children 0 6.8 1 38.7 2 43.2 3 36.7 4+ 39.5 Total 37.1 22.0 11.1 0.0 0.0 0.0 10.9 0.0 298 17.7 0.8 0.8 0.0 7.6 3.0 23.6 7.9 0.0 0.7 00 13.7 1.2 6.9 4.9 0.0 0.0 0.0 1.0 1.0 ~.4 13.7 0.9 0.9 0.9 7.2 1.6 7.5 3.0 0.0 0.0 0.0 4.5 0.0 25.0 9.0 0.0 0.0 0.0 14.5 1.4 17.8 11.6 1.4 0.0 0.0 4.0 0.9 22.6 14.1 00 0.0 00 6.1 2.4 8.3 4.5 0.0 0.0 0.0 3.9 0.0 13.4 6.1 0.0 0.0 0.0 5.9 1.3 29.4 16.9 1.2 0.7 0.4 92 1.0 41.1 19.3 00 2.0 0.0 15.0 4.8 4.7 LI 2.1 0.0 0.0 1.5 0.0 22.2 9.0 0.0 0.0 0.0 13.2 0.0 21.3 11.9 0.9 0.0 0.0 8.5 0.0 21.5 11.2 00 1.1 0.0 8.7 0.5 23.0 12.7 0.3 0.5 0.3 6.4 2.8 21.0 10.9 0.4 0.4 0.2 7.7 1.4 17.0 8.1 5.4 3.5 60.9 100.0 83 9.8 7.6 2.3 0.0 60.4 100.0 174 20.7 8.1 5.4 7.2 55.7 100.0 150 19.9 6.0 3.0 10.9 73.2 100.0 78 25.1 12.1 7.0 6.0 49.5 100.0 160 10.1 3.1 6.9 0.0 82.4 100.0 112 27.6 1,4 11.2 15,1 47.4 I{X).0 36 11.8 5.2 0.9 5.7 70.4 100.0 95 2 4 0.0 2.4 0.0 75.0 100.0 56 14.8 2.5 2.5 9.7 76.9 100.0 71 14.4 5.5 3.8 5.1 72.2 100.0 454 20.2 9.6 7.0 3.7 50.4 100.0 345 8.2 7.2 1.0 0.0 50.7 I00.0 73 2.1 0.0 2.1 0.0 93.2 100.0 72 16.6 7,8 4.6 4.1 61.3 I00.0 138 21.9 I0.0 %8 4.1 56.8 I00.0 151 15.2 6.7 5.3 3.2 63.3 I00.0 137 16.5 6.7 3.8 5.9 60.5 100.0 446 16. I 6.9 4.7 4.5 62 9 I00.0 944 Figure 4.3 Percentage of Currently Married Women Using e Contraceptive Method by Background Characteristics RESIDENCE Urban Rural PROVINCE Central Copperbelt Eastern Luapula Lusaka Northern Ne, flh-W~t~r n Southern Western EDUCATION No Education Primary Secondary Higher 33 21 I 11 17 21 122 13 30 35 33 42 i i ~.,i17 7 , ? ; : , , . . . . . , ~ ,,123 10 20 30 40 50 Percent 60 ZDHS 1996 The largest differentials in current use of contraception are found among educational groups. Contraceptive use increases steadily with increasing level of education, from 17 percent among married women with no education to 55 percent of women with secondary or higher education. Better educated women are also more likely to use modern methods; women with secondary or higher education are eight times more likely to use modern methods than women with no education. Women with no education mostly use traditional methods such as withdrawal, while those with higher education are more likely to use the pill, condom, or female sterilisation. These women hardly use any traditional methods except for natural family planning. Childless women seldom use any contraception, which suggests that they would like to have a child before regulating their childbearing. However, once they begin childbearing, regardless of the number of living children, there is little variation in the proportion of women who are using a method of family planning. Data for men shown in Table 4.6.2 demonstrate basically the same pattern as that for women. Urban men, those living in North-Western and Lusaka Provinces, those who are better educated, and those who have had children are more likely than other men to be using contraception. 4.6 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. 54 Table 4.7 shows the number of children ever-married respondents bad when they first used contraception. In general, younger women are more likely to have started using contraception at lower parities than older women. For example, less than 20 percent of women in their 40s started to use contraception when they had either no children or only one child, compared to around 40 percent of women age 15-24. As a matter of interest, one observes that 12 percent of women 15-19 started using contraception before they had a child. Table 4.7 Number of children at first use of contracention Percent distribution of ever-married women by number of living children at the time of first use of contraception, and median number of chddren at first use, according to current age, Zambia 1996 Median Never Number of living children at time number of used of first use of contraception Number children contra- of at first Current age ceptlon 0 1 2 3 4+ Missing Total women use 15-19 61.5 12.1 25.1 1.1 0.0 0.0 0.2 100.0 546 1.3 20-24 43.7 7.6 33.9 11.4 2.9 0.0 0.5 100.0 1,428 1.6 25-29 36.6 4.2 30.4 16.0 7.5 4.8 0.5 100.0 1,I63 1.9 30-34 36.0 2.6 24.9 14.9 9.6 11.6 0.4 100.0 1,051 2.3 35-39 38.1 2.3 21.6 9.5 8.6 19.8 0.1 100.0 748 2.7 40-44 35.0 1.7 17.5 9.3 10.8 24.9 0.8 100.0 561 3.3 45-49 48.7 0.5 17.2 6.3 5.5 21.4 0.4 100.0 491 3.3 Total 41.5 4.7 26.4 ll.l 6.4 9.5 0.4 100.0 5,988 1.9 4.7 Knowledge o f Fer t i le Per iod A basic knowledge of reproductive physiology is useful for the successful practice of coitus- dependent methods such as withdrawal, condoms, or barrier methods, but it is especially important for users of natural family planning (also called periodic abstinence or the rhythm method). The successful practice of natural family planning depends on an understanding of when during the ovulatory cycle a women is most likely to conceive. Table 4.8 presents the percent distribution of all women respondents and those who have ever used natural family planning by reported knowledge of the fertile period in the ovulatory cycle. Of all the women interviewed in the survey, 29 did not know when the fertile period occurs within the monthly cycle and 27 percent said that there is no particular Table 4~ Knowledge of fertile DeriQ~ I Percent distribution of all women and of those who currently use natural family planning or the calendar rhythm method, by knowledge of the fertile period during the ovulatory cycle, Zambia 1996 Current users of'. Natural Perceived All family Calendar fertile period women planning rhythm During menstrual period 1.0 0.7 0.0 Right after period has ended 20.1 20.9 18.1 In the middle of the cycle 13.3 40.6 45.9 Just before period begins 9. l 13.8 14.9 At any time 26.5 18.9 17.3 Other 0.4 0.0 0.0 Don't know 29.4 5.1 3.8 Missing 0.2 0.0 0.0 Total 100.0 100.0 100.0 Number 8,021 124 75 Note: Users of calendar rhythm are a subset of all natural family planning users. time within the cycle when women are more likely to get pregnant. Only 13 percent of respondents gave the correct response, i.e., that a woman is most likely to conceive in the middle of her ovulatory cycle. Users of natural family planning are considerably more knowledgeable about their ovulatory cycle: 41 percent correctly identified the middle of the cycle as the fertile time. There is little difference in knowledge of the fertile period between all natural family planning users and the subset of these users who are using the calendar rhythm method. 55 4.8 Contraceptive Effects of Breastfeeding Knowledge of the effect of breastfeeding on the risk of pregnancy is important for post-partum contraceptive programmes and programmes that promote the use of the lactational amenorrhoeic method (LAM). The effective use of breastfeeding as a contraceptive method depends on being able to satisfy several criteria: that the woman is post-partum amenorrhoeic (menstruation has not returned since the last birth), that she is exclusively or almost exclusively breastfeeding and that less than six months has passed since the birth. To satisfy the full criteria of the lactational amenorrhoeic method, a woman should also know that if any of the preceding criteria no longer hold, then she is at increased risk of a pregnancy and should no longer rely on breastfeeding. Because questions are not asked on knowledge of the full LAM criteria, true use of LAM is not ascertained. Women may be amenorrhoeic for periods longer than six months but they are at substantially increased risk of becoming pregnant before the return of menstrual bleeding. Table 4.9 shows the distribution of currently married women by their perception of the effect of breastfeeding on the risk of pregnancy and the percentage of women who have ever relied on or are currently relying on breastfeeding to avoid pregnancy and those who meet the LAM criteria, according to selected background characteristics. About half of currently married women say that breastfeeding has no impact on the risk of pregnancy. There is only slight variation according to the woman's age, urban-rural residence, and education. However, better educateA women are more likely to know that breastfeeding decreases the chances of becoming pregnant. There are significant differentials in the perceived effect of breastfeeding on fertility by province. While only 6 percent of women in Central Province believe that breastfeeding can decrease the risk of pregnancy, the proportion in Copperbelt Province is 25 percent. Older women tend to have relied on breastfeeding to delay or avoid pregnancy more than younger women. While 5 percent or less of women age 15-24 have used breastfeeding to avoid pregnancy, the corresponding proportions for older women (age 30 and above) is 10 percent or higher. Urban women, women in Copperbelt Province and those with secondary or higher education are more likely to rely on breastfeeding as a method to avoid pregnancy than other women. Only 6 percent of women meet the LAM criteria. ~ 4.9 Source 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. Such information is important to family planning programme officials. 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. LAM users are women who are breastfeeding a child under six months of age, are still post-partum amenorrhoeic, and are not feeding the child anything but breast milk or breast milk and plain water. 56 Table 4.9 Percetved contraceDtive effect of breastfeedin~ Percent distribution of currently married women by perceived risk of pregnancy associated with breastfeeding, percentage who rely on breastfeeding to avoid pregnancy, and percentage who meet lactational amenorrhoeic method (LAM) criteria, according to selected background characteristics, Zambia 1996 Perceived risk of pregnancy associated with breastfeeding Relianceon breastfeeding to avoid pregnancy Don't Meet Number Background Un- In- De- know/ Previ- Cur- LAM of characteristic changed creased creased Depends Missing Total ously rently criteria women Age 15~19 46.4 12.2 11.3 6.1 24.0 100.0 2.7 1.1 7.8 498 20-24 48.1 18.1 14.8 9.7 9.3 100.0 4.6 1.6 8.5 1,207 25-29 48.6 17.6 17.3 9.2 7.3 100.0 9.3 3.9 7.0 969 30-34 50.6 18.3 15.0 11.5 4.6 100.0 10.2 2,9 5.7 857 35-39 47.4 17.5 16.6 13.9 4.4 100.0 11.7 4.6 4.7 586 40-44 49.4 16.9 15.7 13.0 5.0 100.0 10.1 1.5 2.1 419 45-49 50.9 16.8 14.2 15.1 3.0 100.0 12.2 1.1 0.4 367 Residence Urban 46.0 15.2 19.2 12.7 6.9 100.0 10.9 3.4 5.4 1,972 Rural 50.5 18.5 12.5 9.5 9.0 100.0 6.4 2.0 6.5 2,930 Province Central 61.4 18.6 6.2 4.9 8.9 100.0 3,7 0.9 8.2 419 Copperbelt 36.4 14.1 25,4 17.6 6.5 100.0 14.6 4,0 5.7 910 Eastern 35.5 29.9 13.0 7.3 14.2 100.0 4.6 1.5 4.3 764 Luapula 26.7 25.1 15.0 25.3 7.9 100.0 10.0 2.9 5.4 448 Lusaka 53.3 14.0 15.1 7.6 10.0 100.0 8.1 2.5 5.2 796 Northern 49.0 22.5 10.9 11.9 5.6 100.0 5.6 1.2 5.7 552 North-Western 68.1 9.6 19.2 2.9 0.3 100,0 4.4 2.3 7.3 197 Southern 73.5 4.0 10.6 7.0 4.9 100.0 9.4 3.8 9.7 518 Western 66.6 6.8 16.4 2.6 7.7 100.0 7.5 3.3 5.6 298 Education No education 48.4 17.3 13.5 9.0 11.8 100.0 6.7 1.9 3.9 803 Primary 50.3 17.3 13.3 11.2 7.8 100.0 8.1 2.7 6.7 3,053 Secondary 44.5 17.7 20.7 10.7 6.4 100.0 6.4 2.8 5.7 924 Higher 43.2 8.8 32.2 10.9 4.8 100.0 4.8 0.6 5.9 122 Total 48.7 17.2 15.2 10.7 8.1 100.0 8.2 2.5 6.1 4,902 Table 4.10 and Figure 4.4 show the sources of supply for contraception methods. The data indicate that most users of modern methods (60 percent) obtain their methods from public (government) sources, while 24 percent rely on private medical sources and 13 percent use other private sources such as shops, friends, and relatives. Government health centres are the single most frequently reported source, serving 41 percent of users, followed by government hospitals (16 percent) and private hospitals and clinics (11 percent). Shops also provide for 11 percent of the users. The source a woman uses to obtain contraceptive methods depends on many things, one of which is the type of method she has chosen. Most pill users obtain their method from public sources (75 percent), 59 percent from government health centres and 13 percent from government hospitals. Private medical sources provide for 20 percent of current pill users. Injectables users are also likely to obtain their method from public sources (71 percent), followed by private medical (25 percent). As with pill users, government healthcentres 57 Table 4. l0 Source 9f SUPPLY for modern contraceotive methods Percent distribution of women currently using modem contraceptive methods by most recent source of supply, according to specific methods, Zambia 1996 Contraceptive method F~mal¢ Inject- Con- sterili- Source of supply Pill ables dora satlon Total Public 74.9 70.9 39,6 48.8 59.9 Government hospital 12,6 12.3 8.3 47.7 16.2 Government health centre 58.5 47.0 29,6 1.0 40.6 Government field worker 1.6 0.0 1.7 0.0 1.3 Other public 2.2 11.7 0.0 0.0 1.8 Medical private 20,0 24.8 17.1 50.6 23.8 Private hospital/clinic 8.9 13.6 2.7 34.7 10.8 Mission hospital/clinic 3.4 2.3 3.5 15.9 5.0 Pharmacy 4.1 0,0 7.4 0.0 4.3 Private doctor 0.6 2,3 1.4 0.0 1.0 Private mobile clinic 2.5 0.0 0.3 0.0 1.2 Private field worker 0.2 0.0 1.0 0.0 0.4 Other private 0.3 6.8 0.9 0.0 1.0 Other private 3.4 2.3 35.6 0.0 13.0 Shop 2.0 0.0 30.8 0.0 10.6 Friend/relative 0.8 0.0 3.3 0.0 1.4 Other 0.5 2.3 1.5 0.0 1.0 Don't know 0.0 0.0 3.9 0.0 1.2 Missing 1.6 2.0 3.8 0.7 2.1 Total I 100.0 100.0 100.0 100.0 100.0 Number of users 416 59 282 112 901 L Total includes 21 IUCD users, four condom users, and two users of male sterdisauon. are the single most important supplier for injectables users (47 percent). Condom users are about equally likely to use government health centres and private shops to obtain their method (about 30 percent each). Almost half of women who have been sterilised had the operation at a government hospital, while about one-third used a private hospital or clinic. In the past few years, there has been a slight shift away from reliance on private medical sources towards greater use of other private sources for family planning methods. Since 1992, the proportion of users who get their methods from private medical sources has declined from 36 to 24 percent, while the proportion who obtain methods from other private sources has increased from 7 to 13 percent (Gaisie et al., 1993:46). This shift is due in part to increased use of condoms, many of which are purchased in shops. Public sources supply a slightly greater share of users now than in 1992 (60 vs. 56 percent). 4.10 Future Use of Contraception Intention to use contraception in the future provides a forecast of potential demand for services and acts as a convenient summary indicator of disposition towards contraception among current nonusers. Table 4.11 shows the distribution of married women and men who are not currently using contraception by whether they intend to use family planning in the future. The distinction between intended use in the next 12 months and later on provides a more refined indication of demand in the near future. More than half of married women who are currently not using contraception intend to use in the next 12 months, while 13 percent say that they will use contraception some time later. For men, the corresponding proportions are 33 percent and 23 percent, respectively. Three in ten married women and one in three men do not intend to use any contraception at all. The intention to use contraception is lowest among childless women and highest among women with two children. 58 Figure 4.4 Distribution of Current Users of Contraception by Source of Supply Ot~lQ~ prJv==fa 'J '~ ¢tt. Don't know/Miuing Other Govt, 3% . tedlcal) 24% Govt, Hospital 16% Govt, Health Centre 41% ZDHS 1996 4.11 Reason For Nonuse of Contraception It is crucial for the purpose of designing intervention mechanisms to identify reasons for nonuse of contraception. Table 4.12 presents the main reasons 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. Thirty-two percent of all women say they do not intend to use because they want children, while over one-third (38 percent) cite inability to conceive (either infecundity or menopause/hysterectomy) as the reason. Other reasons given by women include respondent opposed (7 percent), side effects (7 percent) and opposition of her husband or partner (3 percent). Men cite similar reasons for nonuse as women, namely that they want more children (38 percent), or that infecundity or menopause obviates the need for contraception (29 percent). Contrary to popular belief, only 9 percent of men say that the reason they do not intend to use family planning is that they are opposed to it. The main difference in the reasons for nonuse cited by younger and older respondents is that a much larger proportion of the former say they want to have more children, while the latter are more likely to cite infecundity as the reason for nonuse. 4.12 Preferred Method Nonusers who said they intended to use family planning in the future were asked which method they preferred. The data are presented in Table 4.13. Most of these women say they would prefer to use the pill (55 percent), followed by injections (12 percent) and female sterilisation (6 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. 59 Table 4.11 Future use of contraception Percent distribution of currently married women and men who are not currently using a contraceptive method, by intention to use in the future, according to number of living children, Zambia 1996 Number of living children I Future intentions 0 1 2 3 Total Total for for 4+ women men Intend to use in next 12 months 26.1 51.2 56.4 56.7 54.8 52.1 33.2 Intend to use later 27.6 13.9 15.4 12.2 7.8 12.8 23.2 Unsure as to timing 1.1 2.1 0.7 1.0 0.6 1.0 1.3 Unsure as to intention 9.3 5.8 3.3 4.3 3.6 4.6 6.8 Do not intend to use 35.8 27.1 24.1 25.6 32.6 29.3 33.3 Missing 0.0 0.0 0.1 0.1 0.6 0.3 2.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women/men 331 697 652 540 1,415 3,633 594 I Includes current pregnancy Table 4.12 Reasons for not usine contraceotion Percent distribution of currently married women and men who are not using a contra- ceptive method and who do not intend to use in the future, by main reason for not using, according to age, Zambia 1996 Women Men Age Age Reason for not using contraception <30 30-49 Total <30 30-59 Total Want children 53.0 21.3 31.9 (76.4) 27.2 37.6 Side effects 11.2 4.6 6.8 (0.0) 6.1 4.9 Health concerns 1.1 2.2 l.g (2.8) 2.0 2.2 Interferes with body 1.7 0.3 0.g (0.0) 3.3 2.6 Knows no method 5.7 1.5 2.9 (2.8) 2.2 2.4 Knows no source 0.3 0.5 0.4 (2.8) 1.5 1.8 Hard to get 0.8 0.2 0.4 (0.0) 0.0 0.0 Religion 0.6 1.6 1.3 (1.6) 4.3 3.7 Respondent opposed 9.7 5.3 6.8 (3.3) 11.0 9.4 Partner opposed 4.5 2.4 3.1 (0.0) 0.6 0.5 Others opposed 0.5 0.0 0.1 (0.0) 0.5 0.4 Up to woman to use NA NA NA (1.8) 1.9 1.9 Infrequent sex 0.7 2.6 2.0 (6.2) 0.5 1.7 Manopausal/hystemctomy 0.1 23.2 15.6 (0.0) 24.3 19.2 Sub fecund/in fecund 7.5 29.8 22.4 (0.0) 12.3 9.7 Inconvenient 0.3 0.4 0.4 (2.2) 1.0 1.2 Other 1.0 3.1 2.4 (0.0) 0.0 0.0 Don't know 1.4 0.8 1.0 (0.0) 0.9 0.7 Missing 0.0 0.2 0.1 (0.0) 0.3 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women/man 354 710 1,064 42 157 198 Note: Figures in parentheses are based on 25-49 men. NA = Not apphcable 60 Table 4.13 Preferred method of contracemion for future use Percent distribution of currendy mamed women who are not using a contra- ceptive method but who intend to use in the future by preferred method, according to timing of intended use, Zambia 1996 Intend to use In next After Unsure Preferred method 12 12 about of contraception months months timing Total Pill 55.5 52.2 (46.2) 54.7 IUCD 1.5 1.3 (0.0) 1.4 Injectables 12.1 10.6 (14.9) 11.9 Diaphragm/Foam/Jelly 0.4 0.4 (0.0) 0.4 Condom 4.8 7.3 (10.7) 5.4 Female sterilisation 5.6 6.0 (9.3) 5.7 Periodic abstinence 1.9 2.4 (0.0) 2.0 Withdrawal 3~2 1.5 (0.0) 2.8 Norplant 0.5 1.8 (0.0) 0.7 Other 3.6 6.4 2.4 4.1 Don't know/Missing 10.9 10.1 (16.3) 10.8 Total 100.0 100.0 100.0 100.0 Number of women 1,892 464 36 2,393 Note: Figures in parentheses are based on 25-49 women. 4.13 Family Planning Communications It is important to assess the coverage of radio and television messages so that the right channels of communication in population matters are utilised. Table 4.14 presents data on the proportion of women and men who have heard family planning messages on radio or television in the few months preceding the survey, according to selected background characteristics. Fifteen percent of women reported that they heard a family planning message on both the radio and television, while 59 percent had not heard a message on either radio or television. In general, messages broadcast on radio are more commonly heard than those on television; 39 percent of women heard a message about family planning on the radio, compared to only 18 percent who heard a message on the television. Except at ages 15-19, there are only slight variations by age group in the exposure of women to family planning messages. Exposure to mass media is limited in rural areas; for example, 30 percent of women in urban areas have heard about family planning on both radio and television, compared to 4 percent of women in rural areas. In the more urbanised provinces in the country-----Central, Copperbelt, and Lusaka women are much more likely to have access to mass media through radio and television than women in other provinces. However, in all provinces, the role of radio as a media for disseminating information is significant. Women with higher education are much more likely to have heard a family planning message on radio and television than those with less education. Men who were interviewed show a pattern similar to women: family planning messages in the mass media are heard less commonly by male teenagers, by men in rural areas, and by less educated men. Respondents were asked whether they consider it acceptable or not acceptable to air family planning messages over radio or television. The response is used to assess the level of popular support for family planning education and advertising on the radio or television. 61 Table 4.14 Exoosure to family ulannin~, messages through the media Percent distribution of women and men by whether they have heard a radio or television message about family planning in the months prior to the interview, according to selected background characteristics, Zambia 1996 Heard about family planning on radio or television Women Men Background characteristic Heard Tele- Heard Number Heard Tele- Heard Number on Radio vision on of on Radio vision on of both only only neither Total women I both only only neither Total men Age 15-19 10.9 16.4 2.7 69.7 100.0 2,003 142 21.0 4.0 609 100.0 460 20-24 15.3 25.3 2.6 56.8 100.0 1,830 20.6 28.9 4.8 45.7 100.0 404 25-29 20.0 26.4 1.9 51.6 100.0 1,286 23.6 41.0 1.6 33.8 100.0 255 30-34 19.6 29.9 1.2 49.1 100,0 1,081 25.0 37.9 1.7 35.4 100.0 225 35-39 16.0 25,3 3.3 55.3 100.0 758 27.3 32.2 4.8 35 7 100.0 184 40-44 15.7 23.4 2.3 58.4 100.0 568 22.2 39.2 4.3 34.3 100.0 121 45-49 9.9 20,0 1.0 69.0 100.0 494 21.6 35.9 4.1 38.5 100.0 83 50-54 NA NA NA NA NA NA 29.3 32.7 2.6 35.4 100.0 65 55-59 NA NA NA NA NA NA 9.3 28.3 0.0 62.4 100.0 52 Residence Urban 29.7 24,4 4.4 41.5 100.0 3,604 37.9 26.7 6.8 28.6 100.0 852 Rural 3.6 22.7 0.6 73.1 100.0 4,417 6.1 34.8 0.7 58.3 100.0 997 Province Central 13.3 20,3 2.6 63.8 100,0 653 16.3 29.3 5.3 49.0 100.0 157 Copperbelt 36,5 23.8 4.8 34.8 100.0 1,588 41.3 22.6 7.1 28.9 100.0 396 Eastern 1.2 24.6 0.3 73.8 100.0 1,075 4.6 48.7 0.7 46.1 100.0 254 Luapula 4,4 30,6 0.9 64.1 100.0 726 5.2 41.9 0.5 52.4 100.0 151 Lusaka 27.1 24.1 4.1 44.6 100.0 1,403 43.0 24.6 7.1 25.3 100.0 316 Northern 3.9 25,3 0.5 70.3 100.0 872 4.5 23,6 0.3 71.6 100.0 221 North-Western 2.9 23.4 0.3 73.2 100.0 288 16.5 64.8 0.0 18.7 100.0 48 Southern 9.5 20.5 1.9 68.1 100.0 816 7.6 26.4 1.4 64.6 100.0 173 Western 3.0 15,2 0.4 81.5 100.0 600 5.9 34.7 0.0 59.4 100.0 132 Education No education 3.3 16.7 0.4 79.4 100.0 1,067 5.5 35.2 1.6 57.7 100.0 127 Primary 9.9 24,3 1.5 64.2 100,0 4,721 11.6 30.7 1.8 55.8 100.0 938 Secondary 30.2 25.4 4.6 39.8 100.0 2,007 32.0 30.9 5.8 31.3 100.0 686 Higher 52.9 19.7 6.4 21.1 100.0 226 48.9 31.1 5.7 14.4 100.0 98 All women/men 15.3 23,5 2.3 58.9 100.0 8,021 20.7 31.1 3.5 44.6 100.0 1,849 Note: Figures may not add to 100.0 due to rounding and/or missing data. NA = Not applicable I Includes one woman with missing mlbrmation on education Eighty-seven percent of women and 82 percent of men report that such messages are acceptable to them (Table 4.15). Women in the oldest age group (45-49 years) are the least likely to find media messages on family planning acceptable. Acceptability is highest among women with higher education (95 percent) and lowest among women with no education (78 percent). The same is true for men (94 percent and 79 percent, respectively). 62 Table 4.15 Accet3tabilitv of media messages on family olannina Percentage of women and men who believe that it is acceptable to have messages about family planning on the radio or television, by selected background characteristics, Zambia 1996 Acceptability of family planning messages on radio or television Women Men Not Number Not Number Background Accept- accept- of Accept- accept- of characteristic able able Unsure Total women able able Unsure Total men Age 15-19 81.3 11.8 6.9 I00.0 2,003 70.5 7.4 22.1 I00.0 460 20-24 91.3 6.5 2.2 I00.0 1,830 83.2 8.4 8.5 I00.0 404 25-29 92.7 6.0 1.3 I00.0 1,286 90.8 6.6 2.6 I00.0 255 30-34 89.3 9.1 1.6 100.0 1,081 92.0 5.8 2.1 I00.0 225 35-39 88.6 10.1 1.3 I00.0 758 85.2 10.4 4.4 I00.0 184 40-44 82.3 16.4 1.2 100.0 568 90.4 8.1 1.4 I00.0 121 45-49 74.0 21.6 4.4 I00.0 494 81.6 18.4 0.0 I00.0 83 50-54 NA NA NA NA NA 66.4 21.5 10.4 I00.0 65 55-59 NA NA NA NA NA 71.3 15.5 13.3 I00.0 52 Residence Urban 87.4 I0.5 2.0 I00.0 3,604 85.5 11.5 3.0 100.0 852 Rural 86.3 9.6 4.1 I00.0 4,417 78.7 6.6 14.6 100.0 997 Province Central 85.7 12.7 1.6 I00.0 653 92.1 5.3 26 I00.0 157 Copperbelt 90.3 8.1 1.6 100.0 1,588 83.7 12.9 3.4 100.0 396 Eastern 80.6 10.0 9.4 100.0 1,075 90.3 6.9 2.8 100.0 254 Luapula 90.4 7.6 2.0 100.0 726 89.8 4.1 6.1 100.0 151 Lusaka 82.6 14.1 3.2 100.0 1,403 85.6 12.3 1.8 100.0 316 Northern 88.4 9.7 2.0 100.0 872 56.2 10.3 33.4 100.0 221 North-Western 96.6 3.4 0.0 100.0 288 100.0 0.0 0.0 100.0 48 Southern 90.1 9.2 0.8 100.0 816 69.1 4.2 26.7 100.0 173 Western 83.8 10.7 5.5 100.0 600 82.7 9.1 8.2 100.0 132 Education No education 77.9 14.2 7.9 100.0 1,067 78.9 12.8 8.3 100.0 127 Primary 86.5 10.4 3.2 100.0 4,721 75.5 9.1 15.3 100.0 938 Secondary 91.3 7.7 0.9 100.0 2,007 89.3 8.3 2.4 100.0 686 Higher 95.3 4.7 0.0 100.0 226 94.3 5.7 0.0 100.0 98 Total women/men 86.8 10.0 3.1 100.0 8,021 81.8 8.9 9.2 100.0 1,849 Note: Figures may not add to 100.0 due to rounding. NA = Not applicable 1 Includes one woman with no information on education Women were asked whether they had received a message about family planning from print media in the few months prior to the survey. The results are presented in Table 4.16. More than one-third of the women received family planning messages from print media. Posters are the most likely source for women to receive such messages (29 percent), followed by newspapers or magazines (17 percent) and leaflets or brochures (11 percent). The proportion of women who receive messages through print media increases with age until the 30s and declines among older women. Half of urban women saw a message in print, compared to less than one-quarter of their rural counterparts. Women in Eastern Province, as well as those with no education are the least likely to receive any family planning messages in print. 63 Table 4.16 Farmlv nlannin~ messages in orint Percentage of women who received a message about family planning through the print media m the months prior to the interview, according to selected background characteristics, Zambia 1996 Type of print media containing family planning message Number Background Any Newspaper/ Leaflet/ No of characteristic source magazine Poster brochure source women Age 15-19 28.5 14.6 20.2 7.7 71.5 2,003 20-24 38.9 18.3 32.2 12.1 61.1 1,830 25-29 43.5 20.6 37.4 15.1 56.5 1,286 30-34 41.0 18.7 36.2 13.7 59.0 1,081 35-39 36.2 18.1 31.7 13.1 63.8 758 40-44 34.6 17.8 28.8 13.3 65.4 568 45-49 19.7 7.9 I7.6 4.9 80.3 494 Residence Urban 51.6 30.1 41.3 18.3 48.4 3,604 Rural 22.5 6.5 19.7 5 9 77,5 4,417 Province Central 31.3 18.8 21.6 14.6 68.7 653 Copperbelt 54.3 28.9 45.3 19.9 45.7 1,588 Eastern 7.4 1.8 6.4 1.2 92.6 1,075 Luapula 35.9 9.4 34.3 5.5 64.1 726 Lusaka 45.5 31.1 34.1 17.0 54.5 1,403 Northern 31.2 11.0 27.9 8.0 68.8 872 North-Western 29.8 5.0 28.4 2.9 70.2 288 Southern 37.3 14.2 30 9 10.8 62.7 816 Western 24.5 6.7 21.0 8.2 75.5 600 Education No education 8.4 0.6 8.0 0.8 91.6 1,067 Primary 27.2 8.1 23.7 5.6 72.8 4,721 Secondary 63.5 40.4 48.5 25.5 36.5 2,007 Higher 92.0 75.5 80.4 58.6 8.0 226 Total I 35.6 17.1 29.4 11.4 64.4 8,021 1 Total includes one woman with no information on education. 4.14 Contact of Nonusers with Family Planning Providers One way to increase the level of knowledge about family planning and perhaps to increase use as well is to take advantage of "lost opportunities," instances in which health professionals make contact with women and men but neglect to discuss family planning. To assess the extent to which information is transferred through the health system, women interviewed in the ZDHS who were not currently using contraception were asked if they had contact with a family planning field worker in the previous 12 months or, if they had visited a health facility in the previous 12 months, whether any staff at the facility had spoken to them about family planning. Table 4.17 shows that only a small proportion of women (4 percent) were visited by a family planning worker. Of the 62 percent of women who visited a health facility in the 12 months before the survey, only about one-third (or 21 percent of nonusers) discussed family planning with a staff person at the facility. Overall, more than three-quarters of nonusers had no family planning contact in the 12 months preceding the survey. The lack of contact spreads across all categories--in urban and rural areas, at all ages, in all provinces and at all educational levels. 64 Table 4.17 Contact of nonusers with family olannimz vroviders Percent distributton of nonusers of family planning by whether they were visited by a family planning field worker or spoke with a health facility staff member about family planning (FP) methods during the 12 months prior to interview, according to selected background characteristics, Zambia 1996 Nonusers of family planning Visited b x family Not visited by planning field worker fatally planning fieldworker Visited Visited health facility health facility Did not Did not No FP Dis- Did not visit Dis- Did not visit services or Number Background cussed discuss health cussed discuss health informationofnon- characteristic FP FP facility FP FP facility Missing Total provided users Age 15-19 0.7 0.6 0.9 7.1 41.2 49.5 0.1 100.0 90.7 1,855 20-24 2.0 1.1 2.0 23.1 42.2 29.5 0.1 100.0 71.7 1,459 25-29 2.9 1.4 2.0 28.5 38.5 26.4 0.3 I00,0 64.9 956 30-34 2.3 1.2 1.1 27.9 39.7 27.9 0.0 100.0 67.5 818 35-39 3.4 0.8 1.6 28.2 34.4 31.6 0.0 100.0 66.0 557 40-44 2.4 0.0 2.1 18.0 38.3 39.2 0.0 100.0 77.5 420 45-49 1.2 1.2 1.9 12.0 32.2 51.5 0.0 I00.0 83.7 419 Residence Urban 1.1 0.6 1.4 18.0 41.5 3%3 0.0 100.0 78.8 2,751 Rural 2.5 1,1 1.6 20.2 38.0 36.4 0.2 100.0 74.4 3,733 Province Central 2.3 0.8 2.9 12.7 29.1 52.1 0.1 100.0 81.2 563 Copperbelt 1.2 0.4 0.7 22.5 48.5 26.6 0,0 100.0 75.1 1,261 Eastern 2.6 0.7 0.4 33.5 28.7 33.6 0.4 100.0 62.4 895 Luapula 1.3 1.1 2.2 13.0 44.2 38.1 0.0 100.0 82.3 674 Lusaka 1.2 1.1 2.5 14.8 32.6 47.8 0.0 100.0 80.4 1,035 Northern 3.4 1.8 2.1 14.6 37.3 40.6 0.2 100.0 77.9 682 North-Western 0.5 0.3 0.0 26.3 48.8 24.1 0.0 100,0 72.9 192 Southern 2.3 1.0 1.1 20.5 47.0 28.2 0.0 100.0 75.1 672 Western 1.9 1.0 1.4 13.1 45.0 37.6 0.0 100.0 82.6 510 Education No education 1.5 0.9 0.9 18.3 36.0 42.2 0.2 100.0 78.2 926 Primary 2.1 0.9 1.7 20.3 37.8 37.1 0.1 100.O 74.8 3,894 Secondary 1.2 0.7 1.5 17.4 45.4 33.8 0.0 100.0 79.2 1,546 Higher 3.9 4.0 1.7 19.4 46.6 24.3 0.0 100.0 71.0 117 Total I 1.9 0.9 1.5 19.3 39.5 36.8 0.1 100.0 76.3 6,483 J Includes one woman wah no information on education 4.15 Discussion of Family Planning with Husband While husband-wife discussion about family planning and an agreement to use contraception is not a necessary precondition for adoption of certain methods, its absence may be a serious impediment. Inter- spousal communication is therefore an important intermediate step along the path to eventual adoption and sustained use. Lack of discussion may reflect a lack of personal interest, hostility to the subject or a customary reticence in talking about sex-related matters. Information is presented in Table 4.18 on the number of times married women discussed family planning matters with their husbands in the year preceding the survey. 65 Table 4.18 Discussion of family olannin~ bv couoles Percent distribution of currently married women who know a contraceptive method by the number of times family planning was discussed with their husband in the year preceding the survey, according to current age, Zambia 1996 Age Never Number of times family planning discussed Number Once or More Nothing of twice often ascertained Total women 15-19 44.0 35.9 20,1 0.0 100,0 467 20-24 34.6 34.7 30.5 0.2 100.0 1,191 25-29 27.5 35.1 37.2 0.2 100.0 959 30-34 29.6 34.0 36.2 0.2 100.0 842 35-39 31.4 33.8 34.6 0.2 100.0 558 40-44 43.5 25.6 30.8 0.2 100.0 372 45-49 62.6 25.2 12.0 0.2 100.0 333 Total 35.5 33.3 31.1 0.2 100.0 4,720 Note: Figures may not add to 100.0 due to rounding. More than one-third of women said they never discussed family planning with their partners in the previous year, while one-third discussed the subject once or twice, and 31 percent discussed it more often. Women in the oldest age group (45-49) are the least likely to discuss family planning with their spouses. 4.16 Attitudes of Couples Toward Family Planning In countries where contraceptive use is limited, widespread disapproval of contraception may act as a major barrier to adoption of methods. In the ZDHS, women were asked if they approved of a couple using family planning and, if they were married, whether they thought their husband approved of the use of family planning. With regard to the information on the husband's attitude, the wife may be wrong about her spouse's opinion. Her perception is important, however, since it may be a factor in shaping her behaviour. In addition to concem about the data on husband's attitude, the attitudinal information is not suitable for precise or detailed interpretation because no attempt is made to uncover the depth of feeling or its origin. Nevertheless, the data portray the general climate of opinion. This information will be useful in the formation of family planning policies, by indicating the extent to which further education and publicity is needed to gain acceptance of the principle of contraception. Table 4.19 shows that 56 percent of married women say that not only do they approve of family planning use, but that their husband approves as well. Sixteen percent of married women report that they approve of family planning but their husband does not. A very small percentage of women said the opposite---that they disapprove while their husband approves. In general, opposition to contraceptive use is not widespread: 84 percent of married women approve, I 0 percent disapprove, and 5 percent are unsure. Fifty- eight percent of women say their husband approves of family planning use, while about 22 percent say their husband disapproves, and roughly 15 percent are unsure of their husband's attitude. 66 Table 4.19 Wives' perceptions of their husbands' attitudes toward family vlannine Percent distribution of currently married women who know of a contraceptive method by wife's attitude toward family planning, and wife's perception of her husband's attitude toward family planning, according to selected background characteristics, Zambia 1996 Wife Wife Wife Wife approves, approves, disap- disapproves, husband husband's proves, Both husband's Number Background Both dJsap- attitude husband disap- attxtude Wife Wife Husband of characteristic approve proves unknown approves prove unknown unsure Missing Total approves approves ~ women Age 15-19 49.3 10.7 21.5 1.i 5.6 3.7 7.8 0.2 100.0 81.5 51 4 467 20-24 584 14.6 14.8 1.3 4.8 1.2 4.9 0.1 100.0 87.8 606 1,191 25-29 62.8 16.3 8.9 0,7 5.1 2.5 3.7 0 0 100.0 88 0 63 8 959 30-34 60.8 16.6 10.5 1.2 4.6 1.7 4 4 0.1 100.0 87 9 62.9 842 35-39 55.8 17.2 9.0 2.5 6.3 4.2 4,9 0.1 100.0 820 58.8 558 40-44 46.4 18.3 14.0 1.3 11.4 2.6 5.9 0.0 100.0 78.8 49 7 372 45-49 35.1 17.1 14.6 2.5 11.6 5.6 13.6 0.0 100.0 66.7 40.1 333 Residence Urban 64.6 16.2 10.6 1.1 3.8 1 0 2.7 0.1 100.0 91,5 66.2 1,888 Rural 50.1 15.4 14.2 1.6 7.6 3.7 7.4 0.1 100.0 79 6 52.9 2,833 Province Central 48.4 17.7 9.9 2.3 10.8 3.8 7.0 0.0 100.0 76,0 52 2 414 Copperbelt 63 6 14.3 14.6 0.5 4.1 0 6 2.1 0.2 100 0 92 7 64.1 859 Eastern 57 3 13.7 10,9 1.5 5.5 1 2 9.9 0.1 100,0 81 8 60.5 724 Luapula 426 12.8 18.7 1.3 8.7 59 10.0 0.0 100,0 742 45.4 440 Lusaka 63.4 16.9 11,1 1.4 3.8 0.8 2.5 00 100.0 91.5 653 765 Northern 55.1 16.7 9.6 2.1 5.3 3,4 7,7 0.2 100.0 81,3 59.7 547 North-Western 76.0 16.8 2.7 0.3 3.6 0.3 0 0 0 3 100.0 95.6 76 3 185 Southern 54.1 19.8 12.9 I.I 4.8 5,0 2 4 0.0 100.0 86.8 55 3 5(}2 Western 32.4 13.2 23.7 2.2 13.9 5.6 9.0 0.0 100.0 69.2 35 1 285 Education No education 38.0 15.7 16.7 1.1 10.1 5.1 133 0.0 100.0 70.4 41 1 750 Primary 53.7 16.8 13.6 1.7 6.5 2.6 5 0 0.1 100.0 84 1 56.2 2,970 Secondary 74.2 13.2 7.9 0.6 1.8 0.8 1 5 0.0 100.0 95 3 75 3 888 Higher 89.8 7.2 1.2 0.0 1.2 0.0 0 6 0.0 100.0 98.2 90 4 I 12 Total 55.9 15.7 12.8 1.4 6.1 2.6 5.6 0.1 100.0 844 58.2 4,720 t Includes cases m which the wife is unsure about her own attitude, but knows her husband's The proportion of wives and husbands who approve of family planning use is slightly lower at the younger and older age groups. Urban residents are more likely to approve of contraceptive use than their rural counterparts. Approval of family planning use is highest in Copperbelt, Lusaka, and North-Westem Provinces, as well as among those with the highest education. The fact that both women and men in the same households were interviewed provides an opportunity to compare responses obtained from currently married women with those obtained from their husbands. Table 4.20 shows the percent distribution of the 822 matched couples by their perception of their spouse's attitudes, according to the spouse's actual attitude toward family planning. The first thing to note in the table is the fact that 85 percent of both husbands and wives say they approve of family planning, while about 10 percent do not approve, and 5 percent are unsure. Generally speaking, when wives and husbands believe that their spouse approves of family planning they are correct; however, when they believe that their spouse disapproves, they are wrong. For example, among husbands whose wives perceived them as approving of family planning, 88 percent did indeed approve. However, among husbands whose wives believe them to disapprove of family planning, 76 percent say they actually 67 approve. These results imply that greater communication about family planning could improve these false preceptions. An alternative explanation is that respondents who disapprove of family planning are reluctant to report this view to interviewers. Table 4.20 Snouse's perception of soouse's aooroval of familv nlannine Percent distribution of couples by husband's and wife's actual attitude towards family planning, according to their spouse's perception of their attitude, Zambia 1996 Perception Spouse's actual attitude Number Disap- of Approves approves Unsure Total couples Wife's perception of husband's attitude Approves 87.7 7.7 4,5 100.0 514 Disapproves 76.3 18.4 5.3 100.0 152 Don't know 82.6 10.9 6.5 100.0 156 Total 84.6 10.3 5.1 100.0 822 Husband's perception of wife's attitude Approves 88.6 6.9 4.4 100.0 623 Disapproves 80.0 15.1 4.9 100.0 87 Don't know 69.4 18.4 12.2 100.0 112 Total 85.1 9.3 5.5 100.0 822 68 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, post-partum 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 fertility. Populations in which age at marriage is low also tend to experience early childbearing and high fertility; 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 post-partum amenorrhoea and post-partum abstinence and the level of secondary infertility. 5.1 Marital Status Table 5.1 shows data on the marital status of female and male respondents at the time of the survey. In this table, the term "married" is intended to mean legal or formal marriage, while "living together" designates an informal union. In subsequent tables, these two categories are combined and referred to collectively as "currently married" or "currently in union." The widowed, divorced, and no longer living together (separated) make up the remainder of the "ever-married" or "ever in union" category. Six in ten Zambian women of reproductive age are currently in a marital union. The 1992 ZDHS reported a similar figure (61 percent); the same is tree for the proportion never married (25 percent). The proportion of women who have never married drops drastically from 73 percent among women in their teens to 22 percent among women in their early twenties. On the other hand, the proportion divorced rises steeply after age group 15-19, where it stays relatively constant at about 7-12 percent among women 20 years and older. The proportion widowed rises gradually, and reaches 14 percent for women aged 45-49. The proportion of women living together with a man and no longer living together (separated) varies little across age groups. In the case of men, overall, 44 percent have never married, more than half are married, and a small percentage are either living together or no longer in union. Very few men have been married at age 15-19, but by age 30 only 8 percent are still single. It is interesting to note that even in the oldest age group (55-59), nine in ten men are currently married, compared to only three-quarters of women age 45-49. 69 Table 5.1 Current marital status Percent distribution of women and men by current marital status, according to age, Zambia 1996 Current marital status Never Living Age married Married together Widowed Divorced WOMEN No longer Number hving of men/ together Total women 15-19 72.7 24.4 0.5 0,1 1,3 1.0 I00,0 2,003 20-24 22.0 65,2 0.7 2.3 6.8 3.0 100.0 1,830 25-29 9~5 74.3 1.0 2.6 9.3 3.2 100.0 1,286 30-34 2.8 78.3 1.0 5.5 9.6 2.8 100.0 1,081 35-39 1.3 75.7 1.5 7.7 10.8 2.8 100.0 758 40-44 1.2 73.0 0.7 10.9 12.4 1.8 100.0 568 45-49 0.7 74.2 0.1 13.8 9.7 1.6 100.0 494 Total 25.3 60.3 0.8 4.1 7.2 2.3 100.0 8,021 MEN 15-19 99.2 0.6 0.0 0.0 0.0 0.2 100.0 460 20-24 68.3 28.6 0.0 0.0 0.6 2.6 100.0 404 25-29 23.2 68.3 0.0 1.1 3 8 3.6 100.0 255 30-34 8.1 84.6 0.0 1.2 4.3 1.7 100.0 225 35-39 1.8 87.3 0.4 3.4 4.4 2.8 100.0 184 40-44 0.7 93.4 0.0 0.9 5.0 0.0 100.0 121 45-49 1.1 92.3 0.0 3.3 3.3 0.0 100.0 83 50-54 0.0 93.7 0.0 3.2 0.9 2.3 100.0 65 55-59 0.0 92.4 1.2 6.4 0.0 0.0 100.0 52 Total 44.0 51.0 0.1 1.I 2.1 1.7 Note: Figures may not add to 100.0 due to rounding. 100.0 1,849 5.2 Polygyny In Zambia, current marriages can be subdivided into polygynous and monogamous unions. This being the case, married women were asked in the ZDHS whether their husbands had other wives, and if so, how many. Seventeen percent of the currently married women are in polygynous unions. At all age groups, polygyny is more common in rural than in urban areas. Polygyny varies by province (Figure 5.1). The rate is between 11 percent to 20 percent in five of the nine provinces in Zambia, 22 percent or more in Northern and Eastern Provinces, while Southern Province has the largest percentage of women in polygynous unions (32 percent). On the other extreme, women in Copperbelt Province are the least likely to have co-wives. Among women age 20 and 44 years, polygyny decreases with increasing level of education (Table 5.2). The overall level of polygyny has changed little over the past few years. The proportion of currently married women in polygynous unions in 1992 was the same (17 percent) as in 1996. 70 3S 30 25 20 15 10 S 0 Percent Figure 5,1 Percentage of Currently Married Women in a Polygynous Union \ ZDHS 1996 5.3 Age at First Marriage ZDHS data show that half the women in Zambia marry before they reach age 18, and four in five marry before age 22. Cohort trends in age at marriage can also be described by comparing the distribution for successive age groups, as shown in Table 5.3. ~ The proportion of women married by age 15 decreased systematically from 26 percent among women age 45-49 to 4 percent among those 15-19. The reported median age at first union is 18.0 years for women age 20-49 years. The age at marriage appears to have increased over time from about 17 years among women now in their 40s to over 18 among women in their 20s. Another indication of the trend towards later age at marriage is the fact that the median age at first marriage among women age 20-49 has risen from 17.7 in 1992 to 18.0 in 1996. Men marry considerably later than women. While 70 percent of women have been married by age 20, only 16 percent of men 25-59 were married at the same age. Among men age 25-59, one in three marry before they are 22 years old and 62 percent were married before age 25 years. Table 5.4 presents a more detailed picture of the trends in the median age at marriage. 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 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, Lusaka, North- Western, and Western Provinces, whilst the increases in the median age at marriage among women in other 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. 71 provinces are less pronounced. Level of education attained is directly related to age at first marriage: the median age at first marriage is 16.7 years among women with no education compared with 20.8 years for women with secondary or higher schooling. Table 5.2 Polv~vnv Percentage of currently married women and men in a Zambia 1996 polygynous union, by age and selected background characteristics, Current age Background All All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ women men Residence Urban 3.8 5.3 8.9 12.2 12.7 13.0 15.9 NA 9.4 2.4 Rural 7.2 13.0 22.8 30.0 33.5 30.5 29.9 NA 22.3 13.4 Province Central 0.0 6.3 15,5 14.6 12.5 (13.8) (20.4) NA I 1.2 8.6 Copperbelt 0.0 4.3 8,9 11.0 16.6 9.4 (11.6) NA 8.5 1.1 Eastern 6.7 13.2 26.0 34.1 32.9 33.2 37.2 NA 24.3 16,9 Luapula (4.3) 11.8 8.3 22.1 29.3 (21.7) 13.0 NA 15.0 6.0 Lusaka 4.0 5.2 10.9 17.4 14.2 15.3 (23.9) NA 11.5 1.6 Northern 6.9 13.2 20.5 27.3 33.5 (36.9) (39.2) NA 22.2 14.5 North-Western 2.8 6.0 13.1 14.3 19.6 (18.4) (18.0) NA 12.0 6.9 Southern 23,5 20.9 29.9 38.1 49.0 (40.1) (40.1) NA 32.2 17.8 Western (5.4) 11.1 20.6 22.3 20.8 33.3 (25.0) NA 19.6 8.5 Education No education 9.2 17.7 23.6 30.9 29.7 26.1 25.5 NA 23.5 19.5 Primary 5.2 10.8 18.1 23.8 27.6 23.1 27.8 NA 18.0 11.1 Secondary+ 6.4 4.2 9,5 13.5 13.5 18.4 (7.9) NA 9.7 4.3 All women 6.0 10.0 16.6 22.5 25.1 22.8 25.6 NA 17.1 NA All men 0.0 7.3 4,5 9.3 7.3 8.4 11.9 16.2 NA 8,7 Note: Figures in parentheses are based on 25-49 unweighted cases. NA = Not applicable Table 5.4 and Figure 5.2 show that men marry at a later age than women. Data in the last column in Table 5.4 also indicate that men marry on average 6 years later than women. There are slight variations in the median age at first marriage among men by residence and education. 5.4 Age at First Sexual Intercourse While age at first marriage is often used as a proxy for first 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 5.5 and 5.6). (Note that the information on age at first sexual intercourse in Tables 5.5 and 5.6 parallels the information on age at first marriage in Tables 5.3 and 5.4). 72 Table 5.3 A~e at first marria2e Percentage of women and men who were first married by specific exact age and median age at first marriage, according to current age, Zambia 1996 WOMEN Percentage who were Percentage Median first married by exact age: who have Number age at never of first 15 18 20 22 25 married women marriage Current age 15-19 3.6 NA NA NA NA 72.7 2,003 a 20-24 8.9 44.2 64.3 NA NA 22.0 1,830 18.5 25-29 11.6 45.5 65.2 77.2 87.1 9.5 1,286 18.4 30-34 14.5 51.7 69.8 83.0 90.7 2.8 1,081 17.9 35-39 17.6 57.4 74.8 84.6 91.7 1.3 758 17.4 40-44 17.4 57.8 76.4 87.1 94.4 1.2 568 17.4 45-49 25.5 63.8 81.6 91.4 95.5 0.7 494 16.8 Women 20-49 13.7 50.4 69.4 80.6 87.0 9.5 6,018 18.0 Women 25-49 15.9 53.1 71.6 83.0 90.9 4.1 4,187 17.7 MEN Current age 20 Percentage who were Percentage Median first married by exact age: who have Number age at never of first 22 25 28 30 married men marriage 25-29 14.3 37.4 62.1 NA NA 23.2 255 23.4 30-34 15.7 36.5 61.8 77.3 86.4 8.1 225 23.3 35-39 16.1 34.5 64.3 79.8 86.7 1.8 184 23.5 40-44 20.3 33.1 57.1 80.7 86.7 0.7 121 23.8 45-49 13.7 27.6 62.8 83.4 88.7 1.1 83 23.6 50-54 13.2 23.9 67.4 85.2 91.3 0.0 65 23.6 55-59 20.2 37.5 52.7 72.6 76.4 0.0 52 24.6 Men 25-59 15.9 34.4 61.7 78.4 84.0 8.4 986 23.5 NA = Not applicable a Omitted because less than 50 percent of the women or men in the age group x to x+4 were first married by age x. In many cases, sexual activity precedes marriage. By age 18, 70 percent of the women age 20-49 have had sexual intercourse, whereas only 50 percent have been married. Similarly, by age 20, 85 percent of women had intercourse, while 70 percent have married (see Table 5.5). Overall, the median age at first sexual intercourse is about 16 years, which is about 2 years earlier than the median age at first marriage of about 18. Analysis of cohorts indicates that there has been little change in the median age at first sexual intercourse over time. This is corroborated by data from the 1992 ZDHS which showed a median age at first sexual intercourse of 16.3 among women age 20-49. In the case of men, by age 15 only one in four (24 percent) men age 15-59 years have had sexual intercourse compared to 90 percent by age 22 years. Like women, the percentage of men who have had sexual intercourse at different ages varies little by age group. 73 Table 5.4 Median a~e at first marnaee Median age at first marriage among women 20-49 years by current age, and selected background characteristics, and among men age 25-59 by background characteristics, Zambia 1996 Current age Women Women Men Background age age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 25-59 Residence Urban 19.7 19.5 18.6 17.6 17.9 16.7 18.7 18.3 24.4 Rural 17.8 17.7 17.5 17.3 16.9 16.9 17.5 17.4 22.8 Province Central 18.7 18.4 18.6 (18.i) (17.3) (17.0) 18.3 18.1 23.1 Copperbelt 18.8 18.7 18.7 17.7 17.1 (16.1) 18.2 17.9 24.0 Eastern 17.6 17.0 16.6 17.1 (17.4) (16.9) 17.2 17.0 22.0 Luapula 17.7 17.6 16.8 16.7 (16.7) (16.5) 17.2 16.9 22.8 Lusaka a 20.2 19.1 17.7 (18.2) (17.2) 19.1 18.7 24.7 Northern 17.7 17.9 17.7 (17.1) (18.0) (17.2) 17.7 17.6 23.9 North-Western 18.1 17.5 17.0 (15.9) (16.1) * 17.2 16.7 22.8 Southern 18.4 18.5 17.7 17.2 (17.9) (17.5) 18.0 17.9 23.0 Western a 20.2 (19.5) 18.3 (16.9) (16.9) 19.0 18.5 24.9 Education No education 17.4 17.0 16.3 16.5 16.6 16.9 16.8 16.7 22.4 Primary 17.7 17.6 17.3 16.8 17.0 16.6 17.3 17.2 22.9 Secondary+ a 21.4 20.9 * (20.2) * a 20.8 24.2 All women 18.5 18.4 17.9 17.4 17.4 16.8 18.0 17.7 23.5 Note: The median age for women 15-19 could not be determined because some women may still get roamed before reaching age 20. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed, while figures in parentheses are based on 25-49 women. Omitted because less than 50 percent of the women in the age group x to x+4 were first married by age x If 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 5.6 indicates some trend toward later initiation of sexual intercourse among younger urban women. While age at marriage has been increasing, the age of initiating sexual activity has remained almost unchanged, especially in Lusaka and Luapula Provinces. The median age at first sexual intercourse is lowest among women in North-Western Province (15.1 years for women 25-49 years), and in Southern and Western Provinces (16.0 years or younger). Women with secondary or higher education start having sexual intercourse later than women with less than secondary education. Like women, urban men initiate sexual intercourse at a later age than rural men. Regional variations in this median are minimal. Overall, the median age at first sexual intercourse for men increases with increasing level of education. 74 Figure 5.2 Median Age at Marriage by Current Age 25 23 21 19 17 15 Years Zambia 25-29 30-34 35-39 40-44 45-49 Current Age [~Men =Women I ZDHS 1996 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 5.7.1 presents data on sexual activity among women in the four weeks preceding the survey by background characteristics and the length of abstinence among sexually inactive women. Women are considered to be sexually active if they had intercourse at least once in the four weeks preceding 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. Just over half of women (52 percent) were sexually active in the month prior to the interview, while 13 percent were abstaining for post-partum reasons and 22 percent were abstaining for other reasons. Teenagers and women who have never been in a union are less likely to be sexually active than older women and women who are in a union. There are slight variations in the proportion of women who are sexually active according to various background characteristics such as marriage duration and residence, As expected, women who are using a method of family planning are more likely to be sexually active than those who are not. 75 Table 5.5 Aee at first sexual intercourse Percentage of women and men 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 1996 Current age 15 Percentage who had Percentage Number Median first intercourse by exact age: who of age at never had women/ first 18 20 22 25 intercourse men intercourse WOMEN 15-19 21.7 NA NA NA NA 41.7 2,003 a 20-24 21.7 69.1 86.2 NA NA 5.2 1,830 a 25-29 24.6 69.4 84.4 90.4 94.4 0.5 1,286 16.4 30-34 25.4 68.6 83.2 90.3 93.3 0.5 1,081 16.4 35-39 26.9 71.0 84.4 90.1 93.1 0.1 758 16.3 40-44 23.7 69.5 84.2 89.7 93.7 0.0 568 16.6 45-49 28.7 71.5 85.8 91.2 94.0 0.0 494 16.3 Women 20-49 24.4 69.5 84.8 90.7 93.3 1.8 6,018 16.4 Women 25-49 25.6 69.7 84.2 90.3 93.7 0.3 4,187 16.4 MEN 15-19 39.3 NA NA NA NA 33.8 460 a 20-24 31.9 70.2 82.6 NA NA 10.6 404 16.0 25-29 28.7 69.4 83.0 91.5 98.1 0.9 255 16.4 30-34 28.4 69.9 80.1 90.6 93.0 1.4 225 16.0 35-39 24.7 64.4 83.7 92.4 96.1 0.0 184 16.6 40-44 13.0 59.2 80.0 90.8 96.3 0.0 121 17.3 45-49 15.6 42.9 65.6 83.9 92.7 0.0 83 18.6 50-54 20.8 50.4 67. I 87.0 94.5 0.0 65 18.0 55-59 17.5 65.9 84.4 89.0 92 4 0.0 52 16.6 Men 25-59 23.7 63.7 79.7 90.3 95.3 0.6 986 16.7 ~4A = Not applicable Omitted because less than 50 percent in the age group x to x+4 had had intercourse by age x Among men age 15-59 years, 56 percent were sexually active in the four weeks preceding the survey, 33 percent were not sexually active in the same period, and 11 percent had never had sexual intercourse (Table 5.7.2). Sexual activity varies with age, marital status, level of education, and residence. Men in polygynous unions, rural men, and better educated men are more sexually active than other men. 76 Table 5.6 Median ane at first intercourse Median age at first intercourse among women 20-49 years by current age and selected background characteristics, and among men age 25-59 by background characteristics, Zambia 1996 Current age Women Women Men Background age age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 25-59 Residence Urban 17.0 17.1 16.8 I6.9 16.9 16.3 16.9 16.9 17.4 Rural 16.2 15.9 16.1 16,0 16.4 16.2 16.1 16.1 16.0 Province Central 16.7 16.3 16.7 (16.7) (16.4) (16.2) 16.5 16.4 17.6 Copperbelt 16.9 16.9 16.6 16.8 (16.5) (15.7) 16.8 16.7 17.3 Eastern 16.6 16.1 15.9 16.5 (16.9) (16.2) 16.4 16.2 15.8 Luapula 16.4 16.5 16.0 16.4 (16.7) (16.3) 16.3 16.3 15.9 Lusaka 17.0 16.9 17.4 16.5 (17.0) (16.8) 16.9 16.9 17.8 Northern 16.7 17,0 17.1 (16.3) (17.6) (16.9) 16.9 17.0 15.1 North-Western 15.7 15.2 15.3 (14.7) * * 15.3 15.1 15.8 Southern 15.9 15.8 16.0 (15.7) (16,0) (16.4) 15.9 15.9 16.6 Western 15.7 16.0 16.2 15.7 16.2 (15.7) 15.9 16.0 17.9 Education No education 16,4 15.7 15.8 15.7 16.4 16,3 16.1 16.0 16.3 Primary 16.0 15.9 15.9 15.9 16.2 16.0 16.0 15.9 16.4 Secondary+ 17.9 18.0 18.5 18.0 17,7 * 18.0 18.1 17.0 All women/men 16.6 16.4 16.4 16.3 16.6 16.3 16.4 16.4 16.7 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed, while figures in parentheses are based on 25-49 unweighted cases. 5.6 Post-partum Amenorrhoea, Abstinence, and Insusceptibility Post-partum protection from conception can be prolonged by breastfeeding, which can lengthen the duration of ameuorrhoea (the period following a birth, but prior to the return of menses). Protection can also be prolonged by delaying the resumption of sexual relations. Table 5.8 presents the percentage of births whose mothers are post-partum amenorrhoeic and abstaining, as well as the percentage of births whose mothers are classified as still post-partum insusceptible to pregnancy for either reason; data are presented by months since the birth. On average, women are amenorrhoeic for more than 1 year (12.5 months) and abstain from sexual relations following a birth for 8.3 months. The average duration of the post-partum insusceptible period is 14.7 months. Half of women in Zambia remain amenorrhoeic for at least 10 months following a birth; but only 22 percent abstain from sexual intercourse for this duration. The proportion remaining amenorrhoeic 18 months after birth drops significantly to 25 percent, and those still abstaining to 20 percent. Overall, three-quarters of women become susceptible to pregnancy within 20-21 months of giving birth. The median durations of post-partum amenorrhoea, abstinence, and insusceptibility are presented in Table 5.9 by background characteristics of the mothers. Post-partum amenorrhoea generally lasts slightly longer among older (age 30 and above) than younger mothers (14 months compared to 11 months), and among 77 Table ~.7.1 Recent sexual activity: women Percent dJstribution of women by sexual activity in the four weeks preceding the survey, and among those not sexually active, the length of time they have been abstaining and whether post-partum or not post-partum, according to selected background characteristics and contraceptive method currently used, Zambia 1996 Not sexually active in last 4 weeks Background Sexually Abstaining Abstaining characteristic/ active (post-partum) (not post-partum) Never Number contraceptive in last had of method 4 weeks 0-1 years 2+ years 0-1 years 2+years Missing sex Total women Age 15-19 26.9 8.8 0.6 18.7 2.8 0.4 41.7 100.0 2,003 20-24 53.5 17.1 3.2 17.3 2.3 1.3 5.2 J00.0 1,830 25-29 62.3 12.7 2.2 18.1 2.6 1.6 0.5 100,0 1,286 30-34 65.4 11.9 1.7 16.6 2.5 1.5 0.5 100.0 1,081 35-39 62.9 12.9 1.9 14.7 5.6 2.0 0.1 100.0 758 40-44 61.7 4.9 2.7 18.5 8.9 3.3 0.0 100.0 568 45-49 60.6 0.6 1.4 18.6 17.3 1.5 0.0 100.0 494 Duration of union (years) Never married 14.7 6.5 2.8 24.3 5.1 0.2 46.5 1000 2,032 0-4 64.1 19.1 0.9 13.8 0.8 1.2 0.0 100.0 1,463 5-9 62.7 14.8 1.7 16.4 2.3 2.1 0.0 100.0 1.357 10-14 68.2 I 1.7 2.0 14.8 2,0 1.3 0.0 100.0 976 15-19 66.6 13.0 1.6 13.7 3.1 2.0 0.0 100.0 787 20-24 63.1 8.9 2.2 15.4 6.6 3.7 0.0 100.0 625 25-29 63.6 4.2 2.5 17.3 11.8 11.6 0.0 100.0 482 30+ 58.8 0.6 1.3 20.9 16.4 2.0 0.0 100 0 300 Residence Urban 49.0 8.3 1.8 19.6 5.2 1.4 14.8 100.0 3,604 Rural 54.1 13.8 2.1 16,0 3.4 1.4 9.3 100.0 4,417 Province Central 56.3 9.0 2.4 16.8 4.0 2.1 9.4 100 0 653 Copperbelt 48.9 7.4 1.9 21.5 4.8 0.8 14.6 100.0 1,588 Eastern 55.5 12.5 1.3 16.8 3.7 1.9 8.3 100.0 1,075 Luapu/a 53.2 7.9 0.8 17.5 4.4 I.O 15.2 100.0 726 Lusaka 49.8 8.1 1,1 18.6 5.7 1.9 14.8 100.0 1,403 Northern 40.8 19.3 4.0 16.1 4.7 2.0 13.1 100.0 872 Noah-Western 54.7 21.9 1.8 10.9 2.5 1.4 6.8 100.0 288 Southern 61.4 I 1.4 1.0 14.3 2.6 0.5 8 7 100.0 816 Western 52.0 16.7 4.5 17.1 2.4 0.6 6.4 100.0 600 Education No education 56.3 12.0 1.9 17.4 6.1 1.3 4.9 100.0 1,067 Primary 54.2 12.8 1.7 15.8 3.3 1.5 10.8 100.0 4,721 Secondary 43.7 8.0 2.6 21.4 4.8 1.3 18.5 100.0 2,007 Higher 52.0 7.0 0.5 24.2 9.0 1.5 5.8 100.0 226 Contraceptive method t No method 46.5 11.6 2.2 18.6 5.0 1.5 14.5 100.0 6,483 Pxll 84.7 0.9 0.6 12.2 0.0 1.2 0.3 100.0 416 Female stenhsation 81.1 3.2 0.0 10.8 5.0 0.0 0.0 100.0 I 14 Natural family planning 79.8 5.1 0.0 14.1 0.0 1.1 0.0 100.0 124 Other 66.8 16.6 1,4 14.2 0.4 0.6 0.0 100.0 858 Total 51,8 11,3 1.9 17.6 4.2 1.4 t Includes 21 users of IUCD 11.8 100,0 8,021 78 rural (14 months) compared to urban mothers (8 months). Mothers in Western, North-Western, Luapula, and Eastern Provinces show a particularly long median duration of amenorrhoea (13.7 months or longer), while those in Western, North-Western, and Northern Provinces tend to abstain for considerably longer periods (9-13 months) after a birth than women in other provinces. Despite the long amenorrhoeic and abstinence periods in Northern and North- Western Provinces, fertility is high (see Chapter 3). Table 5.7.2 Recent sexual activity: men Percent distribution of men by sexual activity in the four weeks preceding the survey, according to selected background characteristics, Zambia 1996 Not Sexually sexually active active Background in last in last Never Number characteristic 4 weeks 4 weeks had sex Total of men Age 15-19 27.9 38.3 33.8 100.0 460 20-24 49.5 39.9 10.6 100.0 404 25-29 66.1 33.0 0.9 100.0 255 30-34 71,0 27.6 1,4 100,0 225 35-39 76.4 23,6 0,0 100.0 184 40-44 75.3 24.7 0.0 100.0 121 45-49 70.2 29.8 0.0 100.0 83 50-54 77,1 22.9 0,0 100.0 65 55-59 64.9 35.1 0.0 100.0 52 Marital status Never married 32.9 42,1 25,0 100.0 814 Polygynous union 85.7 14.3 0.0 100.0 82 Monogamous union 76.3 23.7 0.0 100.0 862 Formerly married 38.4 61.6 0.0 100.0 91 Residence Urban 53,8 36.5 9.7 100.0 852 Rural 57,4 30,5 12.1 100,0 997 Education No education 55.6 37.7 6.7 100.0 127 Primary 53.5 31.5 15.1 100.0 938 Secondary 57.1 35.5 7.4 100.0 686 Higher 68.6 28.6 2,9 100.0 98 Total 55.8 33.2 11,0 100.0 1,849 Mother's education has a direct relationship with the duration of amenorrhoea; 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 8 months for women with secondary education and to 4 percent for women with higher education. 79 Table 5.8 Post-vartum amenorrhoea, abstinence, and insusceotibilitv Percentage of births in the three years preceding the survey for which mothers are post-partum amenorrhoeic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Zambia 1996 Number Months Amenor- lnsus- of since birth rhoeic Abstaining ceptible births < 2 96.6 92.9 97.8 193 2-3 92.0 70.3 94.8 267 4-5 81.1 46.5 85.0 236 6-7 68.7 32.9 75.4 210 8-9 65.5 32.3 71.6 223 10-11 50.7 22.1 58.4 270 12-13 47.9 22.7 55.7 288 14-15 39.8 21.3 49.6 251 16-17 33.6 14.6 40.2 247 18-19 25.1 202 35.9 219 20-21 19.1 13.8 25.3 246 22-23 10.1 9.2 15.7 255 24-25 6.0 9.1 13.6 294 26-27 2.0 8.5 9.4 237 28-29 0.6 4.7 5.3 241 30-31 3.7 7.6 10.6 191 32-33 0.8 4.3 5.0 243 34-35 1.6 2.7 4.1 251 Total 35.2 23.5 41.3 4,362 14.1 15.3 Median 11.5 4.7 Mean 13.2 9.0 Prevalence/ I Incidence mean 12.5 8.3 14.7 1 The prevalence-incidence mean is borrowed from epidemiology and is defined as the number of children whose mothers are amenorrhoeic (prevalence) divided by the average number of births per month (modance). 5.7 Terminat ion 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 5.10 presents an indicator of decreasing exposure to the risk of pregnancy for women age 30 and above, the prevalence of menopause, which includes women who are neither pregnant nor post-partum amenorrhoeic, but have not had a menstrual period in the six months preceding the survey. Overall, 8 percent of women 30-49 are menopausal according to this indicator. While the proportion is 2 percent or less among women in their 30s, it increases to 16 percent among women 44-45 years. By age 48-49, half of women have stopped menstruating. 80 Table 5.9 Median duration of oost-oartum insuscentibilitv bv background characteristics Median number of months of post-partum amenorrhoea, post-partum abstinence, and post-partum insusceptibility, by selected background characteristics, Zambia 1996 Post-partum Number Background Post-partum Post-partum insuscep- of characteristic amenorrhoea abstinence tibility women Age <30 10.5 4.8 13.4 2,957 30+ 13.8 4.5 15.0 1,404 Residence Urban 8.4 4.3 9.5 1,682 Rural 13.9 5.0 15.8 2,680 Province Central 8.3 3.9 9.5 363 Copperbelt 9.4 3.1 10.8 797 Eastern 13.7 5.0 15.4 677 Luapula 14.0 2.6 15.1 411 Lusaka 8.7 4.5 9.5 638 Northern 12.9 8.7 16.3 536 North-Western 14.1 9.8 18.9 177 Southern 12.3 4.3 15.8 477 Western 14.7 13.1 18.3 286 Education No education 13.9 5.3 15.5 609 Primary 12.3 4.7 14.5 2,798 Secondary 7.9 4.4 9.0 878 Higher 3.8 3.4 4.3 76 Total 11.5 4.7 14.1 4,362 Note: Medians are based on current status. Total includes one woman for whom information on education is missing. Table 5.10 Termination of exnosure to the risk of ore~nancv Indicators of menopause among currently married women age 30-49, Zambia 1996 Menopause I Age Percent Number 30-34 0.6 857 35-39 1.8 586 40-41 4.5 183 42-43 10.8 168 44-45 15.6 134 46-47 26.9 137 48-49 52.1 163 Total 8,3 2,228 I Percentage of currently married women who are not pregnant, not post-partum amenorrhoeic, and whose last menstrual period occurred six or more months preceding the survey or who report that they are menopausal. 81 CHAPTER6 FERTILITY PREFERENCES Three questions were asked in the 1996 ZDHS which allow an assessment of the need for contraception and of levels of unwanted fertility. First, women and men were asked whether they wanted to have another child. Respondents who wanted more children were asked how long they would prefer to wait before having the next child. Finally, women and men were asked how many children they would like to have if they could start afresh. Interpretation of data on fertility preferences has always been the subject of controversy. Survey questions have been criticised on the grounds that answers are misleading because: • They reflect unformed ephemeral views, which are held with weak intensity and little conviction; and They do not take into account the effect of social pressures or the attitudes of other family members, particularly the husband who may exert a major influence on reproductive decisions. Also, women need the means to fulfill their desires. The inclusion of women who are currently pregnant complicates the measurement of views on future childbearing. For these women, the question on desire for more children is rephrased to refer to desire for another child, after the one that they are expecting. To take into account the way in which the preference variable is defined for pregnant women, the results are classified by number of living children, including the current pregnancy as equivalent to a living child. Women who have been sterilised for contraceptive purposes are treated as wanting no more children. 6.1 Fertility Preferences In the 1992 and 1996 ZDHS surveys, 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 if she wanted to have 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. Two-thirds of married women in Zambia want to have another child; however most of these women (39 percent of all married women in 1996) want to wait two or more years before having their next birth (Figure 6.1 ). The percentage of women who want no more children or have been sterilised has increased from 24 percent in 1992 to 28 percent in 1996. The majority of married women want either to space their next birth (want a child later) or to limit childbearing altogether (want no more children). These women are potentially in need of family planning services. Table 6.1 shows that the desire for more children declines as the number of living children increases. There is a sizeable disparity in the fertility preferences of men and women; women want to limit births earlier than men. Whereas 62 percent of women with six or more children want no more, the corresponding percentage of men is 41 percent (Figure 6.2). Women would rather have their first child sooner than men; nine in ten women with no children want to have a child within two years, while among men the proportion is 58 percent. Figure 6.2 also shows there was little overall change in fertility preferences between 1992 and 1996. 83 T~Ie 6.1 Fertility oreferences bv number of livin~ ehildreq Percent distribution of currently married women and men by desire for more children, according to number of living children, Zambia 1996 Desire for Number of living children 1 children 0 1 2 3 4 5 6+ Total WOMEN Have another soork 2 86.3 36.7 28.0 Have another later2 3.4 53.6 54.9 Have another, undecided when 1.6 2,4 1.4 Undecided 0.7 1.9 1.6 Want no more 1.5 2.9 11.5 Sterilised 0,2 0,4 0.6 Declared infecund 6.3 2.1 2,0 Missing 0.0 0.0 0,0 Total 100.0 100.0 100.0 Number of women 343 883 881 20.3 18.0 11.5 5,9 25.2 50.8 44,9 29.7 15,3 38.8 1.0 0.5 1.0 0.5 1.2 2,7 3.6 4.3 3,3 2.6 22.1 28.7 45.6 61,9 26.4 1.1 1.9 1.9 6.5 2.1 1.8 2.3 5.7 6.4 3.6 0,0 0.0 0.3 0.1 0.0 100.0 100.0 100.0 100.0 100.0 771 552 476 996 4.902 MEN Have another soort. 2 57.5 42.5 35.2 35.8 Have another later2 32.4 51.8 49.5 47.6 Have another, undec?tded when 5,6 1,1 3,5 1.5 Undecided 0,0 0.0 1,6 4,0 Want no more 1.0 1.0 8.2 8.4 Sterilised 0.0 0.0 0.0 0.5 Declared infecund 3.4 3.6 2.0 2.2 Total 100.0 100,0 I00.0 I00.0 Number of men 72 138 151 137 31.2 20.4 18.8 31.7 32.2 31.8 22.0 37.3 3 .g 1.3 2.9 2.7 3.9 4.0 5.0 3.0 23.7 36,8 40.5 19.8 2.2 1,5 3.5 1.4 2.9 4.2 7.3 4.1 100.0 100.0 100.0 100,0 97 98 252 944 ] Includes current pregnancy 2 Want next birth within two years s Wartt to delay next birth for two or more years F igure 6.1 Fer t i l i ty P re ferences among Cur rent ly Mar r ied Women 15-49 Want no more* 28% Want a child later 39% (after 2 or more yrs) * Includes sterllised women ZDHS 1996 84 80 Figure 6.2 Percentage of Currently Married Women and Currently Married Men Who Want No More Children by Number of Living Children Percent 60 40 20 Zambla o 1 2 3 4 5 6 Number of Living Children ~2~Women llllMen j Note: Includes stedlised women and men ZDHS 1996 Table 6.2 shows the fertility preferences of women by age. The desire to have another child within two years declines with age, while the desire to limit childbearing increases with age. The proportion of women who want to have another child soon declines from 34 percent among women 15-19 years to 7 percent among women 45-49 years. Conversely, the percentage of women who do not want to have another child increases from 3 percent among women age 15-19 years to 61 percent among women age 45-49 years. Table 6.2 Fertilitv t~references bv aee Percent distribution of currently married women by desire for more children, according to age, Zambia 1996 Desire for Age of woman children I5-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon L 34.0 28.9 28.3 27.8 20.9 13.9 7.1 25.2 Have another later 2 57.9 59.2 50.3 32.8 17.8 5.7 0.8 38.8 Have another, undecided when 3.6 1.3 0.4 0.9 I. 1 1.5 0.6 1.2 Undecided 1.9 2.3 2.3 3,8 3.9 3.0 0.2 2.6 Want no more 2.6 7.9 18.1 30.8 48.7 56.9 61.1 26.4 Sterilised 0.0 0.0 0.2 1.4 4.0 10.1 6.2 2.1 Declared infecund 0.0 0.4 0.4 2.4 3.6 8.8 23.7 3.6 Missing 0.0 0.0 0.0 0.2 0.0 0.0 0.2 0.0 Total 100.0 100.0 100.0 100.0 100.0 I00.0 100.0 100.0 Number of women 498 1,207 969 857 586 419 367 4,902 1 Want next birth within two years 2 Want to delay next birth for two or more years 85 The fact that the 1996 ZDHS included interviews of men allows the linking of data from women and their husbands or partners. These data can be useful in comparing the fertility desires of couples. Table 6.3 shows the distribution of monogamous couples by desire for more children. In 60 percent of couples, both spouses want more children. The percentage of couples in which husbands want more children but wives do not (10 percent) is more than twice as high as the percentage of couples in which wives want more children but husbands do not (4 percent). Seventeen percent of couples agree on their desire not to have any more children. Not surprisingly, the highest level of agreement occurs among couples with no children, 96 percent of whom agree that they want a child. Table 6.3 Desire for more children amon~ monotzamous counles Percent distribution of monogamously mamed couples by desire for more children, according to number of living chddren, Zambia 1996 Husband Wife Both Number of Both more/ more/ want Husband/ Number living want wife husband no wife of children more no more no more more int~cund Other I Total couples Same number 0 95.8 0.0 1.3 0.0 2.9 0.0 100.0 57 1-3 79.3 6.9 2.1 4.6 1.7 5.4 100.0 242 4-6 28.6 15.1 5.0 37.5 1.5 12.3 100.0 115 7+ (7.5) (10.1) (2.8) (58.0) (9.7) (11.9) 100.0 41 Different number Husband > wife 56.5 11.7 5.9 15.5 5.3 5. I 100.0 213 Wife > husband 50.8 15.0 0.9 17.0 5.5 10.7 100.0 54 Total 59.6 9.9 3.6 16.7 3.6 6.7 100.0 722 {qote: Figures in parentheses are based on 25-49 unweighted cases. Undecided or missing Women with different background characteristics differ as to their fertility preferences. Table 6.4 shows that urban women are more likely to want no more children than rural women, regardless of the number of children they already have. For instance, among women with two children, the proportion who want no more is twice as high in urban areas than in rural areas (18 percent vs. 7 percent). There are significant variations among provinces in the desire to stop childbearing. Overall, the percentage of women who want no more children is 30 percent or higher in Copperbelt, Lusaka, and Central Provinces, which may account in part for the fact that the latter two provinces have the lowest fertility in the country. There is a negative relationship between fertility preferences and level of education; women with no education are least likely to want to limit births, while those with higher levels of education are most likely to want no more children. 6.2 Need for Family Planning Services Unmet need for family planning is derived by comparing current use of contraceptive methods with the desire to have no more children or to delay the next pregnancy. Women who are fecund and who either wish to postpone the next birth or who wish to stop childbearing altogether but are not using contraception are classified as having an unmet need for family planning. Pregnant women are considered to have an unmet need for spacing or limiting if their pregnancy was mistimed or unwanted, respectively. Similarly, amenorrhoeic non-contracepting women are classified as having unmet need if their last birth was mistimed or unwanted. Women who are using family planning methods constitute met need for family planning services. Women with unmet and met need constitute the total demand for family planning. Demand for family planning and the percentage of demand that is satisfied differs among women of different backgrounds. 86 Table 6.4 Desire to litmt childbearine Percentage of currently married women who want no more children, by number of living children and selected background characteristics, Zambia 1996 Number of living children 1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 1.1 4.3 18.4 32.5 44.4 66.1 82.4 36.5 Rural 1.9 2.6 7.2 16.5 21.2 36.6 59.9 23.1 Province Central 0.0 3. I 15.4 30.5 36.0 53.2 67.3 31.9 Copperbelt 2.2 5.2 18.3 34.6 47.2 51.9 81.4 37.7 Eastern 0.0 2.1 4.5 14.2 18.0 44.5 63.6 22.3 Luapula 2.6 1.0 1.0 7.2 16.4 30.6 64.3 20.4 Lusaka 0.0 4.0 18.3 34.8 54.1 62.9 84.2 35.0 Northern 4.1 1.1 7.3 18.4 17.9 33.7 48.9 21.1 North-Western 10.4 8.8 5.8 15.6 26.6 51.4 63.4 26.6 Southern 0.0 2.4 16. 7 13.2 9.4 45.4 67.7 25.5 Western 2.1 4.1 7.2 22.4 40.4 50. I 59.4 26.4 Education No education 3.6 1.3 5.1 14.9 27.7 40.1 65.3 28.7 Primary 1.1 3.6 8.2 19.6 24.0 43.8 66.9 26.4 Secondary 1.8 4.0 21.5 31.l 51.4 67.8 79.3 32.1 Higher 0.0 0.0 44.2 71.3 85.5 80.8 100.0 52.2 Total 1.6 3.3 12.1 23.2 30.6 47.5 68.4 28.5 Note: Women who have been sterilised are considered to want no more children. t Includes current pregnancy Table 6.5 shows that 27 percent of currently married women have an unmet need for family planning services, 19 percent for spacing purposes and 8 percent for limiting child bearing. There has been some reduction in the level of unmet need since 1992, when unmet need for family planning constituted 33 percent of married women, 21 percent for spacing purposes and 12 percent for limiting births (Figure 6.3) (Gaisie et al., 1993:73). Unmet need for limiting generally increases with age, while unmet need for spacing decreases with age, resulting in a rather uniform level of total unmet need by age. Unmet need is almost identical among urban and rural women, while it is highest among women in Southern Province and lowest among women in North- Western and Western Provinces. As expected, women with higher education have lower unmet need than less educated women. If all unmet need were to be satisfied, more than half of currently married women (52 percent) would be using family planning (total demand). Just under half of total demand is currently being satisfied. Women in Nortb-Weslem and Lnsaka Provinces have the highest percentage of demand for family planning satisfied. On the other hand, demand for family planning services is least satisfied in Luapula Province (29 percent). Table 6.5 shows that unmet need, met need, and total demand for family planning services are lower among both unmarried women and all women than among mamed women. However, the percentage of demand satisfied is higher among unmarried women and all women than among married women. 87 Table 6.5 Need for family nlannimz services Percentage of currently married women with unmet need for family planning, met need for family planning, and the total demand for fanuly p lanning services, by selected background characteristics, Zambta 1996 Met need for Unmet need for family planning 2 Total demand for Percentage family planning I (currently using) family planning of demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing hmmng Total spacing bmitmg Total fled women Age 15-19 244 0.8 25.2 167 0.2 16.9 41.1 1.0 42.1 40 1 498 20-24 26,2 1.3 27.5 22 9 1.7 24.6 49.2 3.0 52.1 47.2 1,207 25-29 23.6 2.6 26 2 22.1 6.3 28.3 45.6 8.9 54 6 51.9 969 30-34 18.8 7.8 26.7 14.6 13.3 27.9 33.5 21.1 54 6 51.2 857 35-39 11.6 196 31.2 10.1 21.1 31.2 21 7 40.7 62.4 500 586 40-44 4.4 24 3 28.7 3.6 26.5 30.0 8 0 50.7 58.7 51.1 419 45.49 0.4 15.0 15.4 0.8 17.1 17.8 I 1 32.1 33.2 53.6 367 Residence Urban 16.9 9.7 26.6 18 1 15.2 33.3 35.0 24.9 59.9 55 6 1,972 Rural 19 9 6.6 26.5 14 3 6.6 20.9 34.2 13.2 47.4 44 I 2,930 Province Central 19.4 10.5 29,9 9.8 7.7 17,4 29.2 18.1 47.3 36.8 419 Copperbelt 18.2 10.2 28.4 15.2 14.6 29.8 334 24.8 58.2 51.1 910 Eastern 21.8 7.1 28.9 15.7 5.5 21 1 37.5 125 50.0 42.3 764 Luapula 20.9 5.2 26.2 5.5 5 4 10.9 26.4 10 6 37. I 29.4 448 Lusaka 15.1 8.4 23.5 19.4 15.9 35.3 34.5 24 3 58.9 60.0 796 Northern 18.5 6.6 25.1 25.1 7.9 33.0 43.6 14.4 58.1 568 552 North-Western 13.2 4.7 17.9 28.5 13.2 41.7 41.7 17.8 59.6 70.0 197 Southern 24.6 6 9 31.5 13.4 8.5 21.9 38 1 15.3 53.4 41.0 518 Western 10.8 7.5 18.2 11.5 7.3 18.7 22.2 14.7 37.0 50.7 298 Education No educauon 15.2 9 2 24.4 10.3 6.8 17.1 25 5 16.0 41.5 41.2 803 Primary 20.4 7.6 28.1 14.8 86 23.4 35.2 16.2 51.4 45.5 3,053 Secondary 17 1 7.4 24.5 23 8 14.1 37.9 40.9 21.5 62.4 60.7 924 Hxgher 105 7.0 17.4 180 37.4 55.4 28.4 44.4 72.8 76.1 122 Current ly marr ied women 18.7 7.8 26.5 15.8 10.0 25.9 34.5 17.9 52.4 49.4 4,902 Unmarried women 4.5 0.9 5.4 6.1 2.5 86 10.7 3.4 14.1 61.4 3,119 All women 13.2 5.1 18.3 12 1 7 1 19.2 25.2 12.2 37 5 51 1 8,021 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrho¢~c women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning but say they want to wait two or more years for their next bmh. Also included in unmet need for spacing are women who are unsure whether they want another ehdd or who want another child but are unsure when to have the birth Unmet need for hmttmg refers to pregnant women whose pregnancy was unwanted, amenorthoeic women whose last chdd was unwanted, and women who are neither pregnant nor amenorrhoelc and who are not using any method of family planning but want no more children. Excluded from the unmet need category are menopausal or infecund women and unmarried women who have not had sexual intercourse xn the four weeks prior to the interview. 2 Using for spacing is defined as women who are using some method of famdy planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 88 Figure 6.3 Percentage of Currently Married Women by Status of Family Planning Needs Unmet need for Family P~anning 33 Currently using Family Planning Services 26 Total demand for Family Planning 0 10 20 30 40 S0 60 Percent 1~1992 ZDHS i1996 ZDHS I ZDHS 1996 6,3 Ideal Number of Children In the ZDHS, information on what women consider the ideal family size was elicited through two questions. Women who had no children were asked "If you could choose exactly the number of children to have in your whole life, how many would that be?" For women who had children, the question was rephrased as follows: "lf you could go back to the time you did not have any children and would choose exactly the number of children to have in your whole life, how many would that be?" The data obtained from these questions is shown in Table 6.6. The data indicate that the vast majority of women were able to give a numeric response to the question. Only 5 percent of all women gave a non-numeric response such as "it is up to God," "any number," or "don' t know." Those who gave numeric responses generally want large families. Almost 40 percent of women say they want at least six children, while 23 percent cite four children as ideal, and only 8 percent want two children or fewer. Preference for large families increases with increasing number of surviving children. For example, the percentage of women who want to have six or more children is 29 percent among those with two children, 56 percent among those with four children, and 71 percent among those who already have six or more children. The mean ideal number of children is 5.3 children among all women. This ranges from 4.5 for women with no children to 7.1 among those with six or more children. Moreover, the data show that men are generally more pronatalist than women. Not only is the overall mean ideal family size higher among men than women (5.9 vs. 5.3), but it is also about half a child higher with each additional living child. These levels of ideal family size exceed the four children espoused as the ideal family size in the National Population Policy and imply that efforts to encourage smaller family size norms might be warranted. Nevertheless, comparison with data from the 1992 ZDHS suggest that there has been at least some reduction in ideal family size among women over time, from a mean of 5.8 children in 1992 to 5.3 children in 1996 (Galsie et al., 1993:75). 89 Table 6.6 Ideal and actual number of children Percent distribution of all women and men by ideal number of children, and mean ideal number of children for all women and men and for currently married women and men, according to number of living children, Zambia 1996 Number of living children I Ideal number of children 0 1 2 3 4 5 6+ Total WOMEN 0 0.6 0.0 0.0 1 1.5 1,9 0.5 2 13.4 7.8 7.0 3 12.0 13.2 7.2 4 26,8 29.1 29.1 5 17.3 18.9 21.5 6+ 23.2 25.0 29.2 Non-numeric response 5.2 4.2 5.4 Total 100.0 100.0 100.0 Number of women 2,074 1,448 1,129 Mean 1deal number for: All women 4.5 4.6 4.9 Number of women 1,966 1,387 1,068 Currently married women 5.2 4.8 5.0 Number of women 319 846 833 0.0 0.2 0.2 0.2 0.2 0.4 0.2 0.1 0.1 0.9 2.8 2.2 2.8 2.6 7.0 7,2 2.4 1.6 1.2 7.8 21.7 21.5 8.0 I 1.4 22.9 22.5 12.8 20.0 6.7 17, 1 40.6 55.9 62.4 70.6 38.9 4,8 4.8 4.9 7.2 5.2 100.0 100.0 100.0 100.0 100.0 938 682 597 1,154 8,021 5.4 5.9 6.5 7.1 5.3 893 649 568 1,071 7,602 5.4 5.9 6.5 7.2 5.7 732 528 456 925 4,640 MEN 0 0.3 0.0 0.0 0.0 0.0 0.0 1 0 0.3 I 0.3 0 0 0.0 0.0 0.0 0.0 0.0 0. I 2 7,0 3.2 7.9 0.4 0.0 2.1 1.6 4.7 3 I 1.9 12.9 10.2 2.4 4.6 3.7 1.9 8.8 4 25.5 30.0 28.5 21.7 16.3 12.8 7.5 22.2 5 18.6 17,2 14.6 19.4 15.4 11,7 6.5 15.9 6+ 33.3 34.6 37.8 55.7 61.5 67.6 74.4 44.9 Non-numeric response 3.1 2.1 1.0 0.3 2.3 2.1 7,1 3.0 Total 100.0 10t3,0 100,0 100.0 100.0 100,0 100.0 100.0 Number of men 872 188 173 150 104 104 259 1,849 Mean 1deal number for: All men 5.1 5.2 5.1 6.1 7.0 6.8 8.6 5.9 Number of men 844 184 171 149 102 102 241 1,793 Currently married men 5.4 5,2 5.1 6.0 6.9 6.9 8.8 6.6 Number of men 68 134 149 137 95 97 233 914 • q o t e : The means exclude respondents who gave non-numeric responses. Includes current pregnancy Tab le 6.7 presents data on the mean ideal number of chi ldren for women and men by background characteristics. The data show that women have consistently lower ideal fami ly sizes than men, regardless o f the background characterist ic. It can be observed from the data in the table that the ideal fami ly size in Western Province (6.3 for women and 7.2 for men) is the highest in Zambia , despite the fact that the ferti l i ty level in this prov ince is not the highest. Th is suggests, as other research has pointed out, that there is an inferti l ity problem in the province (CSO, 1985b and CSO, 1995). Lusaka and Copperbe l t Provinces have the lowest ideal family size, along with lowest fertil ity rates and the highest contracept ive preva lence rates. Ideal fami ly size decreases as the level o f educat ion increases. 90 TaMe 6.7 Mean idea I pumber of children bY background chara¢lg:gistics Mean ideal number of children for all women by age and selected background characteristics and for all men by age, Zambia 1996 Age Background All All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 women men Residence Urban 3.9 4.2 4.4 5.1 5.2 6.0 7.0 4.6 5.1 Rural 5.2 5,1 5.8 6,3 7.0 7.3 8,1 5.9 6.6 Province Central 4.4 4.6 5.2 5.9 5.8 6.3 7.4 5.2 6.1 Copperbelt 4.1 4,4 4.6 5,2 4.9 5.9 7.2 4.7 5,2 Eastern 4,8 4.9 5.6 6.1 6.9 7.5 8,0 5.8 6.0 Luapula 5.4 5.6 5.9 6.9 7.1 7.8 8.4 6.2 6,1 Lusaka 3.7 3.9 4.2 4,8 5.3 5.7 6.8 4.4 5,0 Northern 5,2 4.9 5,5 6.1 6,6 6.6 7.8 5,7 6.8 North-Western 4.5 4.7 5.6 6.2 6.9 8.5 8.5 5.8 6.3 Southern 4.8 4.8 5.4 6,2 6.9 6.7 7.5 5.6 6.1 Western 5.3 5,6 6.0 6.4 7.4 7.9 8.6 6.3 7,2 Education No educauon 5.2 5.3 5.7 6.3 7.1 7.7 8.0 6.4 7.0 Primary 4.8 5.0 5,6 6.1 6,6 7.1 7.8 5.6 6.4 Secondary+ 3.9 4.0 4.1 4.6 4.6 5.2 5.9 4.2 5.1 Total women~men 4.6 4.7 5. I 5.8 6.2 6.7 7.7 5.3 5,9 Note: Men age 50-59 have been omitted. 6.4 Fertility Planning There are two ways of estimating levels of unwanted fertility from the ZDHS data. One is based on responses to a question as to whether each birth in the five years before the survey was planned (wanted then), mistimed (wanted, but at a later time), or unwanted (wanted no more children). These data are likely to result in underestimates of unplanned childbearing, since women may rationalise unplanned births and declare them as planned once they are born. Another way of measuring unwanted fertility utilises the data on ideal family size to calculate what the total fertility rate would be if all unwanted births were avoided. This measure may also suffer from underestimation to the extent that women are unwilling to report an ideal family size lower than their actual family size. Data using these two approaches are presented below. Table 6.8 shows the distribution of births in the five years before the survey by whether they were wanted at the time of conception, wanted later, or not wanted at all. The data show that 36 percent of these births were unplanned, of which 29 percent were mistimed and 7 percent were unwanted. The proportion of births that were wanted at the time decreases with birth order and mother's age, while the proportion of births that were not wanted at all increases with birth order and age. Compared with 1992 ZDHS data (not shown), changes in levels of mistimed and unwanted births have been minimal since 1992. Table 6.9 presents "wanted" fertility rates. The wanted fertility rate is calculated in the same manner as the total fertility rate, but unwanted births are excluded from the numerator. For this purpose, unwanted births are defined as those which exceed the number considered ideal by the respondent. (Women who did not report a numeric ideal family size were assumed to want all their births.) This rate represents the level of fertility that would have prevailed in the three years preceding the survey if all unwanted births had been prevented. A comparison of the total wanted fertility rate and the actual total fertility rate suggests the potential demographic impact of the elimination of unwanted births. 91 Table 6.8 Fertility olannine ~tatus Percent distribution of births in the three years precedmg the survey and current pregnancies, by ~Ullity planning status, accordingto birth orderand mother's age, Zambm 1996 Planning status of birth Birth order Number and mother's Wanted Wanted Not of age then later wanted Missing Total births Birth order 1 67.9 26.9 3.6 1.6 100.0 1,765 2 66.5 30.3 1.8 1.4 100.0 1,522 3 63.8 33.1 1.5 1.6 100.0 1,248 4+ 58.1 28.6 11.6 1.7 100.0 3,542 Age at birth <20 62.2 33.0 3.3 1.5 100.0 1,698 20-24 65.2 31.3 2.1 1.5 100,0 2,516 25-29 64.6 30.1 3.4 1.9 100.0 1,801 30-34 61.5 26.3 10.7 1.5 100.0 1,163 35-39 57.4 20.8 20.1 1.8 100.0 648 40-44 48.3 12.4 38.5 0.9 100.0 214 45-49 (39.1) (18.9) (39.9) (2.1) 1000 38 Total 62.7 29.2 6.5 1.6 100.0 8,078 Note: Birth order includes current pregnancy. Figures m parentheses are based on 25-49 unweighted cases, Table 6.9 Wanted fertility rates Total wanted tertihty rates and total tertility rates for the three years preceding the survey, by selected background characteristics, Zambia 1996 Total wanted Total Background fertility fertility characteristic rate rate Residence Urban 4. I 5.1 Rural 6.1 6.9 Province Central 4.8 6.3 Copperbelt 4.4 5.6 Eastern 6.6 7.1 Luapula 5.9 6.8 Lusaka 4.0 4.9 Northern 6.5 7.2 Noah-Western 5.8 6.2 Southern 5,0 6.2 Western 5.1 5.5 Education No education 6.0 6.8 Primary 5.7 6.7 Secondary+ 3.9 4.5 Total 5.2 6.1 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey. The total fiertdity rates are the same as those presented in Table 3.3. The wanted fertility rate is 5.2 births per woman for all of Zambia, a slight decline from 5.4 in 1992 (Gaisie, et al., 1993:78). The gap between actual and wanted fertility for urban women is one child. If the desired fertility level were realised, the total fertility rate for urban women would be 4.1 births per woman, two births fewer than that wanted by women in mral areas. Women in Lusaka Province have the lowest wanted as well as actual fertility rates (4.0 births and 4.9 births per woman). On the other hand, women in Eastern and Northern Provinces show the highest wanted and actual fertility rates (a total wanted fertility rate of about 6.5 and a total fertility rate of about 7.1). Women's education has a negative relationship with the level of wanted fertility; women with no education have the highest wanted fertility, while women with secondary or higher education have the lowest wanted fertility (6.0 vs 3.9 births per woman). 92 CHAPTER7 INFANT AND CHILD MORTALITY 7.1 Introduction This chapter presents information on mortality under age five in Zambia. Specifically, estimates of levels, trends and differentials in neonatal, postneonatal, infant, and child mortality are provided, as well as data on high-risk fertility behaviour. The data are disaggregated by sex, socioeconomic, and demographic characteristics, province, and other factors to identify segments of the population requiring special attention. Further, this information is useful for monitoring and evaluating population and health programmes and policies. Infant and child mortality rates are basic indicators of a country's socioeconomic situation and quality of life. Estimates of childhood mortality are based on information from the birth history section of the questionnaire administered to individual women. The section began with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live with the mother, the number who live elsewhere and the number who have died). For each of these births, information was then collected on sex, month and year of birth, survivorship status, and current age, or, if the child had died, age at death. This information is used to directly estimate mortality rates. In this report, mortality in early childhood is described using the following five rates: Neonatal mortality: the probability of dying within the first month of life; Postneonatal mortality: the difference between infant and neonatal mortality; Infant mortality: the probability of dying before the first birthday; Child mortality: the probability of dying between the first and fifth birthday; Under-five mortality: the probability of dying between birth and the fifth birthday. All rates are expressed per 1,000 live births, except for child mortality, which is expressed per 1,000 children surviving to 12 months of age. Examination of data relating to childhood mortality does not indicate that there are any serious biases in reporting (see Appendix C for details). 7.2 Levels and Trends in Infant and Child Mortality Neonatal, postneonatal, infant, child, and under-five mortality rates are shown in Table 7.1 for five- year periods preceding the survey. Under-five mortality for the most recent five-year period (which roughly corresponds to the years mid-1992-mid-1996) is 197 per 1,000 births. This means that almost one in five children born in Zambia dies before reaching the fifth birthday. Half of the deaths under age five occur in the first year of life; the infant mortality rate is 109 deaths per 1,000 births and the child mortality rate is 98 per 1,000 children reaching one year of age. During infancy, the risk of death in the first month of life (35 per 1,000) is about half of that in the next 11 months (74 per 1,000). 93 Table 7.1 Infant and child mortality Infant and child mortality rates by five-year periods preceding the survey, Zambia 1996 Years Neonatal Postneonatal Infant Child Under-five preceding mortality mortality mortality mortality mortality survey (NN) (PNN) (lqo) (4ql) (sqo) 0-4 35.4 73.5 108.9 98.4 196.6 5-9 37.0 69.2 106.2 89.9 186.5 10-14 36.9 55.3 92.2 90.2 174.1 The estimates in Table 7.1 and Figure 7.1 indicate that child survival in Zambia has deteriorated since the mid-1980s. Under-five mortality has increased from 174 deaths per 1,000 births in the period 10-14 years before the survey (approximately 1982-86) to 197 for the period 0-4 years before the survey, an increase of 13 percent. The pace of increase was faster for infant mortality than for child mortality; the infant mortality rate increased by 18 percent (from 92 per 1,000 births 10-14 years before the survey to 109 per 1,000 births 0-4 years before the survey), while the child mortality rate increased by 9 percent over the same period (from 90 to 98 per 1,000 births). It is interesting to note that, while postneonatal mortality rates have increased in the recent past, neonatal mortality rates show little change. 200 150 100 50 Deaths per1,000 Infant Mortality Figure 7,1 Trends in Infant and Child Mortality Zambia, 1982-86 to 1992-1996 Child Mortality Under-five Mortality E~1982-86 Im1987-91 E~1992-96 . l ZDHS 1996 94 Table 7.2 Trends in childhood mortality Infant and under-five mortahty rates from various sources, Zambia 1969-96 1992 1996 1969 1980 1990 ZDHS ZDHS Indicator Census Census Census (1987- (1992- (Ret~rence period) (1962) (1973) (1984) 1991) 1996) Infant mortality rate 141 97 90 107 109 Under-live mortality NA 179 167 19I 197 Note: Estimates from the census data were obtained using indirect estimation methods and refer to a point some seven years prior to the census year. Data from the ZDHS surveys refer to the five-year period prior to the surveys. NA = Not applicable Source: CSO, 1995:4; Gaisie et al., 1993:81; Nsemukila, 1994:32 Further evidence that childhood mortality has either increased or remained at a high level comes from a comparison of data from the 1996 ZDHS with previous data sources. Table 7.2 and Figure 7.2 show infant and child mortality rates from various censuses as well as the 1992 ZDHS. The rates show a decline during the 1970s and 1980s, followed by an increase in the late 1980s and a levelling off in the early 1990s. The infant mortality rate for the five years before the 1992 ZDHS was 107 deaths per 1,000 live births, almost indistinguishable from the rate of 109 deaths per 1,000 live births as measured for the five years preceding the 1996 ZDHS. Figure 7.2 Infant and Under-Five Mortality Rates, From Selected Sources, Zambia, 1969-1996 Dealhs per 1,000 Live Bidhs 200 150 5O Year I-~ Infant rnortalW 4~ Under-five mortality I ZDHS 1996 95 7.3 Socioeconomic Differentials in Infant and Child Mortality Differentials in the various mortality rates by selected background characteristics are presented in Table 7.3. The table focuses on basic socioeconomic characteristics, including urban-rural residence, province, and mother's educational level. A ten-year period is used to calculate the mortality estimates in order to have a sufficient number of cases in each category. Table 7.3 Infant and child mortality by background characteristics Infant and child mortality rates for the 10-year period preceding the survey, by selected socioeconomic characteristics, Zambia 1996 Neonatal Postneonatal Infant Child Under-five Background mortality mortality mortality mortahty mortality characteristic (NN) (PNN) (tqa) (4ql) (sqa) Residence Urban 32.3 59.7 91.9 89.6 173.3 Rural 38.6 79.3 117.9 98.1 204.5 Province Central 29,6 64.9 94.6 77.3 164.5 Copperbelt 28.7 53.3 81.9 101,8 175.4 Eastern 49.7 81.4 131.1 120.0 235.4 Luapula 32,9 124.8 157.8 114.5 254.2 Lusaka 35.5 64.8 100.3 82.1 174.1 Northern 36.5 88.8 125.3 85.7 200.2 North-Western 32.8 58.3 91.1 68.1 153.0 Southern 26.0 40.2 66.2 87.9 148.3 Western 55.8 73.3 129.1 82.8 201.2 Education No education 48.3 84.6 132.9 102.4 221.7 Primary 36.1 74.0 110.2 102.3 201.2 Secondary+ 27.2 54.5 81.7 65.6 142.0 Medical maternity care I No antenatal or delivery care Either antenatal or delivery care Both antenatal and delivery care (55.6) 37.1 31.1 Total 36.1 71.6 107.7 94.6 192.1 Note, Rates based on 250-499 cases (exposed children) are enclosed in parentheses. ~qA = Not applicable Refers to births in the five years before the survey 104.0 159.5 NA NA 77.1 114.3 NA NA 67.3 98.4 NA NA Children in the rural areas of Zambia experience a higher risk of dying before age five than urban children (205 compared to 173 deaths per 1,000 births, respectively) (Figure 7.3). The urban-rural differential in mortality exists at every age group but is more notable during the postneonatal period. Postneonatal rates are 79 per 1,000 births in rural areas and 60 in urban areas. 96 Figure 7.3 Under-Five Mortality by Background Characteristics RESIDENCE Urban Rural PROVINCE Central Copperbelt Eastern Luapula Lusaka Northern North-Western Southern Western EDUCATION No Education Primary Secondary+ 0 50 100 150 200 250 Deaths per 1,000 Live Births Note: Rates are for the 10-year period preceding survey ZDHS 1996 Differences in mortality by province are also quite marked. Childhood mortality is highest in Luapula and Eastern Provinces where almost one in four children do not reach their fifth birthday. It is only slightly lower in Western and Northern Provinces with 20 percent mortality before age five. On the other hand, under- five mortality is lowest in Southern and Noah-Western Provinces (around 150 per 1,000 births). These provincial differentials are roughly consistent with data from the 1990 census which shows the highest levels of under-five mortality in Eastern, Luapula, and Western Provinces; however, unlike the 1996 ZDHS, census data show the lowest levels in Copperbelt and Lusaka Provinces (Nsemukila, 1994:32). Differences in early childhood mortality by education of the mother are large. Children born to mothers who have had no education are about one and a half times as likely to die before their fifth birthday as those born to mothers who have at least some secondary education (222 compared to 142 per 1,000 births, respectively). This educational advantage is apparent for the mortality rates in every age group; for example, infant mortality rates are 133 per 1,000 births to women with no education, compared to only 82 per 1,000 births to women with at least some secondary education. Mortality rotes in childhood also vary according to whether the mother received antenatal care or care during delivery or both. For example, the infant mortality rate for children born to women who received both antenatal and delivery care is 98 per 1,000 births, compared to 160 for children born to mothers who received neither antenatal nor delivery care. 97 7.4 Demographic Differentials in Infant and Child Mortality The relationship between early childhood mortality and various demographic variables is examined in Table 7.4 and Figure 7.4 for the ten-year period preceding the survey. The results show that, as expected, male children have higher mortality rates than females at every age. The difference is especially pronounced in the neonatal period. Table 7.4 Infant and child mortality bv demoeraohic characteristics Infant and child mortality rates for the 10-year period preceding the survey, by selected demographic charactenstics, Zambia 1996 Neonatal Postneonatal Infant Chdd Under-five Demographic mortality mortality mortality mortality mortality characteristic (NN) (PNN) (lq0) (4qt) (sq0) Sex of child Male 42.5 73.8 116.3 96.5 201.6 Female 29.8 69.4 99.3 92.9 182.9 Age of mother at birth < 20 47.9 93.5 141.3 107.9 234.0 20-29 32.6 69.3 101.9 94.4 186.7 30-39 29.3 54.3 83.6 84.4 161.0 40-49 (59.6) 77.9 137.5 76.5 203.5 Birth order l 43.7 77.5 121.2 89.9 200.3 2-3 33. I 81.0 I 14. l 100.6 203.2 4-6 31.7 64.2 95.9 96.3 183.0 7+ 39.2 57.9 97.1 86.5 175.2 Previous birth interval <2yrs 57.1 107.4 164.5 128.4 271.8 2-3 yrs 27.4 59.8 87.2 92.3 171.4 4 yrs + 22.5 54.3 76.7 64 l 135.9 Size at birth I Small/very small 76.8 81.3 158.1 Average or larger 27.8 71.3 99 2 Vigures in parentheses are based on 250-499 births. Refers to births in the five years before the survey The relationship between childhood mortality and mother's age at birth generally shows the expected U-shaped pattern with higher mortality for children of younger (less than age 20) and older (40-49 years old) mothers. For example, the infant mortality rate for children of mothers who were less than age 20 at the time of the child's birth (141 per 1,000) is 70 percent higher than the rate for children whose mothers were 30-39 at the time they gave birth (84 per 1,000). Among the children of mothers age 40-49, the infant mortality rate is again high (138 per 1,000). An exception to the U-shaped pattern is child mortality which decreases with the age of the mother. There is some consistency in the relationship between mortality rates and birth order. In general, higher order children tend to have lower mortality. 98 Figure 7.4 Under-Five Mortality by Selected Demographic Characteristics AGE OF MOTHER < 20 20"29 30.39 40-49 BIRTH ORDER 1 2"3 4"6 7+ PR;OR BIRTH INTERVAL < 2 years 2-3 years 4+ yeses I 234 167 161 2O4 175 !~;!~!~:i!:?:~i!iiii!i!~!~!~.i~:~!~:~i!ii!~!i~:.~:~i:~i?:~:?:~`:~!~!~!~!;iii~i~:iiii`~i`~iii~i~i!i`~i`: I 272 ~, : i :?:~!~!~!~iiiii::~i~i!i:i~!i!!~i~i ! :~:,!::~i!i :!i! :!!~!~!iiil 171 50 100 150 200 250 300 Deaths per 1,000 Live Births Note: Rates are for the I O-year period preceding survey ZDHS 1996 The most consistent findings can be seen in the relationship between mortality rates and the length of the interval between births. The data show that short birth intervals significantly reduce a child's chances of survival. Children born less than two years after a previous birth are twice as likely to die in infancy than those born after an interval of four years or more (165 compared to 77 per 1,000). This relationship persists in all the age groups examined. This finding supports the importance of child spacing practices as a means of reducing mortality of young children. As expected, a child's size at birth is related to his/her chances of survival. Children whose mothers say they were either small or very small at birth have considerably higher mortality rates than those who were of average or larger size. 7.5 High-Risk Fertility Behaviour Previous research has shown strong relationships between fertility patterns and children's survival chances. Typically, infants and children have a greater probability of dying early if they are born to mothers who are especially young or old, if they are born after a short birth interval, or if they are of high birth order. Data to examine these relationships are presented in Table 7.5, which shows the distribution of births in the five years preceding the survey and of currently married women according to these categories of increased risk. In this analysis, a mother is classified as "too young" if she is less than 18 years of age and "too old" if she is over 34 years of age. A "short birth interval" is defined by a birth occurring less than 24 months after a previous birth, and a child is of "high birth order" if the mother had previously given birth to three or more children (i.e., if the child is of birth order 4 or higher). First births, although often at increased risk, are classified in the "not in any high-risk category," because they are considered an unavoidable risk. 99 Table 7.5 Hi~,h-risk fertility behaviour Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality, and the percent distribution of currently married women at risk of conceiving a child with an elevated risk of mortality, by category of increased risk, Zambm 1996 Births in 5 years preceding the survey Percentage of currently Risk Percentage Risk marrie4 a category of births ratio women Not in any high-risk category 26.3 1.00 19.0 b Unavoidable risk: first births 14,2 1.13 6,7 Single high.risk category Mother's age < 18 8.1 1.28 0.9 Mother's age > 34 0,2 * 2.5 Birth interval < 24 months 6.8 (1.28) 10.2 Birth order > 3 26.4 0.85 18.7 Subtotal 55.7 1.04 39.0 Multiple high-risk category c Age <18 & birth interval <24 mo 0.4 * 0.9 Age >34 & birth interval <24 mo 0.0 NA 0.0 Age >34 & birth order >3 9,8 0.57 21.0 Age >34 & birth interval <24 & birth order >3 1,4 * 4,9 Birth interval <24 & birth order >3 6.4 (1.17) 15.2 18.0 0.88 42.0 Subtotal In any high-risk category 73.7 1.00 81.0 Total 100.0 NA 100.0 Number 7,159 NA 4,902 Note: Risk ratio is the ratio of the proportion dead of births m a specific high-risk category to the proportion dead of births not in any high-risk category. Figures in parentheses are based on 250-499 cases. An asterisk means the data are based on fewer than 250 cases and have been suppressed. ~qA = Not applicable Women were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth ~ess than 15 months ago, and latest birth of order 3 or higher. Includes sterilised women C Includes the combined categories Age <18 and birth order >3 Tab le 7.5 is further d iv ided into two categories, with births fa l l ing into e i ther s ingle h igh-r isk categories (such as those born to mothers below the age of 18 or over the age of 34, those born after an interval o f less than 24 months and those o f birth order h igher than three) or mult ip le h igh-r isk categories (such as those born after an interval o f less than 24 months to mothers be low the age o f 18, ch i ldren o f birth order 4 or h igher who are born to mothers over 34 years, etc.). The results indicate that only one in four births in the f ive years pr ior to the survey are free from any high mortal ity r isk due to their mother 's ferti l i ty behaviour; more than hal f (56 percent) o f ch i ldren fal l into at least one high-r isk category; and almost one in f ive births is character ised by two or more h igh-r isk factors. The most common h igh-r isk category is h igh birth order (44 percent o f al l births). 100 Table 7.5 also indicates the relative risk of dying for children born in the five years before the survey by comparing the proportion dead in each high-risk category with the proportion dead among children not in any high-risk category. These risk ratios are presented in column 2. Births to mothers under age 18 and children born less than 24 months after the birth of their older sibling have a 28 percent higher risk of dying than those who are not in any risk category. Column 3 of Table 7.5 shows the proportion of currently married women who fall into the various risk categories. Overall, four in five married women, if they became pregnant today, would conceive a child that would fall into a high-risk category. It is interesting to note that this percentage is higher than that for births (74 percent). To reduce the number of high-risk births, therefore, there is need for women to limit births. 101 CHAPTER8 MATERNAL AND CHILD HEALTH This chapter covers findings in the three main areas of maternal and child health. They are maternal and newborn care, immunisation, and common childhood illnesses and their treatment. The information is vital in identifying categories of mothers and their babies who are at risk and in providing information for planning appropriate improvements in services. The data presented in this chapter refer to all live births which occurred during the five years before the survey to women who were interviewed. 8.1 Antenatal Care and Delivery Assistance Table 8.1 shows the percentage of live births in the five years preceding the survey by source of antenatal care, according to maternal and background characteristics. Interviewers were instructed to record all persons a woman had seen for care during pregnancy. In case more than one provider was seen, only the one with the highest qualification is represented in the table. For virtually all births (96 percent), mothers received antenatal care from a doctor, trained nurse, or midwife (Figure 8.1). Most women rely on a nurse or trained midwife (93 percent). Women received antenatal care from a traditional birth attendant (TBA) for less than 1 percent of births; no antenatal care was received for 4 percent of births. The Ministry of Health, in its health reform programme encourages community-based services provision within the framework of Primary Health Care. The findings of this survey, however, show that TBAs are little utilised as a source of antenatal care. There are few differentials in the sources of antenatal services. Whereas nearly all the births to urban women receive antenatal care from medically trained providers (99 percent), about 6 percent of the births in rural areas do not benefit from any antenatal care at all. Pregnant women in urban areas have a higher chance of being attended to by a doctor than those in mral areas. Although almost all the women surveyed are likely to receive antenatal services from a health worker, women from Central, Copperbelt, and Lusaka Provinces are most likely to receive antenatal services from a doctor, in contrast to women in Eastern, Luapula, North- Western, and Western Provinces. There is a strong relationship between education levels and use of antenatal services. Pregnant women with no education are less likely to seek antenatal services, whereas woman with secondary or higher education are more likely to receive antenatal care from either a doctor or a nurse/midwife. The main reason for this could be that mothers with no education are more likely to live in mral areas where access to information and services is more difficult. As the mother's level of education increases, so does the likelihood that she will be seen by a doctor during pregnancy; only 1 percent of births to mothers with no education receive antenatal care from a doctor, compared to 22 percent of births to mothers with higher than secondary education. Antenatal care can be more effective when it is sought early in the pregnancy and continues through parturition. Obstetricians generally recommend that antenatal visits be made on a monthly basis to the 28th week (7th month), fortnightly to the 36th week (8th month) and then weekly until birth. Regular visits allow proper monitoring of the mother and the child throughout the pregnancy. If the first antenatal visit is made at the third month of pregnancy, this schedule translates to a total of 12 to 13 visits during the pregnancy. Information about the number and timing of antenatal care visits is presented in Table 8.2. In 7 out of 10 births, women made four or more antenatal care visits. However, for a substantial number of births (23 percent), mothers made fewer than four visits. The median number of antenatal care visits was 5.2, implying that women are aware of the importance of frequent visits. However, this is far fewer than the recommended 12 visits. 103 Table 8.1 Antenatal care Percent distribution of live births in the five years preceding the survey by source of antenatal care during pregnancy, according to selected background characteristics, Zambia 1996 Antenatal care provider I Traditional Nurse/ birth Number Background Trained attendant of characteristic Doctor midwife (TBA) No one Missing Total births Mother's age at birth < 20 2.1 92.9 0.6 4.1 0.2 100.0 1,525 20-34 2.6 93.5 0.4 3,3 0.2 100.0 4,819 35+ 4.3 89.3 1.2 4.9 0.3 100.0 815 Birth order 1 2.8 92.7 0.5 3.8 0.2 100.0 1,566 2-3 2.6 93.7 0.4 3.1 0.1 100.0 2,438 4-5 2.4 93.3 0.4 3.6 0.2 100,0 1,512 6+ 2.8 91.4 1.0 4.4 0.3 100.0 1,643 Residence Urban 4.9 93.8 0.1 0.9 0.4 100.0 2,858 Rural 1.2 92.3 0.9 5.5 0.1 100.0 4,301 Province Central 5.4 88.7 0.4 5.2 0.3 100.0 587 Copperbelt 5.1 93.7 0.0 0.6 0.5 100.0 1,347 Eastern 0.5 96.4 0.1 2.9 0.2 100.0 1,103 Luapula 0.4 91.3 3.4 5.0 0.0 100.0 671 Lusaka 4.8 93.1 0.0 1.7 0.4 100.0 1,076 Northern 2.4 84.8 1.8 11.1 0.0 100.0 863 North-Western 0.5 95.5 0.0 3.8 0.2 100.0 287 Southern 1.0 97.5 0.0 1.5 0.0 I00.0 764 Western 0.3 95.0 0.0 4.7 0.0 100.0 460 Mother's education No education 1.3 88.1 0.9 9.5 0.1 100.0 982 Primary 1.9 93.8 0.7 3.4 0.2 100.0 4,604 Secondary 4.4 94.7 0.1 0.7 0.1 100.0 1,437 Higher 22.1 77.3 0.0 0.0 0.6 100.0 135 Total 2.7 92.9 0.6 3.7 0.2 100.0 7,159 ~qote: Figures are for births in the period 0-59 months preceding the survey. If the respondent mentioned more than one provider, only the most qualified provider is considered. For 6 in 10 births, the first antenatal check-up was received before the sixth month of gestation, while for 1 in 3 births, services were not received until the sixth month or later. The median number of months pregnant at first visit was 5.6, rather late if mothers are to receive the major benefits of antenatal care. Early identification of risk factors and medical conditions and initiation of prophylaxis where needed (e.g., against malaria or anaemia) is vital for prevention and early management of complications. In response to the 1994 International Conference for Population and Development (ICPD) Action Resolutions, the government of the Republic of Zambia recognised the need to ensure the reproductive health of individuals. One important means of doing so is immunisation against neonatal tetanus. The recommended schedule to insure protection is for women to receive two or more doses of tetanus toxoid before the first birth, with three subsequent injections. Table 8.3 and Figure 8.1 present data on tetanus toxoid coverage during pregnancy for all births in the five years before the survey. 104 Figure 8.1 Percent Distribution of Births by Antenatal Care and Delivery Characteristics ANTENATAl. CARE Doctor Nurse/Midwite No One TETANUS VACCINATION None One Two or More PLACE OF DELIVERY Health Facility Home DELIVERY ASSISTANCE DoCtor Nurse/Midwife Traditional Birth Attendant Relative/Other No One O 93 20 40 60 80 tO0 Percent Note: Based on bi~hs in the five years preceding the survey. ZDHS 1996 Table 8.2 Number of antenatal care visit8 ~Id staue 9f pregnancy Percent distribution of live births in the five years preceding the survey by number of antenatal care visits, and by the stage of pregnancy at the time of the first visit, Zambia 1996 All Characteristic births Number of visits 0 3.7 1 1.8 2-3 20.7 4+ 71.3 Don't know/missing 2.5 Total 100.0 Median 5.2 Number of mouths pregnant at time of first visit No antenatal care 3.7 <6 months 60.7 6-7 months 33.0 8+ months 2,0 Don't know/missing 0.7 Total 100.0 Median 5,6 Number of births 7,159 Note: Figures are for births in the period 0-59 months preceding the survey. For 4 in 10 births, the mother received two or more doses of tetanus toxoid during pregnancy, while for 48 percent, the mother received only one dose and for 15 percent, the mother did not receive any tetanus toxoid injection during that pregnancy. The higher the age of the woman at the time of birth, the higher the fikeliness that she has not received two or more tetanus injections, increasing the risk of neonatal tetanus. A mother 35 years or older is twice as likely to have not received a tetanus toxoid injection as a mother less than 20 years of age. Similarly, births of higher order are less likely to be protected against tetanus than first or second births. The relationship between urban-rural residence and tetanus injections is not straightforward. While a higher percentage of women in rural than urban areas had received no tetanus injection during the pregnancy, a higher percentage had received two or more injections. Tetanus toxoid coverage varies from one province to another. Births in Central, Eastern, Northern and Western Provinces are more likely to be protected against neonatal tetanus than those in the remaining provinces. At the same time, pregnant women in Northern Province have the highest chance of not receiving any tetanus toxoid injection. These women also have the lowest level of antenatal care coverage (Table 8.1). Women in Copperbelt, Luapula, and Southern Provinces have the lowest chance of receiving two or more doses of tetanus toxoid during a recent pregnancy. 105 Table 8.3 Tetanus toxoid vaccinations Percent distribution of live births in the five years preceding the survey by number of tetanus toxo~d injections during pregnancy, according to background characteristics, Zambia 1996 Number of tetanus toxoid injections Two Number Background One doses Don't know/ of characteristic None dose or more Missing Total births Mother's age at birth < 20 12.2 42.3 44.5 1.0 100.0 1,525 20-34 13.7 50.2 35.1 1.0 100.0 4,819 35+ 23.7 45.2 30.3 0.8 100.0 815 Birth order I 10.5 37.0 51.7 0.9 100.0 1,566 2-3 10.8 54.1 34.3 0.8 100.0 2,438 4-5 I4.4 51.6 32.9 1.1 100.0 1,512 6+ 24.1 45.9 28.9 1.2 100.0 1,643 Residence Urban 10.8 55.0 33.0 1.3 100.0 2,858 Rural 17.0 43.3 38.9 0.8 I00.0 4,301 Province Central 15.1 39.4 43.9 1.5 100.0 587 Copperbelt 10.5 60.5 28.1 0.8 100.0 1,347 Eastern 12.5 36.5 49 9 1.1 100.0 1,103 Luapula 14.5 58.0 27.5 0.0 100.0 671 Lusaka 12.8 51.3 34.0 1.9 100.0 1,076 Northern 23.4 30.8 45.4 0.4 100.0 863 North-Western 18.1 48.0 33.7 0.2 100.0 287 Southern 16.4 56.0 26.8 0.8 100.0 764 Western 12.3 45.8 40.9 1.1 100.0 460 Mother's education No education 21.5 44.8 32.9 0.9 100.0 982 Primary 14.8 47.6 36.6 1.0 100.0 4,604 Secondary 9.4 51.8 37.9 0.9 100.0 1,437 Higher 7.8 43.0 48.6 0.6 100.0 135 Total 14.5 48.0 36.6 1.0 100.0 7,159 Note: Figures are for births in the period 0-59 months preceding the survey. The survey reveals a strong relationship between education and tetanus toxoid vaccinations. The chances of being protected against tetanus increase with the level of education of the mother. Children of better educated women are more likely to have been protected against tetanus than children whose mothers have less education. In the provision of the basic health package, the Ministry of Health, through the Central Board of Health, recognises child health and reproductive health as two of the six major thrusts in health provision. Maternal care has been identified as one area where support is most needed because of its effects on the health of both the mother and child. One aspect of maternal care is the place of delivery, as a woman is more at risk of dying when complications arise while delivering at home. Table 8.4 shows the distribution of births occurring in the five years before the survey according to place of delivery. 106 Table 8.4 Place of delivery Percent distribution of births in the five years preceding the survey by place of delivery, according to selected background characteristics, Zambia 1996 Place of delivery Number Background Health At Don't know/" of characteristic facility home Missing Total births Mother's age at birth < 20 48.9 50.8 0.2 100.0 1,525 20-34 47.3 52.3 0.3 100.0 4,819 35+ 37.4 62.1 0.5 100.0 815 Birth order 1 55.6 44.2 0.2 100.0 1,566 2-3 48.4 51.3 0.2 i00.0 2,438 4-5 43.7 55.9 0.4 100.0 1,512 6+ 37.8 61.7 0.5 100.0 1,643 Residence Urban 76.7 22.8 0.5 100.0 2,858 Rural 26.5 73,2 0.2 100.0 4,301 Pl'ovince Central 37.0 62.6 0.5 100.0 587 Copperbelt 75.2 24.3 0.6 100.0 1,347 Eastern 33.3 66.0 0.7 100.0 1,103 Luapula 27.7 72.3 0.0 100.0 671 Lusaka 73.8 25.7 0.5 100.0 1,076 Northern 24.3 75.7 0.0 100.0 863 North-Western 56.5 43.3 0.2 100.0 287 Southern 27.7 72.3 0.0 100.0 764 Western 37.3 62.7 0.0 100.0 460 Mother's education No education 24.0 75.7 0.3 100.0 982 Primary 40.7 58.9 0.4 100.0 4,604 Secondary 76.2 23.6 0.2 100.0 1,437 Higher 93.5 5.9 0,6 100.0 135 Antenatal care visits None 4.0 96.0 0.0 100.0 262 1-3 visits 31.9 68.0 O.l 100.0 1,611 4 or more visits 52.9 47.0 0.1 100.0 5,105 Don't know/Missing 58.2 32.3 9.5 I00.0 181 Total 46.5 53.1 0.3 100.0 Note: Figures are for births m the period 0-59 months preceding the survey. 7,159 More than half of births in Zambia are delivered at home (53 percent), while 47 percent take place in health facilities (Figure 8.1). Survey findings show a relationship between the place of delivery and both the birth order and the mother's age. Younger mothers and mothers of lower parity have a higher chance of delivering in health facilities than older ones and those of higher parities. A birth to a woman in an urban area is three times more likely to have been delivered in a health institution than a birth in a rural area. This situation calls for concern because fertility levels are higher in rural areas. 107 There are marked differentials from one province to another regarding the proportion of deliveries taking place in health facilities. Approximately one in four births in Northern Province takes place in a health facility, compared to more than 70 percent of the births in Copperbelt and Lusaka Provinces. The regional differences reflect the expected pattern--the more rural provinces have fewer births delivered in health institutions than the more urbanised provinces. There is a positive relationship between delivering in a health facility and the education level of the mother. A woman with higher than secondary education is about four times more likely to deliver in a health institution than a woman with no education. As education also correlates positively with having attended antenatal care facilities and having received two or more doses of tetanus toxoid, better educated women are more likely to have developed a relationship with the health workers and are aware of the advantages of delivering in a health facility. These women are also more likely to be better off economically than women with less education. Delivery in a health facility is one aspect of safe motherhood, but also important are the qualifications of the person who attended to that delivery. Table 8.5 and Figure 8.1 show the distribution of live births in the five years before the survey by type of assistance during delivery. Just under half of births were assisted by medically trained personnel, of which about 4 percent were assisted by a doctor and 43 percent by a nurse or midwife. The others were mainly assisted by a relative (41 percent). Only a small number of births (5 percent) were assisted by traditional birth attendants. Assuming that relatives have not received any training in delivery care and given the fact that home deliveries are at higher risk of having a poor outcome for the mother and the child, the findings are a source of concern. There is a tendency among women, as they grow older and with higher parity, to deliver at home without any assistance. Births to urban women are considerably more likely than those to rural women to be delivered with medically trained assistance, especially from a nurse or midwife. Rural women are most likely to be assisted by a relative during delivery. There are marked variations among the provinces regarding the type of assistance during the delivery. Births in the most urbanised provinces in the country--Lusaka and Copperbelt Provinces--are more likely than those in other provinces to be assisted by a doctor or a nurse or midwife during delivery. This is most likely due to variations in health care seeking behaviour, as well as to the availability of medical personnel. Although utilisation of traditional birth attendants is generally low (5 percent), their usage is more prominent in Luapula (12 percent) and Northern (11 percent) Provinces. Mother's education has a very strong relationship with the probability of being attended to by a trained health worker during delivery. More than 90 percent of births to mothers with higher than secondary education are assisted by trained personnel during delivery, compared to only about one in four births to women without education, most of whom are assisted at delivery by relatives. In line with the relation between number of antenatal visits and the place of delivery, the number of antenatal check-ups also has a positive relationship with assistance during delivery. The higher the number of visits a woman makes during her pregnancy, the more likely she will be assisted by trained personnel during the delivery. Women who had a live birth in the five years preceding the survey were asked whether these children were delivered by caesarean section and what the birth weight was. Overall, 2 percent of babies were delivered by caesarean section. First births, births in urban areas, and births to women who have higher than secondary education have a higher chance of being delivered by caesarean section. 108 Table 8.5 Assistance durin~r delivery Percent distribution of births in the five years preceding the survey by type of assistance during delivery, according to selected background characteristics, Zambia 1996 Assistance during delivery Nurse/ Traditional Don't Number Background Trained birth i Relative/ No know/ of characteristic Doctor midwife attendant Other one Missing Total births Mother's age at birth < 20 3.7 45.2 4.3 44.9 1.3 0.5 100.0 1,525 20-34 3.5 43,8 5.6 40.7 6.0 0.4 100.0 4,819 35+ 3.9 33,6 5.8 36.6 19.9 0.3 100.0 815 Birth order I 6.0 49.5 5.0 38.4 0.7 0.5 100.0 1,566 2-3 3.0 45,5 5.3 43.1 2.7 0.4 100.0 2,438 4-5 2.3 41.2 5.0 43.3 8.0 0.3 100.0 1,512 6+ 3.4 34.4 6.2 38.9 16.6 0.4 100.0 1,643 Residence Urban 7.5 69.4 1.4 17.4 3.8 0,6 100.0 2,858 Rural 1.0 25.4 8.0 56.9 8.4 0.2 100.0 4,301 Province Central 3.1 34.8 1.7 49.0 11. i 0.3 100.0 587 Copperbelt 7.1 68.1 2,2 18.1 3.8 0.7 100.0 1,347 Eastern 1.2 31.8 8.6 49.6 8.3 0.5 100.0 1,103 Luapula 0.5 26.5 11,7 52.1 9.2 0.0 100.0 671 Lusaka 9.6 64.5 0.7 20.6 4.0 0.6 100.0 1,076 Northern 0.5 23.5 10.5 55.4 10.0 0.0 100.0 863 North-Western 1.4 54.9 8.6 32.5 2.3 0.3 100.0 287 Southern 0.9 26.9 5.2 61.7 4.9 0.4 100.0 764 Western 1.8 35.5 1.8 54.8 6.1 0.0 100.0 460 Mother's education No education 1.2 22.8 8.4 58.6 8.7 0.3 100.0 982 Primary 2.7 38.1 5.5 45.7 7.6 0.5 100.0 4,604 Secondary 6.5 69.6 3.2 18.1 2.5 0.1 100.0 1,437 Higher 22.0 71.5 1.4 4. l 0.5 0.6 100.0 135 Antenatal care visits None 0.0 4.0 8.1 72.l 15.9 0,0 100.0 262 1-3 visits 2.2 29.8 5.8 52.7 9.3 0.2 100.0 1,611 4 or more visits 4.1 48.8 5.2 36.3 5.4 0.2 100.0 5,105 Don't know/Missing 6.7 52.2 2.0 29.1 2.0 7.9 100.0 181 Total 3.6 42.9 5.4 41.1 6,6 0.4 100.0 7,159 Note: Figures are for births in the period 0-59 months preceding the survey. If the respondent mentioned more than one ~ttendant, only the most qualified attendant was considered in this table. Traditional midwife Due to the large proportion of births that take place at home (see Table 8.6), birth weight records were unavailable for almost 60 percent of births that occurred in the five years before the survey. Of those babies with known birth weights according to health cards, only 5 percent had a birth weight less than 2.5 kilograms. Mothers were also asked about the size of these children at the time of birth; 14 percent of the babies were reported by their mothers to be small or very small, while 86 percent were reported to be of average or larger size. 109 Tarpl~ 8.6 Delivery characteristics: caesarean section, birth wemht, and size Among live births in the five years preceding the survey, the percentage of deliveries by caesarean section, and the percent distribution by birth weight and the mother's estimate of baby's size at birth, according to selected background characteristics Zambia 1996 Birth weight Size of child at btrth Delivery Less 2.5 kg Don't Background by than or know/ characteristic C-secnon 2.5 kg more Missxng Smaller Average Don't Number Very than or know/ of small average larger Missing Total births Age <20 2.1 6.3 37.4 56 3 4.5 13 9 81 2 0.4 100 0 1,525 20-34 1.7 4.8 39.7 55.5 2.8 97 87.2 0.3 100.0 4,819 35+ 27 2.6 297 67.7 35 60 90.1 0.4 100.0 815 Birth order I 3.4 7.3 43.8 49.0 4.5 13.7 81 5 0.3 100.0 1,566 2-3 1.1 4.6 40.9 54.6 3.2 9 7 86.8 0 3 100.0 2,438 4-5 1.0 4.7 35.6 59.7 2.8 9.3 87.6 0.3 100.0 1,512 6+ 2.3 3.1 30.7 66 2 2.6 8.2 88.9 0.4 100 0 1,643 Residence Urban 3 4 8.0 65.3 26 7 3.2 11 3 84 8 0.6 100 0 2,858 Rural 0.8 2 7 20 0 77.3 3.3 9 4 87.2 0.1 100.0 4,301 Province Central 2.0 3.8 28.2 68.0 5.7 14.6 79.4 0.3 100 0 587 Copperbelt 3.2 7 4 64.8 27.7 2 2 10.9 86.2 o.g 100.0 1,347 Eastern 1.5 3 4 24.3 72.3 0 2 4.8 94.9 0.2 100.0 1,103 Luapula 0 4 3.3 23.7 73 0 2.2 9 4 88.5 0.0 IO0 0 671 Lusaka 3 2 8.5 60 3 31.2 3.7 13 4 82.4 0.5 100.0 1,076 Northern 0.4 2.7 18 0 79.3 5.6 7.0 87 2 0.1 100.0 863 North-Western 2 3 4.8 53.7 41.6 2.9 15.6 81.4 0.2 100.0 287 Southern 1 2 2.2 22.4 75.4 3.5 123 83.8 0.0 100.0 764 Western I.l 4.3 28.2 67.5 7 0 7.1 85.7 0 2 100.0 460 Mother's education No educanon 0.9 l 2 16.6 82.2 2.9 8.4 88 6 0.1 100.0 982 Primary 1 6 4.6 31 9 63.5 3.2 10 4 86.0 0 4 100.0 4,604 Secondary 2.9 7.4 68 6 23.9 3.5 10.3 86 I 0 2 100.0 1,437 Higher 8.3 11.0 79.8 9.2 60 12.3 81 1 0.6 100.0 135 Total 1.9 4.8 38.1 57.1 3.3 10.2 86.3 03 100.0 7,159 Note: Fxgures are for bmhs in the period 0-59 months preceding the survey. 8.2 Childhood Immunisation The 1996 ZDHS collected information on vaccination coverage for all children born in the five years preceding the survey. According to the World Health Organisation (WHO), for a child to be fully vaccinated, he or she should have received BCG, measles, and three doses each of DPT and polio vaccines. BCG protects against tuberculosis and DPT protects against diphtheria, pertussis, and tetanus. DPT is usually given with the polio vaccine at 4-week intervals starting from age 6 weeks. The measles vaccine is given at 9 months of age. The government of Zambia has adopted the WHO goal to ensure completion of vaccinations by 12 months of age; the target is to vaccinate 80 percent of all children fully by that age by the year 2000. 110 Table 8.7 Vaccinations bv source of information Percentage of children 12-23 months who had received specific vaccines at any time before the survey, by whether the reformation was from a vaccination card or from the mother, and the percentage vaccinated by 12 months of age, Zambia 1996 Percentage of children who received: DPT Polio Percent Number Source of of of information BCG 1 2 3+ 1 2 3+ Measles All I None children children Vaccinated at any time before the survey Vaccination card 81.6 81.2 79.1 76.1 81.4 79.2 76.5 73.9 71.7 0.1 81 8 1,102 Mother's report 15.8 15.5 13.3 9.6 16.0 14.6 7.9 12.7 6.7 1.9 18.2 245 Either source 97.4 96.7 92.5 85.7 97.3 93.8 84.4 86.5 78.3 1.9 100 0 1,347 Vaccinated by 12 months of age 96.7 95.8 90.5 80.0 96.5 91.8 78.7 75.8 66 8 2.8 1,347 Note: For children whose information was based on the mother's report, the proportion of vaccinations given during the first ~ear of life was assumed to be the same as for children with a written record of vaccination. Children who are fully vaccinated (i.e,, those who have received BCG, measles, and three doses of DPT and polio). Information presented in Table 8.7 was collected in two ways--from vaccination cards (under-five cards) and mothers' verbal reports. Most health institutions in the country provide under-five cards on which information on vaccination is recorded. When a card was presented to the interviewer, it was used as the source of information by directly transferring dates of vaccination on to the questionnaire. Besides collecting vaccination information from cards, there were two ways of collecting information from the mother herself. If a card was presented, but a vaccine was not recorded as having been given, the mother was asked to recall whether that particular vaccine had been given. In a situation where a mother was not able to present a card for a child at all, she was asked to recall whether the child had received BCG, polio, DPT, or measles vaccinations and the number of doses of polio and DPT. Take 8.7 presents information on vaccination coverage according to the sources of information. The data presented are for children aged 12-23 months. This, therefore, includes only those children who have reached the age by which they should be fully vaccinated. Vaccination cards were available for 82 percent of children age 12-23 months; information for these children is shown on the first line in Table 8.7. Data based on mothers' reports for the 18 percent of children without cards are given on the second line. According to information from both the vaccination card and the mothers' reports, 97 percent of children 12-23 months have been vaccinated against tuberculosis and have received the first doses of DPT and polio. Coverage declines for subsequent doses of DPT and polio, so that only 84 to 86 percent of children receive the third doses of these vaccines. These figures represent a dropout rate of about 12 percent for DPT and polio. The coverage rate for measles (87 percent) is similar to that for the third doses of DPT and polio. Overall, 78 percent of children 12-23 months are fully vaccinated, which means that the national target of 80 percent coverage by the year 2000 is very close to being realised. Only 3 percent of children have not received any vaccines. As mentioned earlier, it is recommended that children complete the schedule of immunisations during their first year of life, i.e., by 12 months of age. Table 8.7 shows that, among children age 12-23 months at the time of interview, 67 percent had been fully vaccinated before their first birthday. l l l Table 8.8 shows the distribution of children who had received specific vaccines by the time of the survey. There is no significant difference in vaccination status by sex of child. Birth order, however, does influence immunisation rates, with first-born children more likely to be fully vaccinated than those that are sixth or higher in the family (84 percent compared to 71 percent, respectively). As expected, vaccination coverage is higher in urban than rural areas (Figure 8.2). The highest proportion of children who are fully vaccinated is in Southern Province (91 percent), while the lowest proportion is among children in Northern Province (59 percent). Education of the mother is associated with higher immunisation coverage. Table 8.8 Vaccinations bv background characteristics Percentage of children 12-23 months who had received specific vaccines by the time of the survey (according 1o the vaccination card or the mother's report) and the percentage with a vaccinatmn card, by selected background characteristics, Zambia 1996 Percentage of children who received" Percent with DPT Polio vacci- Number Background nation of characteristic BCG 1 2 3+ 1 2 3+ Measles All t None card children Sex Male 97.4 96.4 91.9 84.6 97.0 92.8 83.4 86.2 78.2 2.1 81.9 640 Female 97.4 97.0 93.0 86 7 97.6 94.8 85.2 86.8 78.4 I 7 81.7 707 Birth order 1 98 0 97.7 94.2 88 2 98.4 96.7 87 3 92.2 83.6 1.2 81 1 299 2-3 97 5 97.2 92.9 86.6 98.2 94.2 85 2 88.7 81.0 1.8 81.3 442 4-5 97.8 97.0 93.5 85.7 98.2 93.6 84.6 84.8 76.7 1.0 83.3 281 6+ 96.3 94.7 89 4 82.0 94.5 90.9 80.2 80.0 71 2 3.5 81.9 324 Residence Urban 99.4 98.4 95.4 90.2 98.7 97.5 89.2 g9.7 83.4 0.5 82.1 532 Rural 96.1 95.6 90.5 82.7 96.4 91.6 81.2 84.5 75 0 2.8 81.6 814 Province Central 97.4 97 4 94.0 81.6 98 3 93.2 76.1 86.3 71 8 1.7 72.2 88 Copperbelt 99 5 98.4 95.7 91.6 99.5 98.4 91 6 89 5 84.1 0.5 85 9 247 Eastern 97.5 96 3 92.5 84.5 95 8 93.8 83.7 86.6 77 3 2.5 81.4 226 Luapula 98.7 98.7 95.4 90.8 98.7 95.4 90.1 90.7 88.1 1.3 84.7 121 Lusaka 100.0 98.7 94 1 87.7 98.0 94.9 83.7 88.2 79.0 0 0 80.8 200 Northern 88.7 87.4 77.3 69.5 91.2 81.2 67.8 71.4 58.5 7.5 71.6 183 North-Western 99.0 99.0 93.5 83.7 99.0 94.6 86.9 90.3 80.5 1.0 82.9 47 Southern 99.4 100.0 98.8 94 2 100.0 98.8 94.8 96.8 91.0 0.0 90.7 153 Western 97.4 97.4 93.9 84.2 98.3 94 8 82 5 79.9 73.7 1.7 84.2 80 Mother's education No education 96.7 94 9 88.6 79.5 95 5 90.3 77.9 84.3 73.2 2.9 82.4 189 Primary 96.7 96.1 91.3 83.6 96 8 92.8 82.4 84 1 75 4 2.3 81.0 867 Secondary 100.0 99.5 98 4 96.8 100.0 99.4 94.0 95.4 90.4 0 0 85.4 271 Higher * * * * * * * * * * * 19 All children 97.4 96.7 92.5 85.7 97.3 93.8 84.4 86.5 78.3 1.9 81 8 1,347 Note: An astertsk indicates that the rate is based on fewer than 25 children and has been suppressed. t Chddren who are fully vaccinated (i e , those who have received BCG, measles and three doses of DPT and polio) Trends in vaccination coverage can be assessed by comparing coverage among children of different ages, since those age 24-35 months received their vaccinations roughly one year prior to those age 12-23 months, etc. To be comparable, the data refer only to vaccinations received before age 12 months. Table 8.9 shows information on the proportion of children age 12-59 months who had been vaccinated by 12 months 112 of age by their current age. The coverage figures are based on both the card and mothers' reports. Vaccination cards were seen by interviewers for 69 percent of the children aged 12-59 months. The proportion of children with cards decreases with increasing age, from 82 percent for children age 12-23 months to 55 percent of children age 48-59 months. This decline may be due to many reasons: unavailability of cards in health institutions in the past, genuine loss due to time, or the increase over time in coverage of immnnisation services. Figure 8,2 Percentage of Children Age 12-23 Months Who Have Received All Vaccinations by Background Characteristics TOTAL - - RESIDENCEurban ~ Rural PROVINCE [ Central ;';;';;';i:i Cop erbelt ~3;i;3:i;;' ~a(ste r n 13; ; ;}; I . l J~pU~l ~3323;';.';;" Lusaka l Y.3~3".Y.3 Northern ~3:3:3:3;: North-Western ~:.;:.;:.~:.::, Southerh ~7~7:7;;';7 Western L;~;:;;;;:. EDUCATION ~////~ NO Education g////////~, Primary Secondary r,~/,/////~, - - 78 • 7~ i i i i i {~ ;}? i i i ;3 ;373333333: ; ; ; ; ;37333331 /7 3333733 ;7 ] ]3 i :;3 : F73333: : ;3 : 2333 .2179 .~.;7~7~7:~:~:i:i;3:7:~;7;~:~:i:i~.i~.::3~7~7;~;.;7~7;~.i~.):i:~;~;~:7:~:7.i:~:7~i~7;~>:':'>X':;.:;`~ 81 ' ' ' ' ' ~ 91 74 ~ii i i i / i i / i i~f i i i i i i i~i /~/ i i i i i i i i~i i i i i i i~i i / i i i i i i i~i f i i i i i i i i / i~y~i/ i i i i i~i i i i fZ/ i i i i j / i i~i~i i i i i i i i i i i~i~i / i i i / i i / i i i i~ ~0 20 40 60 80 Percent 100 ZDHS1996 Comparing vaccination coverage among different age groups of children shows that the proportion who were fully immunised by their first birthday rose gradually from 55 percent of those who were four years old at the time of the survey to 67 percent of those age one year. This analysis implies that immunisation coverage has been increasing over the past four years. Another way to assess trends in immunisation coverage is to compare data from the 1992 and 1996 ZDHS surveys (Figure 8.3). This comparison shows that coverage has improved, from 67 percent of children age 12-23 months fully vaccinated in 1992 to 78 percent in 1996 (Gaisie et al., 1993:98). The fact that there is a general increase in coverage indicates that the immunisation programme is increasingly achieving its goals to reach children. To meet the goal of 80 percent coverage in the next four years, more effort will be needed to encourage mothers to bring back their children for all the recommended vaccines and doses, especially for rural mothers and those in Northern Province. 113 Table 8.9 Vaccinations in first year of life Percentage of children one to five years of age for whom a vaccination card was seen by the interviewer and the percentage vaccinated for BCG, DPT, polio, and measles during the first year of life, by current age of the child, Zambia 1996 Vaccine Current age of child in months All children 12-59 12-23 24-35 36-47 4~-59 months Vaccination card seen by interviewer 81.8 72.0 64.0 54.7 69.0 Percent vaccinated at 0-11 months BCG 96.7 96.2 93.2 93.2 95.0 DPT 1 95.8 94.8 89.7 90.6 92.9 DPT 2 90.5 88.4 84.8 84.9 87.3 DPT 3 80.0 76.3 71.8 73.2 75.6 Polio 1 96.5 95.4 91.0 92,1 93.9 Polio 2 91.8 90.5 85.9 85.8 88.7 Polio 3 78.7 77.5 70.3 71.5 74.8 Measles 75.8 71.4 69.7 67.8 71.4 All vaccinations b 66.8 60.9 55.6 54.9 60.0 No vaccinations 2.8 4.5 6.4 7.0 5.0 Number of children 1,347 1,239 1,112 1,091 4,789 a . . . Informataon was obtained either from a vaccination card or from the mother if there was no written record. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as ~hat for children with a written vaccination record. Children who have received BCG. measles, and three doses each of DPT and polio vaccines Figure 8.3 Trends in Vaccination Coverage Among Children Age 12-23 Months 115 95 75 55 35 15 All 1 BCG OPT1 DPT2 DPT3 Polio1 Polio2 Polio3 Measles ]i1992ZDHS Q1996ZDHS i 11ncludas BCG, measles, and three doses each of DPT and polto ZDHS 1996 114 8.3 Acute Respiratory Infection Medical records show that pneumonia is among the top three causes of hospital admissions and among the top five causes of infant mortality in Zambia. The ZDHS estimated the prevalence of respiratory infection by asking mothers if their children under the age of five had been ill in the two weeks before the survey with coughing accompanied by short, rapid breathing. Early diagnosis and treatment with antibiotics can prevent most deaths due to pneumonia. It should be noted that prevalence of respiratory illness as measured by the ZDHS, is based on a mother's subjective assessment of her child's symptoms. Table 8.10 shows that 13 percent of children under five years of age were ill with a cough and rapid breathing during the two weeks before the survey. Seventy-one percent of these children were taken to a health facility or provider for treatment. The reported prevalence of symptoms suggestive of pneumonia peak in the first two years of life. The prevalence is similar for most background characteristics, except that it is lower for children in Luapula Province and children whose mothers have higher than secondary education. Children in Copperbelt and Eastern Provinces with pneumonia symptoms are much more likely to be taken for treatment than their counterparts in other provinces; more than 80 percent are taken for treatment, compared to only about half of children in Central, Northern, and Western Provinces. Higher-order children, rural children, and those whose mothers have no education are less likely to be taken to a health provider when ill with respiratory problems. 8.4 Fever Malaria is the major cause of hospital admissions and the number one killer among all age groups in Zambia. To assess the prevalence of malaria among children, mothers were asked whether their children under age five had a fever in the two weeks preceding the survey. Whereas fever is the primary symptom of malaria, fever can be a symptom of a large variety of diseases, including pneumonia, common colds/coughs, flu, etc. Table 8.10 shows that 40 percent of children under five years of age were reported to have had fever in the two weeks preceding the survey. Fever is more common among children aged 6-11 months (56 percent) and decreases with age. Prevalence of fever is similar in the different sexes, birth order, and residence groups. It ranges from 27 percent of children in North-Western Province to 55 percent in Western Province. Fever becomes less common among children as mother's education increases. 8.5 Diarrhoea Dehydration caused by severe diarrhoea is a major cause of morbidity and mortality among Zambian children. The most important role that caretakers in the home can play in the prevention of dehydration is giving a child with diarrhoea an increased amount of fluids, possibly in the form of solution prepared from oral rehydration salts (ORS) or water, juices, soups, etc.; and preventing malnutrition (from diarrhoea) by continuing and increasing the feeding of children with diarrhoea. Dehydration can be treated by the use of ORS, or if dehydration is severe, intravenous fluids. The most common treatment for dehydration is oral rehydration therapy (ORT)--solution prepared from commercially produced packets of oral rehydration salts (ORS, locally known as madzi a moyo), or a home-made solution of sugar, salt, and water. ORS is usually distributed through health facilities and pharmacies, while proper preparation of home-made solutions is taught in health centres. 115 Table 8.10 Prevalence and treatment of acute rest~iratorv infection and orevalence of fever Percentage of children under five years who were ill with a cough accompanied by short, rapid breathing (acute respiratory infection) during the two weeks preceding the survey, the percentage of ill children who were taken to a health facility, and the percentage of children with fever during the two weeks preceding the survey, by selected background characteristics, Zambia 1996 Percentage of children with Percentage cough and rapid of children breathing who were Percentage Background with cough and taken to a health of children characteristic rapid breathing fac h y or provider with a fever Number of children Child's age < 6 months 16.0 70.1 31.2 673 6-11 months 16.3 82.5 56.3 647 12-23 months 15.1 72.9 50.9 1,347 24-35 months 12.2 69.8 42.3 1,239 36-47 months 10.6 65.9 33.1 1,112 48-59 months 8.1 60. I 27.0 1,091 Sex Male 12.2 67.7 39.3 2,989 Female 13.1 73.4 40.8 3,120 Birth order 1 11.5 71.5 38.0 1,292 2-3 13.3 73.5 40,5 2,057 4-5 12.7 73.6 40.6 1,306 6+ 12.7 63.3 40.8 1,454 Residence Urban 12.6 78.4 38.1 2,445 Rural 12.7 65.6 41.4 3,664 Province Central 17.0 51.1 40.6 508 Copperbelt 11.1 84.1 36.2 1,171 Eastern 18.7 81.1 41.6 941 Luapula 5.2 (71.3) 39.5 545 Lusaka 12.5 70.0 38.8 909 Northern 9.7 53.7 44.5 744 North-Western 7.3 (86.1) 26.9 252 Southern 13.5 72.8 38.0 657 Western 15.6 52.9 54.7 381 Mother's education No education 13.3 57.9 44.1 829 Primary 12.5 71.3 40.8 3,897 Secondary 13.6 78.0 36.2 1,263 Higher 4.4 * 29.7 118 Total 12.7 70.7 40.1 6,109 Note: Figures are for children born in the period 0-59 months preceding the survey. Figures m parentheses are based on 25-49 children. An asterisk indicates that the rate is based on fewer than 25 children and has been suppressed. I Includes heal h cen re, hospital, cllmc, and pnvate doctor 116 Table 8. l 1 shows the prevalence of diarrhoea among children under the age of five. Nearly one in every four children had diarrhoea at some time during the two weeks before the survey and about 4 percent had diarrhoea with blood in the stool, generally an indication of dysentery. The peak of diarrhoea prevalence is in the weaning period, 6-23 months (40 percent and over). Only small variations are found in the prevalence of diarrhoea by sex, birth order, and type of residence. Diarrhoea is more common among children whose mothers have less education than those whose mothers have higher education. Diarrhoea is more prevalent in Lusaka and Eastern Provinces, with the latter having the highest prevalence of bloody diarrhoea. Table 8.12 shows data on knowledge among mothers of children under five about caring for a child with diarrhoea. Knowledge of ORS packets is nearly universal among Zambian mothers; 94 percent of women who had a birth in the five years preceding the survey had heard of or know about ORS packets. There were no marked differences in knowledge across different age groups of mothers or by urban-rural residence; but among provinces, mothers in Western Province are by far the least likely to know about ORS packets (74 percent, compared with 90 percent or more in the other provinces). Knowledge of ORS packets increases with increasing level of education of the mother. Table 8.12 also shows that three- quarters of Zambian mothers know that they should increase the quantity of liquids given to children when they have diarrhoea. Thirteen percent of mothers erroneously believe that the quantity of liquids should be decreased. This misperception is particularly Table 8.11 Prevalence of diarrhoea Percentage of children under five years who had diarrhoea and diarrhoea with blood in the two weeks preceding the survey, by selected background characteristics, Zambia 1996 Diarrhoea in the preceding 2 weeks Number Background All Diarrhoea of characterzstic diarrhoea with blood chddren Child's age < 6 months 10.8 0.6 673 6-11 months 44.0 5.2 647 12-23 months 39.9 5.7 1,347 24-35 months 24.5 4.8 1,239 36-47 months 13.0 2.9 l, l 12 48-59 months 8.6 1.6 1,091 Sex Male 24.1 3.5 2,989 Female 22.9 3.9 3,120 Birth order 1 23.4 2.5 1,292 2-3 24.0 3.4 2,057 4-5 23.6 4 5 1,306 6+ 22.8 4.3 1,454 Residence Urban 23.8 2.4 2,445 Rural 23.3 4.5 3,664 Province Central 23.7 3.1 508 Copperbelt 20.8 2.7 1,171 Eastern 27.0 6.2 941 Luapula 20.9 1.3 545 Lusaka 28 7 2.7 909 Northern 21 8 3.4 744 North-Western 17.4 2 0 252 Southern 22.4 5 7 657 Western 23.3 4.9 381 Mother's education No education 24.2 4.8 829 Primary 24.3 3.8 3,897 Secondary 21.7 2 7 1,263 Higher 12.5 1 3 118 Total 23.5 3.7 6,109 Note: Figures are for children born in the period 0-59 months preceding the survey. common among younger mothers, those who live in Eastern Province, and those with no education. Sixty-two percent of mothers know that it is best to increase the amount of solid food given to children when they have diarrhoea, while 16 percent believe it is better to decrease the amount. Variations by background characteristics in beliefs about feeding practices during diarrhoea are less pronounced than for beliefs about liquid intake. 117 Table 8.12 Knowledge of diarrhoea care Percentage of mothers with births in the last five years who know about the use of oral rehydration salts (ORS) for treatment of diarrhoea and the percent distribution by knowledge of appropriate feeding during diarrhoea, according to background characteristics, Zambia 1996 Quantities that should be gwen during diarrhoea Liquids Solid foods Know about ORS for Don't Don't Number Background treatment know/ know/ of characteristic of diarrhoea Less Same More Missing Less Same More Missing Total mothers Age 15-19 91.5 22.2 137 61.5 2.7 176 19.8 60.2 2.3 1000 451 20-24 94.8 14 5 14.8 68.4 2.3 16 1 21.7 60.5 1.6 100.0 1,225 25-29 95 6 9.4 9.6 79.1 1.9 15.9 17.8 64.3 2.0 100.0 853 30-34 95 2 9 7 10.6 78 4 1.3 14 8 19.5 63.6 2.2 100.0 663 35+ 93.4 9.2 I 1 2 78.5 1.1 16 4 20.8 62.0 0.7 100 0 598 Residence Urban 98.7 7 9 12.8 78,8 0,5 13.5 22,5 63.3 0,7 100.0 1,470 Rural 91.8 15.5 11.8 69.9 2,8 17.6 18 6 61 4 2.4 100.0 2,320 Province Central 95.3 14 0 13 1 70.2 2 6 15 6 21.2 61.5 1 6 I00.0 305 Copperbelt 98.9 6.4 17.9 75 8 0.0 14.1 31.7 54.0 0.2 100.0 681 Eastern 98.6 25 4 7.4 63 1 4.2 21.0 8 6 66.6 3.8 100.0 589 Luapula 92.5 5.9 12.5 81 2 0 4 10.5 23.2 65 2 1,1 100.0 355 Lusaka 99.6 9.3 6,9 82.6 1 1 13.7 16.3 69.3 07 100.0 560 Northern 90.4 10.2 14.6 73.2 1.9 16.8 20.2 60 6 2,4 100.0 470 North-Western 92,5 6.9 9 5 83.6 0.0 11.1 20 3 68.7 0.0 100.0 156 Southern 93.8 15.7 8,1 73.1 3.1 21.5 166 58.6 3.2 1000 411 Western 73,9 17.2 21 7 57.5 3.7 15.6 23 5 58.8 2.1 tO00 264 Mother's education No educauon 891 21.5 13.3 59.8 54 22.6 20.8 52.8 3.7 1000 524 Primary 94.1 13.1 13 1 72.2 1.7 164 20.1 61.9 1 7 100.0 2,419 Secondary 98.8 6.3 9.8 83.5 0.5 10.6 20 0 68.6 0 8 100.0 778 Htgher 100.0 0.0 0.0 100.0 0.0 15.7 15.1 69.2 0 0 100.0 68 Total 94.4 12.6 122 73.3 1.9 16 0 20 1 62.1 1.8 100.0 3,790 Table 8.13 shows the percentage of children with recent episodes of diarrhoea who received various treatments. About 4 in 10 children with diarrhoea are taken to a health facility or provider. Children in Southern, Western, and North-Western Provinces are more likely to be taken to a facility for treatment when they have diarrhoea than children in other provinces. Overall, 54 percent of children with diarrhoea are treated with a solution made from ORS packets, while 4 percent are given home-made solutions of sugar, salt, and water. Variations in the use of either ORS or home-made solutions by background characteristics are not large, except that the chances of receiving either of these treatments increase with the education level of the mother. Thirteen percent of children with diarrhoea are treated with antibiotics, while 25 percent were given home-made remedies other than sugar-salt-water solution. These remedies were more likely to be given to older children, children in rural areas, especially in Central, Eastern, and Western Provinces, and children whose mothers have less education. 118 Table 8.13 Treatment of diarrhoea Among children under five years who had diarrhoea in the two weeks preceding the survey, the percentage taken for treatment to a health facility or provider, the percentage who received oral rehydration therapy (either solution prepared from ORS packets or recommended home fluids) and increased fluids, the percentage who received neither oral rehydration therapy nor increased fluids, and the percentage receiving other treatments, by background characteristics, Zambia 1996 Percentage Per- Oral rehydration Per- receiving Other treatments centage therapy (ORT) centage neither taken to recalv- ORS nor Anti- ahealth RHF Either ingin- RHF nor biotics, Home No Number Background facility or ORS at ORS or creased increased pillor lnjec- remedy/ treat- of characteristic provider t packet home RHF flmds fluids syrup tion Other ment Missing chddren Child's age < 6 months 41.0 48.9 2.5 51.5 44.4 38.9 17.1 0.0 20.7 25.7 0.0 73 6-11 months 50.3 62.6 5.1 64.8 58.5 23.1 11.1 0.0 23.8 16.0 0.0 285 12-23 months 47.3 57.0 3.4 59.6 56.1 23.5 12.9 0.6 22.7 13.1 0.0 537 24-35 months 37.5 46.6 4.3 49.8 61.2 23.2 11.4 0.0 28.0 11.8 0.2 303 36-47 months 39.4 49.3 1.6 50.9 60.1 26.6 16.0 2.3 26.7 13.3 0.0 144 48-59 months 36.3 44.6 2.4 47.0 58.0 25.8 9.7 0.0 35,6 15.0 0.0 93 Sex Male 45.0 56.0 4.1 58,6 57.1 25.0 14.1 0.8 25.6 13.4 0,0 721 Female 43.0 51.8 3.2 54.4 58.1 24.2 11.0 0.1 24.8 14.9 0.1 714 Birth order 1 43.6 52.7 1.3 53.9 53.4 25.2 9.9 0.8 22.8 16.6 0.0 302 2-3 42.5 53.0 3.9 56.1 58.4 25.7 13.0 0.6 24,1 15.0 0.0 493 4-5 48.8 58.2 5.5 61.1 61.4 21.6 14.4 0.0 26.5 10.2 0.0 308 6+ 42.1 52.5 3.7 55.0 56.5 25.3 12.6 0.2 27.7 14.5 0,2 332 Residence Urban 45.3 58.4 3,8 61.7 65.4 19.9 18.9 0.7 19.2 12.3 0.0 581 Rural 43.1 50.9 3.5 53.0 52.3 27.8 8.3 0.3 29.3 15.5 0.1 854 Province Central 19,8 49.0 5.7 53.1 53.5 30.2 7.9 0.6 30.8 15.7 0.0 120 Copperbelt 30.7 55.1 2.2 57.3 56.7 23.8 14.0 0.0 22.2 15.3 0.0 244 Eastern 52.9 48.7 3.1 50.9 44.4 29.3 11,8 0.5 33.6 13.9 0.0 254 Luapula 26.2 54.8 2.2 56.9 55.3 28.3 14.9 0.0 26.8 17.0 0.0 114 Lusaka 55.2 56.6 5.4 61.1 70.5 18.8 21.1 0.5 19.5 11.8 0.0 261 Northern 21.2 46.8 5.0 47.5 52.5 29.0 8.3 1.1 27.0 16.9 0.0 162 North-Western 61.9 59.5 4.7 61.9 60,4 21.9 10.2 0.0 24.4 11.6 0.0 44 Southern 72.2 64.9 1.8 66.7 76,4 13.0 8.1 0.0 15.4 8.8 0.0 147 Western 63.8 55.9 3.2 57.5 44,9 30.7 5.5 1.6 29.9 18.1 0.8 89 Mother's education No education 37,0 45.6 2.1 47.5 46.7 33.6 9.1 0.3 32,6 18.1 0.3 201 Primary 43.5 52.7 4.0 55.3 56.1 25.0 10.2 0.3 26.6 14.2 0.0 945 Secondary 49.7 62.8 3.7 65.8 69.2 17.5 22.5 0.7 I5.3 I 1.5 0.0 275 Higher * * * * * * * * * * * 15 Total 44.0 53.9 3.6 56.5 57.6 24.6 12.6 0.4 25.2 14.2 0.0 1,435 Note: An asterisk indicates the rate is based on fewer than 25 children and has been suppressed. ORS = Oral rehydration salts RHF = Recommended home fluids i Includes health centre, hospital, and private doctor 119 To gauge the knowledge about drinking and eating standards for a child with diarrhoea, mothers with children under five who had had diarrhoea in the two weeks preceding the survey were asked about the drinking and eating patterns of these children. Table 8.14 shows that almost 6 in 10 children with diarrhoea were given more to drink than usual and 32 percent were given more to eat than usual (Table 8.14). However, 21 percent of children were given less fluids and 43 percent of children were given less solid food. These figures indicate that there is a need for further health education efforts to decrease the number of children becoming dehydrated or malnourished due to diarrhoea. Table 8.14 Feedina practices durin~ diarrhoea Percent distribution of children under five who had diarrhoea in the past two weeks by amount of solid foods given and amount of fluids given, Zambia 1996 Feeding practices Total Amount of fluids Same 21.0 Increase 57.6 Decrease 21.2 Don't know/missing 0.3 Amount of solid foods Same 25.2 Increase 31.6 Decrease 42.9 Don't know/missing 0.2 Total 100.0 Number of children 1,435 Note: Figures are for children bona in the period 0-59 months preceding the survey. 120 CHAPTER9 INFANT FEEDING, CHILDHOOD AND MATERNAL NUTRITION This chapter covers two related topics: infant feeding (including breastfeeding practices, introduction of complementary weaning foods, and use of feeding bottles) and nutritional status of young children and their mothers. Height and weight measurements of the respondent's children under the age of five years and those of the mother were taken to determine their nutritional status. 9.1 Breastfeeding and Supplementation Infant feeding has an impact on both the child and the mother. Feeding practices are important determinants of the child's nutritional status, which in turn influences the risk of dying. Frequent breastfeeding affects the mother through the biological suppression of the return to fertile status, thereby affecting the inter- birth interval and pregnancy outcome. These effects are influenced by both the duration and intensity of breastfeeding, and by the age at which the child receives foods and liquids. The data presented in Table 9.1 show the percentage of children who were ever breastfed as well as the timing of breastfeeding initiation for all children who were ever breastfed. The data indicate that almost all Zambian children (98 percent) are breastfed for some period of time. More than half (58 percent) of children are put to the breast within an hour of birth and 91 percent within the first day. This is an improvement since 1992 when only 40 percent and 87 percent of the children were put to the breast within one hour and one day, respectively. There are few marked differences in timing of breastfeeding initiation except by province. While in Eastern and North-Western Provinces, 82 percent or more of children are put to the breast within the first hour of birth, less than half the children (41 percent) in Luapula Province are breastfed within the first hour. Breast milk is safe, convenient, and contains all the nutrients needed by children in the first six months of life. In addition, it provides immunity to disease through the mother's antibodies. The percent distribution of children under age three years by breastfeeding status at the time of the survey is presented in Table 9.2, based on information about feeding practices in the 24 hours preceding the survey. Almost all children are breastfed for at least one year, with only 4 percent of children age 12-13 months not breastfed. By age 16-17 months, 13 percent of children are no longer being breastfed. Children who are exclusively breastfed receive nothing apart from breast milk, not even plain water. The recommended exclusive breastfeeding duration is 6 months. Early supplementation is unnecessary and discouraged since the likelihood of contamination and the resulting risk of diarrhoea are high. Early supplementation also reduces breast milk output since the production and release of milk is modulated by the frequency and intensity of suckling. Exclusive breastfeeding has improved in Zambia since 1992. For example, whereas in 1992 only 16 percent of children under 2 months of age were fed only breast milk (Gaisie et al., 1993:111), the figure had increased to 35 percent in 1996 (Table 9.2). The ZDHS results also show that the proportion of children below the age of 2 months receiving water in addition to breast milk has declined from 68 percent in 1992 to 54 percent in 1996. These results may be attributed to the intensive breastfeeding campaign implemented by the National Food and Nutrition Commission (NFNC) through the support of UNICEF in which hospitals have been made more baby friendly, campaigns to promote breastfeeding have been initiated, and staff were trained to counsel on breastfeeding. 121 Table 9.1 Initial breast feedin~ Percentage of children born in the five years preceding the survey who were ever breastfed, and the percentage who started breastfeeding within one hour of birth and within one day of birth, by selected background characteristics, Zambia 1996 Percentage who started breast feeding: Percentage Within Within Number Background ever 1 hour 1 day of characteristic breastfed of birth of birth children Sex Male 98.3 57.3 90.6 3,542 Female 98.1 59.0 92.2 3,617 Residence Urban 98. i 53.5 90.7 2,858 Rural 98.2 61.2 91.9 4,301 Province Central 98.8 46.7 88.4 587 Copperbelt 98.2 48.9 91.3 1,347 Eastern 97.1 87.3 95.7 1,103 Luapula 99.6 40.9 97.6 671 Lusaka 97.7 60.4 91.2 1,076 Northern 98.7 46.8 86.0 863 Noah-Western 98.8 82.0 98.2 287 Southern 98.6 62.5 94.2 764 Western 97.3 50.1 78.1 460 Mother's education No education 97.2 67.4 93.2 982 Primary 98.4 57.7 91.4 4,604 Secondary 98.4 53.7 90.5 1,437 Higher 96.3 53.1 90.3 135 Assistance at delivery Health professional 98.5 58.8 91.9 3,332 Traditional midwife 98.5 57.3 92.5 384 Other or none 97.8 57.8 91.2 3,416 Place of delivery Health facility 98.5 58.7 91.8 3,333 At home 97.9 57.8 91.4 3,803 All chddren 98.2 58.1 91.4 7,159 Note: Total includes 2 children for whose mother's education was missing, 27 children for whom data on assistance at delivery are missing and 24 children for whom data on place of delivery are missing. As many as 46 percent children age 2-3 months and 77 percent of children 4-5 months are receiving supplements, in addition to breast milk. This implies that a greater number below the age of 6 months are at risk of being contaminated by low quality foods even though they started well. By age 8-9 months, almost all children (97 percent) are given complementary foods. 122 Table 9.2 Breastfeedin~ status Percent distribution of living children by current breastfeeding status, according to child's current age in months, Zambia 1996 Percentage of living children who are: Breastfeeding and: Number Not Exclusively Plain of breast- breast- water Comple- living Age in months feeding fed only ments Total children <2 0.5 34.5 54,3 10.7 100.0 190 2-3 0.4 20.2 33,7 45.7 100.0 259 4-5 1.2 5.2 16.4 77.3 100.0 223 6-7 0.6 1.4 4.7 93.3 100.0 191 8-9 2.2 0.0 1.1 96.7 100.0 206 10-11 3.7 0.0 1.8 94.5 100.0 250 12-13 3.9 0.3 0.8 94.9 100.0 270 14-15 5.4 0.0 0.9 93.7 100.0 226 16-17 13.2 0.0 0.6 86.2 100.0 221 18-I9 22.4 0.0 1.7 75.9 100.0 186 20-21 44.4 0.6 0.0 55.0 100.0 223 22-23 69.0 0.0 0.0 31.0 100.0 220 24-25 82.0 0.0 0.3 17.7 100.0 253 26-27 91.5 0,0 0.0 8,5 100.0 209 28-29 94.3 0.0 0.0 5.7 100.0 204 30-31 94.7 0.0 0.0 5.3 100.0 161 32-33 95.5 0.0 0.6 4.0 100.0 208 34-35 99.0 0.0 0.0 1.0 100.0 205 0-3 months 0.4 26.3 42.4 30.9 100.0 449 4-6 months 1.2 4.2 13.1 81.6 100.0 321 7-9 months 1.5 0.3 1.9 96.3 100.0 300 Note: Breastfeeding status refers to preceding 24 hours. Children classified as breastfeeding and plain water only receive no complements. Complementary foods are important as frequency of breastfeeding declines or stops altogether as the child gets older (Table 9.2). In Zambia, the percent of children receiving complementary foods drops by the time the children are 18-19 months old. This drop is due to the fact that children are fully weaned on an adult diet. This is the age at which malnutrition--particularly wasting and stunting--peaks as shown by previous studies (Gaisie et al., 1993; CSO, 1994). Breast milk plays a major role in complementing the nutrient content of bulky diets that are often inadequate to promote growth. Whilst most children are breastfed for a full year, 5 percent of those aged 12-13 months are reportedly not yet receiving supplements to their diet of breast milk and water. Complementary foods are foods eaten by most family members and are often solid or mushy. These foods are introduced into the diet as early as one month after birth to 11 percent of breastfeeding children (Table 9.2). By age 4-5 months, 7 out of 10 breastfeeding children have complementary food introduced into their diets. By the time they are one and a half years old, over 75 percent are receiving supplements. Compared to the 1992 ZDHS, the number of children receiving complementary foods has declined. This may perhaps be due to rising household food insecurity for most Zambian households (CSO, 1994) and consequent reduction in number of meals consumed (NFNC/BASICS, 1995). The median duration of breastfeeding is 20 months (Table 9.3 and Figure 9.1). Differentials in median duration of breastfeeding are minimal except that children are breastfed the longest in Western and Northern Provinces (22 months or longer). 123 Table 9.3 Median duration and freouency of breastfeedm~ Median duration of any breastfeeding, exclusive breastfeeding, and full breastfeeding among children under three years of age, and the percentage of children under six months of age who were breastfed six or more times in the 24 hours preceding the survey, according to background characteristics, Zambia 1996 Children under 6 months Median duration in months I Number of Breastfed children 6+ times Any Exclusive Full under in Number Background breast- breast- breast- 3 years preceding of characteristic feeding feedmg feeding 2 of age 24 hours children Sex Male 19.9 0.5 2.4 2,199 94.4 356 Female 20.2 0.6 2.6 2,250 94.3 317 Residence Urban 19.1 0.9 2.5 1,719 93.1 262 Rural 20.7 0.5 2.5 2,730 95.1 411 Province Central 19.2 0.5 3.1 368 86.6 65 Copperbelt 19.0 1.0 2 7 815 91.2 114 Eastern 21.2 0.4 1.8 690 93.4 103 Luapula 19.6 0.5 2.2 416 97.5 63 Lusaka 18.1 1.2 2.6 657 96.0 100 Northern 21.9 0.5 2.4 553 96.9 75 North-Western 21.1 0.4 2.5 179 100.0 31 Southern 20.3 1.2 4.4 480 97.7 77 Western 24.2 0.4 2.9 293 93.7 45 Education No education 21.3 0.4 1.8 622 95.7 82 Primary 20.1 0.6 2.8 2,856 94.5 439 Secondary+ 19.3 1.1 2.4 971 93.0 150 Assistance at delivery Health professional 19.3 0.9 2.4 1,995 93.5 284 Traditional midwl fe 20.1 0.5 2.4 255 98.3 40 Other or none 20.7 0.5 2.7 2,191 94.5 348 Total 20.0 0.6 2.5 4,449 94.3 673 Mean 19.7 1.8 3.9 98.3 Prevalence/Incidence 3 19.1 I. 1 3.1 Note: Total includes one child for whom data on mother's education are missing, and one child for whom data on assistance at delivery are missing. I Medians and means are based on current status 2 Either exclusive breastfeeding or breastfeeding and plain water only 3 Prevalence-incidence mean Chi ldren are classif ied as fully breastfed i f they are either exclusively breastfed or are receiv ing breast mi lk and water. The median durat ion o f ful l breastfeeding is 3 months (Table 9.3). There is l ittle variat ion in median durat ion o f ful l breastfeeding. F requency o f breast feeding inf luences the production o f mi lk and nutrit ion status o f the baby. The delayed return to ferti l ity is also enhanced by the frequency o f breastfeeding. The data in Tab le 9.3 indicate that almost all chi ldren (94 percent), under the age of 6 months were fed six t imes or more in the 24 hours pr ior to the survey. 124 Figure 9.1 Median Duration of Breastfeeding ZAMBIA RESIDENCE Urban Rural PROVINCE Central Cop erbett EPastern Luapula Lusaka Northern Norl~-Western Southern Western EDUCATION NO Education Primary Secondary+ ASSISTANCE AT DELIVERY MedR:all Trained Tradition~ Midwife Other or None 20 ~"""~R~="""""" " " " " "~m~m""~""""""~mm~""""~ 19 ~ 1 9 19 21 ~ ~ 20 ~ 22 ~ 2 0 ~ 24 21 I 5 10 15 20 Months 25 ZDHS1996 In addition to questions about breastfeeding, the ZDHS also included questions about the types of foods given to children during the 24 hours preceding the survey. The results in Table 9.4 show that two-thirds of children below the age of 3 years were fed grain, flour, or cereal, while about half received meat, poultry, fish, or eggs, and about one in three were given liquids other than breast milk, infant formula, and other milk (Table 9.4). There appears to be no age-related preference for foods, although preparation methods for these foods for the different age groups may differ. The bottom part of Table 9.4 presents the feeding pattern of children who are not breast fed. These children are much more likely to have started receiving supplements at an earlier age than children who are breastfed. Bottle feeding is uncommon in Zambia (Table 9.4). Only 3 percent of babies age 0-1 months are being given a bottle and teat (nipple) in addition to being breastfed. However, the proportion of children who are bottle fed almost doubles at age 6-7 months. This follows a pattern of return to work by mothers after the matemity break of 3 months, which often is extended to about 5-6 months. Nevertheless, the practice reduces to the initial 3 percent by the age of one year and above, presumably since older children are more likely to feed on solid foods and require less bottle feeding. These ftndiugs are encouraging, since infants are particularly vulnerable to infections and use of unsterilised bottles with nipples is a prime source of infections. 125 Table 9.4 Tvoes of food received bv children in orecedin~ 24 hours Percentage of children under three years of age who received specific types of food in the 24 hours preceding the survey, and the percentage using a bottle with a nipple, by breastfeeding status, and child's age in months, Zambia 1996 Meaff Using Breast poultry/ Grain/ bottle Number Age milk Infant Other Other fish/ flour/ Tubers/ wuh a of (in months) only formula milk liquid eggs cereal plantains Other nxpple children BREASTFEEDING CHILDREN 0-1 34 7 2.5 3.5 2.5 0.4 2.5 0.4 2.1 3.3 189 2-3 20.3 2.3 2.9 6,4 2.5 21.0 3.8 18.8 4.4 258 4-5 5.2 6.4 8.6 12,8 14.1 53.8 5.8 32.1 3.1 221 6-7 1.4 6.2 8.9 30.9 42.0 73.4 14.6 56.1 5.9 190 8-9 0.0 1.8 14.1 43.0 52.6 86.0 21.8 67.0 2.1 202 10-11 0.0 2.3 16.3 46,7 65.2 83.6 26.8 68 5 3.2 241 12-13 03 1.7 17.8 52,6 63.7 82.9 27.9 70.1 2.8 260 14-15 0.0 1.0 15.9 50.3 62.0 83.1 31.4 72.9 1.9 214 16-17 0.0 1,5 16 6 58 1 70.8 84.2 40.9 77.5 2.9 192 18-23 0 4 0.0 14 3 50,2 62.3 81.6 36.3 69.4 1.4 337 24-29 0,0 0.9 20 2 38,0 67.8 91.2 39.9 72.2 0.0 75 30-35 * * * * * * * * * 20 0-3 months 264 2.4 31 4,7 1.6 132 23 11.7 39 448 4-6 months 42 5.5 8.1 18,1 20.5 58.2 8.4 39.3 2.6 317 7-9 months 0.3 4.1 13.0 39.4 51.5 83.6 19.6 63.7 4.7 295 Total 5 6 2 3 12 4 36 2 45.2 67.0 22.4 55.0 2.9 2,397 NON-BREASTFEEDING CHILDREN 18-23 0 0 0 0 21 9 69 1 76.1 77.3 33.0 69.8 2.7 292 24-29 0,0 0.9 20 1 62.0 67 4 80.4 37.9 70.8 2.2 591 30-35 0.0 0 7 16 7 60.6 66.1 80.9 36.2 68.9 0.8 554 Note: An asterisk inthcates that a figure is based on fewer than 25 unwelghted cases and has been suppressed. 9.2 Nutrit ional Status of Children The study of child health status in the ZDHS included body measurements for children under age five. These data known as anthropometric measurements are used to derive three indicators characterising the nutritional status of children. These indicators are important because children's nutritional status influences their susceptibility to disease and untimely death. Children's nutritional status reflects infant and child feeding practices as well as acute and chronic or recurrent infections. In the ZDHS, all children born since January 1991 were eligible for anthropometric measurement as were their mothers. Both the height and weight were measured; these data were used to construct the following indices for children: Height-for-age (stunting) Weight-for-height (wasting) Weight-for-age (underweight). Not all children eligible to be weighed and measured are included in the results presented here; the height and weight measurements are missing for 8 percent of eligible children, and one or both of the measurements are grossly improbable in 3 percent of the cases. The month and year of birth is not known for a small number of children, which renders two of the indices (height-for-age, and weight-for-age) incalculable. Hence, height and weight data are shown for 89 percent of the eligible children. Although the term "height" 126 is used here, children younger than 24 months were measured lying down on a measuring board (recumbent length), while standing height was measured for older children. As recommended by the World Health Organisation (WHO), the nutritional status of children in the survey is compared with an international reference population defined by the U.S. National Centre for Health Statistics (NCHS) and accepted by the U.S. Centres for Disease Control (CDC). Each of the three nutritional status indicators described below are expressed in standard deviation units (z-scores) from the median for the reference population. The use of this reference population is based on the finding that well-nourished young children of all population groups (for which data exist) follow very similar growth patterns. The reference population serves as a point of comparison, facilitating the examination of differences in the anthropometric status of subgroups in a population and of changes in nutritional status over time. In any large population, there is variation in height and weight; this variation approximates a normal distribution. The height-for-age index is an indicator of linear growth retardation. Children whose height-for-age z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age, stunted, and are chronically malnourished. Children who are below minus three standard deviations (-3 SD) from the median of the reference population are considered severely stunted. Stunting reflects failure to receive adequate nutrition over a long period of time, and is also affected by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-term effects of malnutrition in a population and does not vary appreciably according to season of data collection. Stunted children are not immediately obvious in a population; a stunted three-year-old child could look like a well-fed two-year-old. The weight-for-height index measures body mass in relation to body length, and describes current nutritional status. Children whose z-scores are below minus two standard deviations (-2 SD) from the median of the reference population are considered thin, wasted, and am acutely malnourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or recent episodes of illness, causing loss of weight and the onset of malnutrition. Children whose weight-for-height is below minus three standard deviations (-3 SD) from the median of the reference population are considered to be severely wasted. Weight-for-age is a composite index of height-for-age and weight-for-height; it takes into account both acute and chronic malnutrition. It is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as underweight. In the reference population only 2.3 percent of children fall below minus two (-2 SD) for each of the three indices. Table 9.5 shows the percentage of children under five years of age classified as malnourished according to height-for-age, weight-for-height, and weight-for-age indices, by the child's age and selected demographic characteristics. Forty-two percent of the children are classified as stunted and 18 percent are severely stunted (< -3 SD). The figures are high and suggest chronic food insecurity and probably repeated illnesses. Stunting is evident even among children under age 6 months (10 percent). The prevalence of stunting increases as children get older. At age 6-11 months, 24 percent of the children are stunted, and twice as many (48 percent) are stunted by age 12-23 months. Currently, 5 out of 10 children who are two years and older in Zambia are stunted. The prevalence of stunting varies slightly by other demographic characteristics. Few differences exist according to the sex of the child, birth order, and interval since preceding birth. 127 Table 9.5 Nutritional status of children by demmzraohic characteristics Percentage of children under five years who are classxfied as malnourished according to three anthropometric ind~ces of nutritional status: height-for-age, weight-for-height, and weight-for-age, by background characteristics, Zambia 1996 Background characteristic Height-for-age Weight-for-height Weight-for-age (Stunting) (Wasting) (Underweight) Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD l -3 SD -2 SD 1 -3 SD - 2 SD I children Age <6 months 1.5 10.4 0.7 2.3 0.5 3.7 597 6-11 months 7,1 24.4 1.5 7.3 6.7 22.9 618 12-23 months 20.2 47.7 1.0 8.8 9.1 34.7 1,257 24-35 months 23.5 52.3 0.4 2.3 6.2 27.6 1,116 36-47 months 22.1 50.4 0.2 1.5 4.2 21.4 963 48-59 months 19.5 47.4 0.3 1.9 2.3 18.2 892 Sex Male 18.1 43.1 1.0 5.0 6.1 24.5 2,665 Female 17.0 41.7 0,3 3,3 4.6 22.5 2,778 Birth order 1 17.4 45.2 0.4 4.2 5.0 24.4 1,074 2-3 16,6 40.4 0.6 4.4 5.0 22.5 1,825 4-5 17.3 40.2 0.9 3.6 5.4 22.5 1 ~203 6+ 19.1 44.7 0.7 4.3 5.9 24.9 1,341 Birth interval First birth 17.4 45.0 0.4 4.2 5.0 24.3 1,079 < 24 months 21.1 43.6 0.6 4.0 5.3 24.3 784 24-47 months 17.1 42. l 0.g 4. I 5.4 23.1 2,851 48+ months 15.6 38.2 0.4 4.5 5.4 22.8 729 Total 17.5 42.4 0.6 4.2 5.3 23.5 5,443 Note: Figures are for children born in the penod 0-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the medxan of the NCHS/CDC/WHO international reference population. Chddren are classified as malnourished if their z-scores are below minus two or minus three standard ~eviations (-2 SD or -3 SD) from the median of the reference population. Includes children who are below -3 SD Four percent of the children are wasted and less than 1 percent are severely wasted (<-3 SD). The weight-for-height indicator gives information about children's recent nutritional status. Wasting is highest for children between the age of 12-23 months. This is consistent with other study results in Zambia and elsewhere. Variations in the level of wasting by other demographic characteristics of the child are minimal. Twenty-four percent of the children are classified as being underweight and 5 percent are severely underweight (i.e., below -3 SD). Weight-for-age is an index of chronic or acute malnutrition (or both), but does not distinguish between a child who is underweight because of stunting and one who is underweight because of wasting. Children under 6 months of age are the least likely to be stunted or wasted or underweight. This is most likely due to the positive effects of breastfeeding. As shown in Table 9.2, less than 1 percent of children of this age are not being breastfed. After 6 months of age, the percentage of children who are underweight rises substantially to 35 percent among those 12-23 months and remains relatively high. The likelihood of being underweight varies little by sex of the child, birth order, or interval between births. 128 The percentage of children under five years of age classified as malnourished according to the three anthropometric indices is presented in Table 9.6 by socio-economic characteristics. A much higher percentage of children in rural areas are stunted, wasted, and underweight than in urban areas. For example, 49 percent of rural children are stunted, compared to 33 percent of urban children. The percentage of children who are stunted is highest in the outlying provinces of Northern and Luapula Provinces (57 percent or higher). Lusaka and Copperbelt Provinces have the lowest percentages of stunted children. Stunting is inversely related to the level of education of the mother, ranging from one in two children among those whose mothers are uneducated to only 9 percent of children among those whose mothers have higher than secondary education. In general, the differentials in wasting and underweight by urban-rural residence and mother's education are the same as those for stunting. Luapula Province has the highest percentage of children who are stunted, wasted, and underweight. Figure 9.2 shows the percentage of children under five years of age who are stunted, by selected background characteristics of the mother. Table 9.6 Nutritional status of children bv backeround characteristics Percentage of children under five years who are classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by background characteristics, Zambia 1996 Background characteristic Height-for-age Weight-for-height Weight-for-age (Stunting) (Wasting) (Underweight) Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD 1 -3 SD -2 SD I -3 SD - 2 SD I children Residence Urban 10.1 32.7 0.5 3.1 2.7 16.5 2,159 Rural 22.4 48.7 0.8 4.8 7.0 28.0 3,284 Province Central 12.6 38.1 1.3 6.1 4.8 19.9 458 Copperbelt 9.3 31.4 0.6 4.3 2.8 17.2 1,051 Eastern 22.7 48.1 0.4 2.7 5.6 26.0 866 Luapula 30.5 57.7 1.3 6.5 7.6 32.7 498 Lusaka 8.6 30.2 0.3 3.0 2.9 15.5 786 Northern 29.6 57.3 0.8 4.8 10.4 31.5 671 North-Western 19.3 47.4 0.7 2.3 4.8 27.1 224 Southern 13.6 39.5 0.2 3.5 4.5 21.1 564 Western 19.5 44.9 0.6 5.3 6.8 32.1 326 Education No education 23.1 50.1 0.8 5.9 7. l 30.9 757 Primary 19.3 44.7 0.7 4.2 6.0 24.8 3,472 Secondary 9.8 32.9 0.3 3.0 2.5 15.5 1,111 Higher 2.1 8.5 0.0 1.1 0.0 8.3 101 Total 17.5 42.4 0.6 4.2 5.3 23.5 5,443 Note: Figures are for children born in the period 0-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as malnourished if their z-scores are below minus two or minus three standard ~leviations (-2 SD or -3 SD) from the median of the reference population. Includes children who are below -3 SD 129 Figure 9.2 Percentage of Children under Five WhoAreStunted ZAMBIA RESIDENCE Urban Rural PROVINCE Central Copperbelt Eastern Luapula Lusaka Northern North-Western Southern Western EDUCATION NO Educstlon Primary Secondary Higher 42 33 49 38 31 48 58 - - -- 30 - - - - - ~ 57 47 - 40 4S :}:};!~i;}:}:}~i~i~i;!~i~i~i:i:i:}~i;:;;;i~i:i~i:i:iG:~;!;~i:i~:;:;~:!~i:!:i:i!~;;};!;i:i~ 4 s 10 20 30 40 50 Percent 60 ZDHS 1996 9.3 Nutritional Status of Mothers As mentioned above, all mothers of children born since January 1991, approximately the five years preceding the survey, were weighed and measured. The objective was to determine the nutritional status of women of reproductive age. However, since weighing and measuring all respondents would add considerably to the length and cost of the fieldwork, it was decided to limit the anthropometric section to women with young children who would be measured anyway.' Women were weighed on an electronic bathroom-type scale which measured the weight to an accuracy of 100 grams. Their height was measured with an L-shaped wooden board that was specially designed for the DHS project. This information was used to construct the following indicators of mothers' nutritional status: Mean height (in centimetres) Mean weight (in kilograms) Body mass index. Women who were pregnant at the time of the survey and those who had delivered within the two months before the interview day were excluded from the tables on weight and body mass index. Thus, data on height are available for 4,507 women, while data on weight are available for 3,677 women. Interviewers were instructed to weigh and measure all women who had a birth since January 1991, regardless of whether or not the child was still living. 130 Table 9.7 presents the distribution of mothers by mean height and body mass index (BMI) by background characteristics. For each indicator, the mean is presented, as well as the proportion falling below certain arbitrary cut-off points. Height, as well as being a good indicator of socioeconomic status of the mother, is also used to identify mothers at nutritional risk. Height of mothers can be used to predict the risk of difficulty in delivering children, given the association between height and size of the pelvis. Also, the risk of giving birth to low-weight birth children is higher among women of small stature. Although the cut-off point at which the mother can be considered at risk varies between populations, it probably falls in the range of 140- 150 centimetres. Indices of body mass are used to assess thinness or obesity. The most commonly used index is the BMI (also referred to as the Quetelet index), which is defined as weight in kilograms divided by the square of the height in metres. The main advantage of the BMI is that it does not require a reference table from a well-nourished population. For the BMI, a cut off point of 18.5 has been recommended for defining thinness, or acute undemutrition. Obesity has not been defined clearly in terms of the scale, though a BMI of 25.0 and above is usually considered obese. Table 9.7 Nutritional status of mothers bv background characteristics Among mothers of children under five years, mean height, and percentage of women shorter than 145 centimetres,zmean body mass index (BMI), and the percentage of women whose BMI is less than 18.5 (kg /m) , by selected background characteristics, Zambia 1996 Height BMI Number Percent Number Background Percent of <18 5 of characteristic Mean <145 cm women Mean (kg/m 2) women Age 15-19 157.1 1.5 473 21.1 I I .0 387 20-24 157.4 1.4 1,357 21.5 9.5 1,044 25-29 158.7 0.6 1,010 22.0 8.2 797 30-34 158.6 IA 817 22.2 8.0 671 35-49 158.4 1.5 850 22.7 9.6 766 Residence Urban 159.0 0.5 1,851 22.6 7.8 1,543 Rural 157 5 1.7 2,656 21.4 10.1 2,122 ProviglCe Central 158.4 0.4 363 21.9 6 7 286 Copperbelt 158 8 0.6 837 22.6 7 6 681 Eastern 156.9 2.2 679 21.9 6.6 536 Luapula 1557 2.9 412 21.6 9.3 331 Lusaka 159.5 1.1 705 22.9 6 5 590 Northern 157.3 1.1 530 21.4 10.4 433 North-Western 157.0 2.3 181 21.0 13. I 149 Southern 159.5 0.4 479 21 3 11.0 387 Western 158.3 0.4 320 20.6 19.0 271 Education No education 156.5 2.2 624 21.5 9.5 499 Primary 157.8 1.4 2,820 21.9 8.8 2,245 Secondary 161.0 0.2 960 22.2 10.2 838 Higher 161.5 0.0 102 23.7 4.2 82 Total I 158.1 1.2 4,507 21.9 9.1 3,665 Note" Table includes only women who had a birth in the five years preceding the survey. The BMI index excludes pregnant women and those who are less than two months post-partum. To al ncludes one woman for whom reformation on educa on s m ssmg 131 The average height of the mothers measured in Zambia (158 centimetres) falls above the critical cut- off point of 145 centimetres. Only about one percent of mothers are shorter than 145 centimetres. Nine percent, or one in eleven mothers, are chronically undernourished (i.e., BMI under 18.5). There are few differences among provinces for weight, height, and BMI of mothers. Teenage mothers are more likely to fall below the BMI cut off value of 18.5, as are rural compared with urban mothers (8 and 10 percent, respectively). Among the provinces, the proportion of mothers whose BM! falls below the cut-off point is highest in Western province (19 percent). 132 CHAPTER 10 MATERNAL MORTALITY Although the level of maternal mortality is generally considered to be one of the most important indicators of Zambia's health, no reliable data are available at the national level and estimates vary widely. A study conducted in 1982-83 at the University Teaching Hospital in Lusaka estimated a maternal mortality ratio of 118 deaths per 100,000 births, while a study in Mongu district in Western Province in 1991-92 produced a maternal mortality ratio of 889 (Nsemukila, 1994:10). National-level estimates vary from 202 (UNICEF, 1995) to 940 (WHO, 1996:15) maternal deaths per 100,000 births. Data were collected in the ZDHS that allow estimation of maternal mortality using a direct estimation procedure, as well as overall adult male and female mortality. The information concerns the survivorship of all live births of the respondent's natural mother (siblings). The direct approach to estimating adult and maternal mortality maximises use of the available data, using information on the age of surviving siblings, the age at death of siblings who died, and the number of years ago the sibling died. This allows the data to be aggregated to determine the number of person-years of exposure to mortality risk and the number of sibling deaths occurring in defined calendar periods. Rates of maternal and adult mortality are obtained by dividing maternal (or all female or male adult) deaths by person-years of exposure (Rutenberg and Sullivan, 1991). 10.1 The Data Each female respondent was first asked to give the total number of her mother's live births. Then she was asked to provide a list of the children born to her mother starting with the first-born, and whether or not each sibling was still alive at the survey date. For living siblings, current age was collected; for deceased siblings, age at death and years since death were collected. Interviewers were instructed that when a respondent could not provide precise information on ages or years ago, approximate answers were acceptable. For sisters who died at ages 10 years or older, three questions were used to determine if the death was maternity-related: "'Was [NAME OF SISTER] pregnant when she died?" and if negative, "Did she die during childbirth ?" and if negative, "Did she die within six weeks of the birth of a child or pregnancy termination ?" The estimation of adult and maternal mortality requires reasonably accurate reporting of the number of sisters and brothers the respondent ever had, the number who have died, and the number of sisters who have died of maternity-related causes. There is no definitive procedure for establishing the completeness or accuracy of retrospective data on sibling survivorship. Table 10.1 shows the number of siblings reported by the respondents and the completeness of the reported data on current age, age at death, and years since death. The sex ratio of enumerated siblings (the ratio of brothers to sisters) is 0.99, which is somewhat lower than the expected value of 1.02 or 1.03 and may indicate underreporting of brothers by respondents (see Table 10.1). In very few cases (one half of one percent), siblings' ages were not reported by the respondents. Respondents were highly knowledgeable about their siblings' survival status, with only 6 out of over 50,000 siblings missing this information. In the case of deceased siblings, complete reporting of age at death and years since death were also nearly universal; 96 percent of deceased siblings have both age at death and years since death reported. Rather than exclude the small number of siblings with missing data from further analysis, information on the birth order of siblings in conjunction with other information was used to impute the missing 133 data. t The sibling survivorship data, including cases with imputed values, were used in the direct estimation of adult and maternal mortality. Table 10.1 Data on siblintzs Number of siblings reported by female survey respondents and completeness of reported data on sibling age, age at death (AD) and years since death (YSD), Zambia 1996 Sisters Brothers All siblings Siblings Number Percentage Number Percentage Number Percentage An siblings 25,650 100.0 25,499 100.0 51,149 100.0 Living 20.851 81.3 20,233 79.3 41,083 80.3 Dead 4,796 18.7 5,264 20.6 10,060 19.7 Missing survival information 4 0.0 2 0.0 6 0.0 Living siblings 20,851 100.0 20,233 100.0 41,083 100.0 Age reported 20,750 99.5 20,146 99.6 40,896 99.5 Age trussing 100 0.5 87 0 4 187 0.5 Dead siblings 4,796 100.0 5,264 100.0 10,060 100.0 AD and YSD reported 4,588 95.7 5,025 95.5 9,613 95.6 AD missing 36 0.7 41 0.8 77 0.8 YSD missing 63 1.3 66 1.3 129 1.3 Both AD and YSD missing 108 2.3 132 2.5 241 2.4 10.2 Direct Estimates of Adult Mortality Another way to assess the quality of data used to estimate maternal mortality is to evaluate the plausibility and stability of overall adult mortality. It is reasoned that if estimated rates of overall adult mortality are implausible, rates based on a subset of deaths, i.e., maternal deaths in particular, are unlikely to be free of serious problems. Table 10.2 presents the age-specific rates of female and male mortality (15-49 years) for the seven-year period before the survey. Since the number of deaths on which the rates are based is not large (only 1,128 female and I, 142 male deaths), the estimated five-year, age-specific rates are subject to considerable sampling variation. Generally, female mortality is higher than male mortality below age 30 and is lower than male mortality at ages 30 and above. As expected, mortality among both sexes increases with age, however the rates generally level off at age group 25-29 for women and age group 35-39 for men. t The imputation procedure is based on the assumption that the reported birth ordering of sibling in the history is correct. The first step is to calculate birth dates. For each living sibling with a reported age and each dead sibling with complete information on both age at death and years since death, the birth date was calculated. For a sibling missing these data, a birth date was imputed within the range defined by the birth dates of the bracketing siblings. In the case of living siblings, an age was then calculated from the imputed birth date. In the case of dead siblings, if either the age at death or years since death was reported, that information was combined with the birth date to produce the missing information. If both pieces of information were missing, the distribution of the ages at death for siblings for whom the years since death was unreported, but age at death was reported, was used as a basis for imputing the age at death. 134 Tpble 10. 2 Adult mortality rates Estimated adult mortality rates for women and men in the period 0-6 years before the survey, Zambia 1996 Mortality Age Deaths Exposure rate WOMEN 15-19 102 23,813 4.29 20-24 188 24,321 7.74 25-29 278 20,068 13.86 30-34 241 15,749 15.32 35-39 178 10,781 16.48 40-44 93 6,305 14.70 45-49 48 3,326 14.45 15-49 1,128 104,364 10.61 a MEN 15-19 80 23,312 3.42 20-24 132 24,470 5.38 25-29 238 20,355 11.67 30-34 270 15,426 17.51 35-39 224 10,085 22.23 40-44 130 5,769 22.53 45-49 69 3,249 21.34 15-49 1,142 102,665 11.32 a "Age-a0justed rates 10.2). Embodied in a model life table is a relationship between mortality during childhood and mortality during later years. Some models posit high child relative to adult mortality levels; others describe low child relative to adult mortality. So that by selecting model mortality schedules based on an observed under-five mortality level, one can assess whether adult rates are higher or lower than would be expected. Here, the ZDHS under-five mortality estimates of 183 per thousand for females and 202 per thousand for males (from Table 7.3) are used to enter the model mortality schedules: model North and South of the Coale-Demeny life tables, The figures show that adult mortality in Zambia substantially exceeds rates described in the reference schedules for a given childhood mortality level. This is especially true for male mortality in age 35 and above. These findings indicate that underreporting of deceased siblings is unlikely to be a serious problem in the ZDHS data. The fact that the estimated rates exceed model rates may be realistically explained by the recent deterioration in adult survival prospects due in part to the AIDS problem. An analysis of trends in adult mortality would be a useful extension to this line of inquiry; unfortunately, the sparseness of the data will not support a statistically reliable look across the relevant calendar periods. 20 18 16 14 12 10 8 6 4 2 0 Figure 10.1 Female Adult Mortality in Zambia for the Period 0-6 Years Before the Survey, by Age, from Various Sources Deaths per 1,000 15-19 i 20-24 251.29 301.34 351.39 40~44 Age Group I-e-1996 ZDHS ~ North Model 13 ellSouth Model 15 I 45-49 ZDHS 1996 135 Figure 10.2 Male Adult Mortality in Zambia for the Period 0-6 Years Before the Survey, by Age, from Various Sources Deaths per 1,000 24 22 20 18 16 14 12 10 8 6 4 2 0 15-19 20-24 l I I 20-29 30-34 35-39 Age Group 40-44 14-1996 ZDHS ~North Model 13 ==South Model 15 I 45-49 ZDHS 1996 10.3 Estimates of Maternal Mortality Direct age-specific estimates of maternal mortality from the reported survivorship of sisters are shown in Table 10.3 for the 0-6 year period before the survey. The number of maternal deaths (147) is not large, so age-specific rates are subject to large sampling errors. However, the age-specific rates show a plausible pattern, being higher at the peak childbearing ages of the 20s and 30s than at the youngest and older age groups. For the entire childbearing period (15-49) for the seven-year period before the survey (1990-1996), the rate of mortality due to causes related to pregnancy and childbearing is 1.34 maternal deaths per 1,000 woman-years of exposure. Maternal deaths represent approximately 13 percent of all deaths to women aged 15-49. The maternal mortality rate can be converted to a maternal mortality ratio and expressed per 100,000 live births by dividing the Table 10.3 Direct estimates of maternal mortalitv Direct estimates of maternal mortality for the period 0-6 years before the survey, Zambia 1996 Mortality Age Deaths Exposure rate 15-I9 I8 23,813 0.75 20-24 34 24,321 1.40 25-29 43 20,068 2.14 30-34 31 15,749 1.96 35-39 16 10,78l 1.46 40-44 3 6,305 0.50 45-49 3 3,326 0.82 I5-49 147 104,364 1.34 a General Fertility Rate (GFR) 0.206 a Maternal Mortality Ratio (MMR) 2 649 ~Expressed per woman-years exposure 1 ~000 of Per 100,000 live births; calculated as the maternal ~Aortallty rate divided by the general fertility rate. ge-adjusted rates rate by the general fertility rate of 0.206 operating during the same time period. In this way, the obstetrical risk of pregnancy and childbearing is underlined. By direct estimation procedures, the maternal mortality ratio is estimated as 649 maternal deaths per 100,000 live births during 1990-1996. 136 CHAPTERl l AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES 11.1 Background HIV/AIDS remains a major concern in Zambia due to continuing high prevalence rates. Sero- surveillance data from antenatal clinics from 1994 show a great diversity in the spread of HIV across the country, ranging from 2 percent to 32 percent (National AIDS/Sexually Transmitted Diseases/Tuberculosis and Leprosy Program (NASTLP, 1994). Sentinel survey data are collected every two years from a sample of women attending antenatal clinics. All provinces have sentinel sites, one each in rural and urban areas. Since 1984, when AIDS was first recognised as a threat to public health, the Ministry of Health has spearheaded various strategies to contain and limit the spread of HIV infection. The strategies have ranged from protection of the blood supply to information dissemination and campaigns to change social attitudes and behaviour. Information, Education and Communication (IEC) messages have been used to educate the population at large about sexually transmitted diseases (STDs). There is a correlation between STDs and vulnerability to H1V infection. AIDS control measures have been directed at sensitising the public that STDs are avoidable with the practice of responsible sexual behaviour and treatable once infected. 11.2 Sexual Behaviour Messages advocating behavioural change have been an important strategy for containing the spread of H1V/AIDS and assisting those already infected to live positively. IEC programmes have encouraged women and men to practice safe sex, which has been interpreted as abstinence when not in a continuous union with a partner who can be trusted to remain faithful, and faithfulness to one partner. When this behaviour cannot be practiced, people are encouraged to use condoms. Women and men interviewed in the ZDHS were asked about their sexual behaviour, the number of sexual partners in the 12 months preceding the survey, and receipt of payment for sexual relations. Data in Tables 11.1.1 and 11.1.2 show that virtually all married women have only one sex partner, their spouse or partner. Among unmarried women, six in ten do not have any sex partner and the majority of those who are sexually active have only one partner. Men are much more active sexually than women; 14 percent of married men have two or three partners, and 4 percent had four or more partners in the 12 months preceding the survey. Unmarried men are also more active sexually than unmarried women (61 percent compared to 38 percent). Young married men are more likely to have multiple partners than older married men. For example, one in five married men 20-24 years of age reported having two or three partners, and 12 percent had four or more partners, including their wives, while among men age 50 and above, less than 3 percent have multiple partners. Exchange of sex for money or gifts is a coping strategy for dealing with poverty and may not be perceived as commercial sex work. Nearly 11 percent of the women and 24 percent of the men interviewed reported exchanging sex for money or gifts during the 12 months prior to the survey (Table 11.2). Respondents who were not currently in union were much more likely to report this relationship. Unmarried young women (below age 25) and unmarried men, particularly those age 25-39, were more likely to be involved in sex for money/gift relationships. Almost 40 percent of unmarried men of all ages indicated involvement in a money/material exchange. Women respondents were either less likely to have engaged in a commercial relationship or less likely to admit to it. 137 oo Table l l . l . l Number ofrecent sexual oartners: women Percent distr ibution of currently married women and of currently unmarried women by the number of sexual partners in the 12 months preceding the survey, according to selected background characteristics, Zambia 1996 Currently m~L~rted women Unmanied women Number of partners Number of partners including spouse excluding spouse Number of partners Don't Number Don't Number Background know/ of know/ of charaetensuc 0 1 2-3 4+ Mtssmg Total Mean 0 1 2-3 4+ Total Mean women 0 1 2-3 4+ Missing Total Mean women Age 15-19 20 96.6 1.3 0.2 00 100.0 1.0 98.6 0.6 06 0.2 100.0 0.0 498 68.9 25.0 5.0 0.7 0.4 100.0 0.4 1,506 20-24 3 4 94.6 1.8 0.1 0.1 1000 1 0 98.1 1.2 0.6 0.1 100.0 0.0 1,207 52.6 36.3 8.5 1.1 1.5 100.0 0.6 623 25-29 2.8 95.5 1.4 0.3 00 100.0 1.0 98.3 1 2 0.2 0.3 100.0 0.0 969 42.3 45.5 8.1 1.0 3.0 100.0 0.7 317 30-39 4 1 947 1.2 0.0 0.0 100.0 1.0 98.8 1.0 0.3 0.0 100.0 0.0 1,443 50.4 40.4 4.5 0.4 4.3 100.0 0.5 397 40~19 5.0 93.1 1.3 0.2 0.3 100.0 1.0 98.5 1.1 0.2 0.2 100.0 0.0 786 67.3 25.8 3.6 0.8 2.4 100.0 0.5 276 Marital duration 04 2.9 95 5 1 5 0 1 0.0 100.0 1.0 98.3 0.9 0.6 0.1 I00.0 0.0 1,277 NA NA NA NA NA NA NA 0 5-9 3.7 944 1 7 0 1 0.1 100.0 1.0 98.2 1.4 0.4 0.1 I00.0 0.0 1,077 NA NA NA NA NA NA NA 0 10-14 2.1 964 1 3 02 0.0 100.0 1.0 984 1.2 0.2 0.2 100.0 0.0 820 NA NA NA NA NA NA NA 0 15+ 4.8 93 8 1 2 0.1 0.2 1000 1.0 987 0.9 0.3 0 1 100.0 0.0 1,728 NA NA NA NA NA NA NA 0 Residence Urban 2.3 9@0 13 0.2 0.2 1000 1.0 98.4 1.0 0.4 02 100.0 0.0 1,972 61.6 30.6 5.7 0.9 1.2 100.0 05 1,633 Rural 4.5 940 15 0.0 0.0 100.0 1.0 98.5 1.1 0.4 00 100.0 0.0 2,930 59.2 32.2 6.0 0.6 2.0 100.0 0.5 1,486 Education Noeducauon 5.7 92.6 1.4 0.2 0.2 1000 1 0 98.4 1.2 0.2 0.2 100.0 0.0 803 62.7 30.3 5.2 0.3 1.6 1000 04 264 Primary 37 94.6 1.5 0.1 00 100.0 1.0 98.4 1 l 0.4 0.1 100.0 0.0 3,053 59.7 30.9 6.6 0.8 2.0 100.0 0.5 1,668 Secondary 1 9 96.8 1.2 0.I 00 100.0 1.0 98.7 0.8 0.4 0.I 100.0 0.0 924 62.2 31.2 4.8 0.9 0.9 100.0 0.5 1,082 Higher 1.1 96.7 1.1 0.0 1.1 100.0 1.0 98.9 1.1 0.0 0.0 100.0 0.0 122 48.0 43.4 6.2 0.0 2.4 100.0 0.6 104 Total I 3 6 94.8 1 4 0 1 0.1 100.0 1.0 98.4 I . l 0.4 0.l 100.0 0.0 4,902 60.4 31.4 5.9 0.8 1.6 100.0 0.5 3,119 NA = Not applicable i Includes one woman with no information on educauon Uo Table 11.1.2 Number of recent sexual partners: men Percent distribution of currently mamed men and of currently unmarried men by the number of sexua/partners in the 12 months preceding the survey, according to selected background characteristtcs, Zambia 1996 Currently mamed men Unmamed men Number of partners Number of partners including spouse excluding spouse Number of partners Don't Don't Number Don't Number Background know/ know/ of know/ of characteristic 0 1 2-3 4+ Missmg Total Mean 0 1 2-3 4+ Missing Total Mean raen 0 I 2-3 4+ Missing Total Mean men Age 15-19 * * * * * 100.0 * * * * * * 100.0 * 3 49.4 21.5 20.4 8.5 0.3 100.0 1.2 457 20-24 1.6 66.5 19.9 12.0 0.0 1000 1.9 68.1 15.6 93 7.0 0.0 100.0 0.9 115 30.6 33.8 21.7 13.7 0.2 100.0 1.7 288 25-29 0.6 74.6 19.5 5.3 0.0 100.0 1.4 75 3 156 6.6 2.5 0.0 100.0 0.4 174 13.4 39.1 31.6 14.9 0.9 100.0 2.0 81 30-39 2.1 78.3 16.3 3.0 0 3 100.0 1.3 79 5 150 4.4 0.9 0.2 100.0 0.3 352 30.0 37.0 23.7 9.3 0.0 100.0 2.3 57 4049 4.4 85.0 8.1 2.6 0.0 100.0 1.1 89.4 6.2 3.4 1.1 0.0 100.0 0.2 189 * * * * * 100.0 * 14 50-59 5.3 90.8 1.4 1.3 1.2 100.0 1.0 97.3 0.8 1.9 0.0 0.0 100.0 0.1 110 * * * * * 100.0 * 8 Marital duration 0-4 1.2 73.0 18.1 7.7 0.0 100.0 1.6 73.6 14.2 7.9 4.3 0.0 100.0 0.6 234 NA NA NA NA NA NA NA 0 5-9 1.7 78.1 17.4 2.8 0.0 100.0 1.3 79.2 14.8 4.9 1A 0.0 100.0 0.3 202 NA NA NA NA NA NA NA 0 10-14 3.3 77.6 14.5 4.2 0.4 100.0 1.3 80.6 13.5 4.3 1.2 0.4 100.0 0.3 160 NA NA NA NA NA NA NA 0 15+ 3.7 83.9 9.2 2.8 0.5 100.0 1.2 87.9 7.5 3.6 1.0 0.0 100.0 0.2 347 NA NA NA NA NA NA NA 0 Residence Urban 2.9 81.3 12.7 2.7 0.3 100.0 1.2 83.9 11.6 3.7 0.8 0.0 100.0 0.3 401 36.2 28.7 23.2 10.5 1.4 100.0 1.6 451 Rural 2.4 77.0 15.0 5.4 0.2 100.0 1.4 79.3 11.9 6.0 2.7 0.1 100.0 0.4 543 40.9 27.5 20.6 10.6 0.3 100.0 1.4 454 Education No education 3.2 77.2 15.7 20 1.9 100.0 1.3 82.2 11 2 57 1.0 0.0 100.0 0.3 71 27.1 32.4 26.7 13.8 0.0 100.0 1.6 56 Primary 3.3 76.7 14.6 5.3 0.3 1000 1.4 79.5 12.5 5.6 2.2 0.2 100.0 0.4 454 42.8 25.6 17.9 13.1 0.6 100.0 1.5 484 Secondary 1.9 80.5 14.3 3.3 00 100.0 1.3 82.4 11.2 4.4 2.0 0.0 100.0 0.3 345 34.8 30.5 26.4 6.8 1.5 100.0 1.3 341 Higher 1.0 86.5 80 4.4 0.0 100.0 1.2 85.5 10.0 4.4 0.0 0.0 100.0 0.2 73 * * * * 0.0 100.0 * 25 Total 2.6 789 14.0 4.2 0.3 100.0 1.3 81.3 11.7 5 0 1.9 0.1 100.0 0.4 944 38.5 28.1 21.9 10.6 0.9 100.0 1.5 905 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted men and has been suppressed. NA = Not applicable 11.3 Knowledge About Sexually Transmitted Diseases (STDs) Women and men were asked if they knew of diseases that are transmitted sexually. If so, the respondents were asked which ones they knew. Knowledge of sexually transmitted diseases (STDs) other than AIDS is generally high among women and men (73 percent or higher) (Table 11.3). However, the knowledge level for STDs is usually not as high as that for AIDS (90 percent or higher). Men, on average, were more knowledgeable about STDs than women. Furthermore, men are more likely than women to identify AIDS as a sexually transmitted disease. The overall pattern of knowledge about STDs is similar for women and men. Older respondents, those who have ever been married, and those with more education are more likely to know about STDs than other respondents. The least knowledgeable group is adolescent girls and boys age 15-19, although boys tended to have more knowledge of STDs than girls. Table I 1.2 Payment for sexual relatiQfl,5 Among women and men who ever had sexual intercourse, percentage who have given money, gilts or favours in exchange lbr sex in the past 12 months, by marital status, according to selected background characteristics, Zambia 1996 Women Men Not Not Currently married currently married All women Currently married currently married All men Background characteristic Percent Number Percent Number Percent Number Percent Number Percent Number Percent Number Age 15-19 8.2 498 38.4 670 25.5 1,168 * 3 39.3 301 38.9 304 20-24 4.9 1,207 28 4 528 12 0 1,735 25 3 115 36.1 246 32 7 361 25-29 3.7 969 19.7 310 7 6 1,279 13.2 174 46.7 79 23 6 253 30-39 2.6 1,443 16.2 391 5 5 1,834 14 0 352 42.7 54 17 8 406 40-49 1.7 786 9.0 276 3.6 1,062 11.9 189 * 14 135 204 50-64 NA NA NA NA NA NA 4.4 110 * 8 4 1 I 18 Residence Urban 34 1,972 23.7 1,100 10.7 3,071 14.8 401 308 369 22.5 769 Rural 4.0 2,930 27.5 1,075 10.3 4,006 12.8 543 47.5 333 26.(I 876 Education No education 3.2 803 18 3 212 6 4 1,015 8.9 71 50 2 47 25 5 118 Primary 4.2 3,053 29 8 1,160 11 2 4,213 14.9 454 48 2 342 29 2 796 Secondary 3.4 924 23 5 712 12.2 1,636 13.8 345 27 0 290 19.9 636 Higher 1.1 122 4.4 91 2.5 213 9.9 73 * 22 12 5 95 Total 3.8 4,902 25.6 2,175 10.5 7,077 13 6 944 38.7 702 24 3 1,646 Note: An asterisk indicates that a figure is based on fewer than 25 men and has been suppressed NA -- Not apphcable Place of residence seems to be more closely related to knowledge of STDs for women than for men. The gap in knowledge between urban and rural women is much larger than that between urban and rural men (Table 11.3). Knowledge of STDs among women is substantially lower in Eastern Province than in other areas of the country. 140 11.4 Health Seeking Behaviour for Treatment of STDs Less than 3 percent of women and 7 percent of men reported that they had an STD in the 12-month period prior to the survey. Among the women, syphilis and gonorrhoea (both approximately 1 percent) were the most commonly mentioned STDs, while among men, gonorrhoea, discharge from the penis, and genital sores or ulcers (4 percent, 4 percent, and 3 percent, respectively) were the most commonly reported ailments (Table 11.4). STDs are more common among women and men in their 20s and 30s, those who have been been married and those who are better educated. Respondents reporting STD infections in the 12 months preceding the survey were asked about their behaviour in seeking treatment and informing sexual partners. They were also asked about measures taken to avoid infecting their partners. Women were slightly more likely to seek treatment than men (99 percent vs. 91 percent). Also, more than 91 percent of women said they had informed their partner(s) of their status. Approximately 66 percent of men indicated that they had informed their partner(s) of their status (Table 11.5.). There were differences in terms of marital status. A higher percentage of married women and men said they informed partner(s) compared to men and women not currently married or in union. More than half of women reported that their partner was already infected, hence they had taken no action to avoid infecting their partners. 11.5 Knowledge About AIDS In addition to general questions on knowledge of STDs, respondents in the 1996 ZDHS were asked if they had ever heard about AIDS. Tables 11.6.1 and 11.6.2 show the percentage of respondents who answered affirmatively, according to the sources of AIDS information. Results indicate that knowledge of AIDS is nearly universal among respondents (just under 100 percent). There is no significant difference between women and men in level of knowledge of AIDS, but sources of information vary. Over 60 percent of women and nearly the same percentage of men said they relied on friends or relatives for information. Overall, information disseminated through other sources was more likely to be received by men than women, except communications through health workers. Fifty-three percent of the women reported receiving information from this source compared to 26 percent of men. There were differences according to background characteristics in source of knowledge of AIDS. Dependency on friends for information about AIDS was more apparent in rural areas compared to urban areas. The dominant sources of information for rural populations were friends (72 percent) and health workers (57 percent) compared to urban populations whose major sources of information were radio (66 percent) and friends (51 percent). 11.6 Knowledge of Ways to Avoid AIDS Less than 10 percent of the respondents believe that AIDS is unavoidable (Tables 11.7.1 and 11.7.2). There were only slight variations between women and men in identifying methods to avoid AIDS. The majority of women and men cite faithfulness with one partner (49 percent for both women and men) and condom use (38 percent of women and 49 percent of men). More men (40 percent) than women (29 percent) identified abstinence as an option, irrespective of their background and residence. Older and better educated persons are more likely to cite having one sexual partner as a means of avoiding AIDS, while younger men cite condoms. The responses of respondents from North-Western Province deserve mention; women in this province are especially likely to cite limiting to one sexual partner as a means of AIDS prevention (81 percent), while men are likely to say that avoiding sex with prostitutes is a good way to avoid the disease (70 percent). 141 Table 11.3 Knowledee of sexually transmitted thseases Percentage of women and men who know of specific sexually transnmted diseases, by selected background characterisUcs, Zambia t 996 Women Men Number Background HIV/ Genital Don't of HIV/ Genital Don't Number characteristic Syphilis Gonorrhoea AIDS t warts Other know any women Syphilis Gonorrhoea AIDS t warts Other know any of men Age 15-19 56.4 57.6 85.8 3.4 1.2 9.1 2,003 61,9 63.3 92.8 5.1 2.0 4.1 460 20-24 73.5 76.1 88.5 6.1 1.3 5.5 1,830 85.6 87.9 94.8 7.7 0.8 1.4 404 25-29 76.2 78.4 89.9 6.4 1.3 4.2 1,286 93.0 93.0 93.9 11.6 1.3 0.3 255 30-39 78.6 79.1 91.3 7.0 1.8 3.3 1,840 89.8 91.7 92,9 10.7 1.7 1.0 409 40-49 74.2 76.6 87.9 5.8 0.9 4.5 1,062 85.5 89.8 93.3 7,7 2.0 1.4 204 50-59 NA NA NA NA NA NA NA 90.0 90.6 95.2 12.8 3.8 0.0 1 lg Current marital status Never married 61.3 62.6 87.5 3.6 1.1 6.8 2,032 72.0 74.6 93.9 6.6 1.3 2.6 814 Had sex 69.1 70.8 87.8 5.1 0.5 5.4 1,087 79.3 81.9 95.0 7.6 0.9 1.0 611 Never had sex 52.3 53.2 87.2 1,9 1.7 8.4 944 50.3 52.6 90.8 3,4 2.7 7.5 203 Currently mamed 73.5 75.3 88.9 6.0 1.3 5.4 4,902 89.8 91.2 93.1 9.9 2.1 1.0 944 Formerly marned 77.3 79,3 89.4 7.9 1.9 3.8 1,086 88.6 87.8 95.9 13.0 0.7 1.7 91 Residence Urban 79.6 76.9 90.3 5.2 1.3 3.1 3,604 85.3 86.2 92.4 8,2 1.9 1.2 852 Rural 63.8 69 1 87.2 6.0 1.3 7.6 4,417 79.1 81.6 94.7 8.9 1.5 2.2 997 Province Central 73.5 73.1 90.7 30.2 1.4 4.2 653 83.4 90.5 92.7 0.5 4.0 0.5 157 Copperbelt 86.1 85.1 89.9 3,4 1.3 2.9 1,588 88,7 87.6 92.6 9.6 1.3 2.9 396 Eastern 34.6 56.8 81.3 1.1 0.0 16.0 1,075 83.4 92.6 97.1 2.2 1.4 0.4 254 Luapula 89,4 90.2 90.5 1.6 0.1 3,1 726 97.4 98.5 95.4 0.5 0.5 0.0 151 lmsaka 72.2 64.0 90.8 2.5 0.7 3.8 1,403 80,2 85.1 88.2 3.2 1.9 0.8 316 Northern 80.4 67.5 88.9 3.4 1,1 3.3 872 82.1 79.8 96.3 9.5 0.9 3.2 221 North-Western 64.5 67.6 81,7 6.7 16,3 14.4 288 71.7 82.0 88.2 3.4 4,1 9.6 48 Southern 68.6 72.8 95.5 4.4 0.8 3.4 816 80.7 49.0 96.4 21,4 0.5 1.4 173 Western 59.8 75.7 82.0 9.8 0.6 4.1 600 48.7 79.6 95.9 33,3 3.6 1.6 132 Education No education 53.0 58.2 79.1 3.2 0.8 15.5 1,067 73.2 82.2 89.7 6.3 1.2 3.7 127 Primary 69.3 72,1 89.1 5.8 1.4 5.4 4,721 76.4 78.6 93.4 7.8 2.1 2.6 938 Secondary 81.6 79.5 92.0 5.4 1.3 1.3 2,007 89.4 88.6 93.9 9.5 1.2 0.5 686 Higher 93.2 90.8 92.I 16.1 3.0 0.0 226 94.8 100.0 98.7 12.5 2.2 0.0 98 Total 70.9 72.6 88.6 5.7 1.3 5.5 8,021 81.9 83.7 93.6 8.6 1.7 1.7 1,849 {qote: Figures are based on spontaneous knowledge of sexually transmitted diseases (i.e., without probing). See Tables 11.6.1 and 11.6.2 for level of knowledge of HIV/AIDS afterprobing, Table 11.4 Self-reoortin~ of sexually transmitted diseases in the last vear Percentage of women and men who report having had specific sexually transmitted diseases (STDs) in the 12 months preceding the survey, by background characteristics, Zambia 1996 Women Me/i Number Discharge Sole/ Background Any HIV/ Genital of Any HIV/ Genital from ulcer Nu~ characteristic STD Syphifis Gonorrhoea AIDS warts Other women STD Syphihs Gonorrhoea AIDS warts penis on penis Otho" ofraen Age 15-19 1.3 0.6 0 6 0.0 0.2 0.0 2,003 3.3 0.3 2.0 0.0 0.0 2.2 1.3 0.0 460 20-24 2.8 1.2 1.3 0,2 0.1 0.1 1,830 7.6 1.8 4.3 0.0 0.4 3.6 3.5 0.0 404 25-29 2.8 1.4 1.4 0.2 0.2 0.0 1,286 9.6 3.4 6.4 0.8 0.3 6.2 4.1 0.0 255 30-39 2.5 1.1 1.3 0.1 0.0 0.1 1,840 9.1 2.4 4.1 0.0 0.0 4.5 4.1 0.3 409 40-49 2.0 0.4 1.4 0.0 0.1 0.1 1,062 8.1 1.5 5.0 0.0 0.3 6.2 3.9 0.0 204 50-64 NA NA NA NA NA NA NA 2.2 1.6 1.2 0.0 0.0 0.5 0.5 0.0 118 Marital duration Never roamed 0.7 0.2 0.3 0.0 0.1 0.0 2.032 4.8 1.4 2.6 0.2 0 1 2.5 2.2 0.0 814 Currendy married 2.5 1.1 1.3 0.1 0.1 0.1 4,902 7.9 1.8 4.5 0.1 0.2 4.4 3.4 0.1 944 Formerly roamed 4.1 2.0 2.1 0.4 0.1 0.3 1,086 14.3 4.5 7.6 0.0 0.0 11.9 6.7 0.0 91 Residence Urban 2.3 1.3 1.0 0.1 0.1 0.0 3,604 7.2 2.6 3.4 0.2 0.2 4.2 3.4 0.1 852 Rural 2.2 0.8 1.3 0.1 0.1 0.1 4,417 6.5 1.1 4.2 0.1 0.2 3.7 2.7 0.0 997 Province Central 2.8 1.6 0.6 0.3 0.6 0.1 653 11.4 4.0 6.0 0.5 0.0 6.6 5.0 0.7 157 Copperbelt 2.1 0.9 1.1 0.0 0.0 0.2 1,588 6.9 2.0 2.6 0.3 0.0 3.9 3.0 0.0 396 Eastern 2.8 1.1 1.7 0.3 0.0 0.0 1,075 4.1 0.8 3.0 0.0 0.0 2.4 2.6 0.0 254 Luapula 2.2 0.8 1.5 0.0 0.0 0.0 726 4.6 1.0 3.6 0.0 0.0 3.0 1.0 0.0 151 Lusaka 1.6 1.1 0.4 0.0 0.2 0.0 1,403 7.5 2.7 4.5 0.0 0.5 4.0 3.5 0.0 316 Northern 2.2 0.8 1.2 0.1 0.1 0.1 872 8.9 1.9 3.8 0.0 0.0 3.2 4.0 0.0 221 North-Western 2.1 0.9 1.3 0.0 0.0 0.0 288 5.3 1.2 4.1 0.0 0.0 4.3 0.0 0.0 48 Southern 2.6 1.2 1.4 0.2 0.1 0.0 816 1.9 0.0 1.4 0.0 0.5 1.0 0.0 0.0 173 Western 2.4 0.4 1.9 0.1 0.1 0.1 600 11.1 1.0 8.5 0.0 0.5 9.5 6.0 0.0 132 Education No education 1.8 0.5 1.1 0.0 0.2 0.0 1,067 2.6 0.6 0.9 0.0 1 2 0.9 0.6 0.0 127 Primary 2.4 1.1 1.2 0.2 0.1 0.1 4,721 6.5 1 2 4.2 0.1 0.2 4.0 2.8 0.0 938 Secondary 2.3 t.1 1.1 0.0 0.1 0.1 2,007 8.4 3 0 4 1 0.2 0.0 4.5 3.8 0.2 686 Higher 0.5 0.5 0.0 0.0 0.0 0.0 226 4.9 0.0 2.9 0.0 0.0 2.8 2.0 0.0 98 Total 2.3 1.0 LI 0.i 0.1 0.1 8,021 6.9 1.8 3.8 0.1 0.2 3.9 3.0 0.1 1,849 Note: Total includes one woman with missing mformauon on education. NA = Not applicable Table 11 ,~; Action taken ~v resnondeats who ret, orted having had a sexually transmitted disease in the hast year Among women and men who reported having had a sexually transmitted disease (STD) in the 12 months prior to the survey, the percentage who sought advice or treatment, the percentage who informed their partner(s), and the percentage who took measures to avoid infecting their partner(s), by selected background characteristics, Zambia 1996 Among respondents who had an STD: Percentage who took action to Percent Percent avoid infecting partner Partner who who infected/ No Number Background sought informed Avoid Used Took no measures measures of men/ characteristic treatment partners sex condoms medicine Other taken taken women WOMEN Age <30 97.8 93.4 7.3 2.0 22.6 0.0 55.9 15.7 114 30+ 100.0 87,7 5.4 0.0 30.1 0.0 51.6 15.2 67 Mar i ta l status Currently married 98.9 94.0 3.0 1,8 25,7 0.0 57.3 13.9 122 Not currently married 98.0 85.6 14.0 0.0 24,8 0.0 48,1 18.9 58 Res idence Urban 98.4 95.5 9.3 1.6 19.9 0.0 57.2 15.1 82 Rural 98.8 87.7 4.3 0.9 30.0 0.0 52.0 15.9 99 Educat ion No education * * * * * * * * 19 Primary 97.8 89.2 6.5 0.8 28.2 0.0 52.7 15.6 114 Secondary (100.0) (94.2) (9.7) (2.9) (15.0) (00) (54.5) (20.5) 46 Higher * * * * * * * * 1 Total 98.6 91.2 6.6 1.2 25.4 0.0 54.3 15.5 181 MEN Age <30 86 2 57.0 44.3 6.9 33.2 1.7 12.6 21.0 70 30+ 96.1 76.4 54.0 12.0 46.4 0.0 11.6 8.8 56 Mar i ta l status Currently married 97.0 76.4 52.7 7.3 50.7 1.6 16.3 4.5 74 Not currently married 81.5 50.4 42.9 11.8 22.5 0.0 6.1 31 2 52 Res idence Urban 95.4 64 9 51.0 8.8 42.1 0.0 12 5 12.9 61 Rural 86 0 66.4 46.4 9,5 36.3 1.8 11.8 18. I 65 Educat ion No education * * * * * * * * 3 Primary 90.1 63.7 49.6 8.4 36.2 1,9 10.2 15 4 61 Secondary 91 I 71 0 47.2 7.8 40.2 0.0 15.9 13.4 58 Higher * * * * * * * * 5 Total 90.6 65.6 48.6 9.1 39.1 0.9 12.1 15.5 127 Note: Figures in parentheses are based on 25-49 women; an asterisk indicates a figure is based on fewer than 25 respondents and has been suppressed. 144 Table 11.6.1 Knowled~eofAIDS and sources of AIDS information: women Percentage of women who have ever heard of AIDS, percentage who have received information about AIDS from specific sources, and mean number of sources of information about AIDS, by background characteristics, Zambia 1996 Ever heard Background of characteristtc AIDS Radio TV Sources of AIDS information Corn- Mean munity Frmnd/ number News- Pare- Health Mosque/ meet- Rela- Work Live Other Num- of paper phlet worker church School ing tive place drama source bet sources I Age 15-19 99.3 46.8 22.0 9.0 6.7 33.1 3.6 31.0 4.0 62.2 0.1 6.4 0.9 2,003 2.3 20-24 99.8 55.8 22.7 12.3 8.4 57.1 5.1 9.8 5.8 60,2 0.8 5.1 0.8 1,830 2.4 25-29 99.6 60.4 24.1 11.6 8.2 65.8 4.2 4.2 6.1 60.2 1.7 5.3 0.6 1,286 2.5 30-39 99.7 59.2 21.9 9.2 8.2 61.3 4.9 1.5 7.4 64.1 2.3 4.5 1.0 1,840 2.5 40-49 99.3 50.7 15.3 6.4 7.5 52.4 6.5 1.7 7.0 69.9 1.9 3.4 2.0 1,062 2.3 Marital status Never married 99.1 49 2 28.0 14.7 8.4 32.2 4.3 33.5 4.2 55.6 1.0 7.3 0.9 2,032 2.4 Currently in union 99.7 56.6 18.8 7.8 7.4 60.5 4.6 3.8 6.4 65.7 1.2 4.1 1.0 4,902 2.4 Formerly in union 99.6 53.9 21.9 10.3 8 3 56.9 6.0 3. I 7.1 63.8 2.2 5.5 1.3 1,086 2 4 Residence Urban 99.9 66.1 42.0 17.5 10.7 47.6 4.9 14.4 7.4 51.2 2.3 6.3 1.4 3,604 2.7 Rural 99.3 44.8 4.9 3.7 5.4 57.1 4.6 8.6 4.7 72.4 0.4 4.1 0.6 4,417 2.I Province Central 99.7 50.6 22.8 9.9 8.4 45.2 2.0 7.9 11.1 45.2 1.3 2.0 0.6 653 2.1 Copperbelt 100.0 72.1 47.3 13.9 8.8 45.0 6.0 14.9 9.3 53,0 1.5 4.4 2.7 1,588 2.8 Eastern 98.5 45.1 1.2 2.8 2.6 50.5 0.9 4.4 0.8 77.9 0.0 2.9 0.i 1,075 1.9 Luapula 99.9 75.7 7.0 4.8 8.7 57.7 5.2 11.4 4.2 82.0 1.4 5.1 0.1 726 2.6 Lusaka 99.8 63.0 42.4 20.9 11.3 44.4 3.4 12.3 6.7 47.3 2.5 6.4 0.8 1,403 2.6 Northern 99.6 52 4 6.9 6.2 6.6 61.6 12.7 8.7 4.3 78.7 0.6 4.6 1 6 872 2.5 North-Western 98.9 52.7 8.7 5.5 14.0 79.1 14.6 11.1 3.0 89.3 1.4 6.4 00 288 2.9 Southern 99.7 28.3 7.7 7.0 6.3 64.6 1.1 15.1 5.1 57.9 1.5 4.7 0.2 816 2.0 Western 99.3 21.6 3.9 4.1 5.2 58.7 2.3 12.8 5 4 65.6 0.6 11.8 0.7 600 1.9 Education No education 98.1 38.9 3.9 0.0 2.5 46.1 4.3 0.4 2.8 80.3 0.4 1.6 0.5 1,067 1.9 Primary 99.7 51.2 13.6 3.5 5.5 55.1 4.6 7.5 6.1 68.2 0.4 4.1 0.8 4,721 2.2 Secondary 99.9 67.7 44.4 25.0 13.5 52.0 5.3 24,9 6.8 44.3 1.7 8.4 1.5 2,007 3.0 Higher 100.0 75.4 69.3 57.4 29.6 44.9 5.3 17.5 8.2 34.0 18.9 13.0 2.7 226 3.8 Total 2 99.6 54.4 21.6 9.9 7.8 528 47 11.2 5.9 62.9 1.3 5.1 1.0 8,021 2.4 t Mean number of sources is based on respondents who have heard of AIDS. 2 Total includes one woman with missing information on education. 145 Table 11,6,2 Knowledge of AIDS and sources of AIDS information: men Percentage of men who have ever heard of AIDS, percentage who have received information about AIDS from specific sources, and mean number of sources of information about AIDS, by background characteristics, Zambia 1996 Ever heard Background of characterastlc AIDS Radio TV Sources of AIDS information Corn- Mean munity Friend/ number News- Pare- Health Mosque/ meet- Rein- Work Live Other Num- of paper phlet worker church School ing tire place drama source bet sources t Age 15-19 98.5 64.9 30.8 20.1 17.8 10.5 5.9 37.8 5.2 58.2 0.7 3.1 1.2 460 2.6 20-24 100.0 76~9 29.7 26.4 23.4 26.0 5.7 22.7 5.6 63.1 3.3 1.9 3.2 404 2.9 25-29 99.7 83.7 37.8 36.5 33.3 32.7 3.6 12.5 4.1 54.9 4.6 2.1 2.5 255 3.1 30-39 99.8 82.3 34.8 34.3 27.7 35.7 6.6 4.7 8.1 55.5 8.9 1.9 2.5 409 3.0 40-49 99.7 82.0 35.0 39.5 27.6 32.1 2.6 1.7 8.5 59.5 8.3 1.3 5.3 204 3.0 50-64 99.6 70.3 26.3 30.0 26.2 30.5 5.6 3.7 10.2 62.0 6.9 1.1 6.0 118 2.8 Marital status Never married 99.1 70.4 32.0 25.7 21.2 16.3 5.5 32.8 5.7 60.6 1.5 3.0 1.7 814 2.8 Currently in union 99 8 81. I 32.1 32.6 27.6 34.4 4.8 5.5 6.9 56.8 8.0 1.4 3 8 944 3.0 Formerly in union 100.0 76.9 42.8 34.6 31.0 29.2 8.7 5.6 8.6 59.6 2.3 1.4 4.5 9l 3.1 Residence Urban 99.8 84.5 60.5 46.0 34 2 27.5 7.7 17.7 7.6 56.4 8.6 2.2 2.7 852 3.6 Rural 99.2 69.1 8.7 15.7 17 1 25.1 3.3 17.4 5.4 60.6 1.7 2.1 3.0 997 2.3 Province Central 100.0 71.8 289 24.8 8.4 8.4 0.0 11.3 8.6 48.0 0,0 0.0 18.1 157 23 Copperbelt 100.0 83.1 65,9 41.9 22.9 30.2 9.0 15.9 11.1 57.6 7,6 5.2 2.3 396 3 5 Eastern 100.0 90.7 5,2 12.5 7.7 17,7 2.6 3.7 3.6 48.8 0,9 3.3 1.1 254 20 Luapula 99.5 84.7 16.0 18.5 42.5 33.7 5.6 19,4 1.0 62.7 3.0 1 0 0.5 151 2.9 Lusaka 99.2 86.5 69.0 59.3 53.8 30.7 6.1 18.5 4.7 49.4 11.3 0.5 0.5 316 3.9 Northern 98.4 74.7 7.3 28.6 27.8 22.1 1.2 37.3 5.1 72.2 3.3 2.8 0.0 221 2.9 North-Western 97.8 80.8 11.9 8.0 16.1 26.4 2.2 5.5 13.4 72.1 2.2 0.0 0.0 48 2.4 Southern 99.0 41.9 6.9 8.6 15.4 39 8 12.6 20.4 8.9 70.6 1.2 0.0 0.0 173 2.3 Western 100.0 44.2 4.9 10.5 5.6 21.0 2.1 19.3 2.5 67.2 5.0 0.5 8 2 132 1.9 Education No educanon 985 67.0 9.2 5.9 6.7 17.1 2.2 2.9 1.1 68.0 0.0 2.4 1.6 127 1.9 Primary 99.2 70. I 17.2 16.3 17.9 25.1 4.7 16.5 4.8 66.0 3.8 1.6 3 0 938 2.5 Secondary 99.9 84.7 52.9 47.4 34.4 29.5 6.2 22.2 8.8 49.5 5.9 2.5 3.2 686 3.5 Higher 100.0 86.5 68.4 64.3 50.0 25.9 8.9 13.7 12.2 39.4 14.6 4.2 1.1 98 3.9 Total 99.5 76.2 32.6 29.7 25 0 26.2 5.3 17.5 6.4 58.6 4.9 2.1 2.9 1,849 2 9 I Mean number of sources is based on respondents who have heard of AIDS. 146 X Table 11.7.1 Knowledge of ways to avoid AIDS: women Percentage of women who have heard of AIDS and who know of specific ways to avoid A IDS and percentage with misinformation, by selected background characteristics, Zambia 1996 Ways to avoid AIDS Have No only Avoid Avoid Percent- way to Abstain one sex with Avoid Avoid Avoid Avcld tradi- Don't age with Number Background avoid from Use sexual prosti- homo- trans- injec- Avoid mosquito tional Other know misin- of characteristic AIDS sex condoms pmaner tutes sexuals fusions Uons kissing bites healers ways ~ any way formation ~ women Age 15-19 9.9 35.4 35.0 34.0 3.1 0.0 2.1 3.6 0.3 0.0 0.1 5.0 22.6 5.5 1,989 20-24 8.6 26.6 42.8 49.3 4.2 0.2 3.8 5.4 0.4 0A 0.3 5.0 14.3 5.7 1,826 25-29 7.9 23.7 46.1 55.0 5.2 0.0 4.4 7.4 0.2 0 1 0.3 4.9 13.3 5.2 1,282 30-39 7.9 26.4 38.9 56.8 5.1 0.0 4.3 6.6 0.3 00 0.3 4.9 12.9 5.4 1,834 40-49 7.9 29.1 27.3 53.9 3.7 0.1 2.7 5.4 0.4 0.0 0.4 4.8 17.2 5.4 1,055 Current marital status Never married 8.6 38.6 40.6 34.6 3.2 0.1 3.6 5.2 0.3 0.1 0.1 5.5 19.1 6.1 2,014 Currently married 8.4 23.6 36.3 55.5 4.8 0.1 3.4 5.9 0.3 0.0 0.3 4.8 15.2 5.3 4,888 Formerly roamed 9.3 32.6 44.2 44.4 37 0.1 3.2 4.7 0.4 0.0 0.5 4.3 15.8 5.2 1,081 Residence Urban 6.1 32.5 50.3 50.8 4.8 0.1 5.1 5.8 0,4 0.1 0.l 4.1 10.1 4.6 3,599 Rural 10.5 25.4 28.7 47.0 38 00 2.1 5.3 0.3 0.1 0.4 5.6 21.3 6.1 4,386 Province Central 17.1 17.6 34.8 33.0 1.0 0.0 1.6 3.1 0.1 0.0 0.1 3.5 27.8 3.7 651 Copperbelt 4.8 28.7 47.7 47.9 2.3 0 1 3.5 4.5 0.3 0.1 0.0 5.3 7.8 5.5 1,588 Eastern 10.3 13.9 21.5 45.5 1.1 0.0 0.8 3.9 0.3 0.0 0.0 2.3 29.0 2.5 1,059 Luapula 15.7 37.3 33.1 31.6 0.7 00 3.2 8.9 0.3 0.1 0.0 7.3 25.7 7.6 725 Lusaka 5.3 36.3 54.0 57.9 8.6 0.1 7.6 6.3 0.5 0.0 0.2 2.0 9.7 2.6 1,400 Northern 3.0 53.0 18.9 55.9 2.9 0.1 3.2 4.5 0.4 0.1 0.1 7.2 8.3 7.6 868 North-Western 9.1 14.1 329 81.1 24.6 0.2 5.4 11.4 0.5 0.0 2.3 29.0 9.1 31.1 285 Southern 7.6 22.0 48.1 55.4 3.3 0.0 1.8 7.4 0.4 0.1 0.9 2.1 12.7 3.5 813 Western 14.t 18.2 35 8 38.1 6.2 0.1 2.3 3.8 0.0 0.1 0.5 3 3 27.2 3.8 596 Education No education 13.8 21.4 20.3 45.6 4.4 0 1 1.0 3.0 0.1 0.0 0.1 4.5 28.1 4.7 1,047 Pnrna~ 9.4 27.4 349 46.9 4.1 0.0 2.0 44 0.4 0.0 0.3 4.2 18.4 4.8 4,707 Secondary 4.6 34.1 53 7 51.3 4.3 0 1 5.9 8.4 0.3 0.0 0.2 6.0 6.5 6.5 2,005 Higher 1.7 38.9 62.0 77.5 4.6 00 22.5 15.4 0.0 1 0 0.2 12.1 2.2 12.9 226 Total 2 8.6 28.6 38 4 48.7 4.2 0 1 3.4 5.5 0.3 0.1 0.3 4.9 16.3 5.5 7,986 I Includes avoiding mosqmto bxtes, kissing, and seeking protecUon from a tradiuonal healer 2 Total includes one woman with missing information on educauon X Oo Table 11.7.2 Knowledge of ways to avoid AIDS: men Percentage of men who have heard of AIDS and who know of specific ways to avoid AIDS and percentage with rmsinformation, by selected background characteristics, Zambia 1996 Ways to avoid AIDS Have No only Avoid Avoid Percent- way to Abstain one sex with Avoid Avoid Avoid Avoid tradi- Don't age with Number Background avoid from Use sexual prosti- homo- trans- injec- Avoid mosquito tional Other know raisin- of ch~ractenstxc AIDS sex condow-s partner tutes sexuals fusions dons kissing bites healers ways anyway formauon ~ men Age 15-19 2.7 43.4 54.5 29.0 6.4 0.0 3.2 4A 1.2 0.5 1.0 6.5 8.1 8.3 453 20-24 4.0 44.9 54.6 42.6 10 5 0.2 9.5 6.5 1.0 0.2 0.0 7.0 6.3 8.2 404 25-29 1.4 39.7 48.8 59.3 105 0.4 7.9 9.1 0.6 0.0 1.3 9.2 3.0 11.1 254 30-39 2.1 33.1 49.0 59.3 15.2 0.3 10.2 11.3 0.7 0.0 0.6 8 7 3.6 9 9 408 40-49 0 9 32.9 41.8 64.4 12.4 0.6 5.9 6.2 1.0 0.0 0.4 7.5 2.4 8.9 203 50-59 0.0 40.4 26.1 57.8 17.8 0.0 t l .9 7.4 0.0 0.0 2.0 5.9 2.2 7.9 117 Mar i ta l status Never manied 3.2 47.6 54.7 31.7 7.6 0.1 6.1 5.9 1.0 0.3 0.7 7.0 7.5 8.5 806 Carrentlymarried 1.4 32.4 43.4 629 14.1 0.3 8.8 8.7 0.8 0.1 0.6 80 2.8 9.5 942 Formerly man'ied 3 4 42.7 62.5 50.4 13.6 1.4 10.1 6.0 0.0 0.0 1.4 8.0 5.9 9.5 91 Residence Urban 1 3 42.5 57.8 54 7 8.5 0.4 12.1 8.7 1.5 0.3 0.8 6.0 2.0 8.5 850 Rural 3 2 37 0 42.0 43 4 13.6 0.1 3.8 6.2 0.3 0.1 0.7 8.9 7.6 9 5 990 Province Central 7 2 28 8 58.5 39.4 0.5 0 5 3.0 2.8 1.4 0.0 0.5 4.8 9 8 6 0 157 Copperbelt 1 1 56 1 56.5 43.0 I 1.6 0 7 5 8 6.4 1.3 0.0 2.3 4.8 2.3 8.4 396 Eastern 1 1 43 1 36.9 59.8 6.4 0.0 0 7 4 3 0.0 0.0 0.0 8.1 1.5 8.1 254 Luapula 2 1 22 1 57.5 65.1 3.6 0 0 8 2 7 2 3.1 1.0 0.0 29.7 3.6 31.3 150 Lusaka 0 5 23 7 60.5 75.7 1.8 0.0 21.2 11 4 0.9 0.5 0.8 5.7 0.5 7.9 314 Northern 0.0 51.6 27.7 48 7 13.1 0.0 6.0 9.1 0.3 0.0 0.0 6.4 9.1 6.7 218 North-Western 0.0 3.2 15.1 379 69.6 2.3 12.1 16.2 0.0 0.0 0.0 67 0.0 6.7 47 Southern 8.8 38.6 50.7 16 7 33.0 0.0 4.4 8.2 0.0 0.0 0.5 4 9 12.4 5.4 172 Western 3.1 47.8 50.9 17.2 11.3 0.0 4.5 5.0 0.0 0.0 0.0 3 1 11.8 3.1 132 Education No educatxon 3.8 31.8 34.7 45.8 7.5 0.0 0.4 1.7 0.0 0.0 0.0 6 1 9.3 6.1 125 Primary 2.7 38.1 44.5 43.4 12 5 0.2 3.4 4.3 0.8 0.2 0.6 5 9 6.9 7.3 931 Secondary 1.7 41.5 56.5 54.0 I0.7 0.4 12.6 11.2 1 1 0.2 0.9 9.3 2.2 11.0 686 Higher 1.1 50.1 63.7 64.8 7.8 0.0 22.2 16.7 08 00 1 3 13.4 1.1 15.5 98 Total 2.3 39.6 49.3 48.6 11.2 0.2 7.6 7.4 0.9 0 2 0.7 7.6 5.0 9 0 1,839 L Includes avoiding mosquito bites, kissing, and seeking protecuon from a traditional healer 11.7 Perceptions of Risks of AIDS Women's and men's knowledge of AIDS transmission, symptoms and chances for cure is similar (Tables 11.8.1 and 11,8.2). Over 80 percent of women and men know that a healthy-looking person can have the HIV virus and that AIDS is almost always fatal. Between 10 to 19 percent of women and 4 to 11 percent of men in all age categories are ignorant of the risk of HIV transmission from healthy-looking people. Although this is a small number compared to those who do know, it is potentially consequential in AIDS control measures. Even a small percentage of the population who do not adopt behavioural change measures because of ignorance can remain a vector for infecting the larger population. More than 90 percent of respondents realise that AIDS is incurable and over 80 percent know that it can be transmitted from mother to newborn baby. A higher percentage of women than men are aware of the latter means of transmission. Over two-thirds of respondents say they know someone who either has AIDS or has died of AIDS. 11.8 Perceptions of the Risk of AIDS Respondents were asked questions to assess their perception of the risk of contracting AIDS. Men were more confident than women about avoiding AIDS (57 percent of men reporting no risk at all, compared to 45 percent of women) (Table I 1.9). Thirty-seven percent of married women said they were not at risk of acquiring AIDS, whilst 12 percent perceived themselves to be at great risk. Rural men and those who live in Northern Province are most likely to say that they have no chance of getting AIDS. In addition, unmarried respondents and men who had sex only with their wives tend to say that their chances of getting AIDS are limited. 11.9 Reasons for Perceptions of AIDS Risk Respondents were asked to explain why they think their risk of getting AIDS is nil or small, moderate or great. The results are presented in Tables 11.10.1 and 11.10.2. Limiting one's sexual partners was indicated most commonly as a reason why respondents believe themselves to be at low risk of getting AIDS. Abstaining from sex and using condoms were also cited. Less confidence was expressed in the faithfulness of the partner, however, as 83 percent of women and 27 percent of men expressed this as a reason for their being at high risk (Table 11.10.2). Women's vulnerability to AIDS was perceived as due to the spouse being unfaithful, while men who feel themselves to be vulnerable to AIDS cite having more than one partner as the cause of their high risk. 11.I0 AIDS Prevention Behaviour ZDHS respondents were asked whether they had changed their behaviour in any way to avoid acquiring the AIDS virus. Results are shown in Tables 11.11.1 and 11.11.2. Twenty percent of women and 6 percent of men said they had not changed their behaviour. Both women (57 percent) and men (48 percent) indicated that they had restricted themselves to one partner. Roughly 10 percent of both women and men said they decided to maintain their virginity to avoid AIDS, while the same proportion said they stopped having sex altogether to reduce their risk. Ten percent of women and men said that they asked their spouses to be faithful. One in five men said they started using condoms, compared to 2 percent of women. Age, residence, and level of education have little effect on behaviouml change. Marital status is, however an important factor. Restricting themselves to one sexual partner is the most often cited preventive measure among married persons, while among those never married, 40 percent of women and 22 percent of men said they would retain their virginity. 149 Table I 1.8.1 Awareness of AIDS-related health issues" women Percent distribution of women who have heard of AIDS by responses to questions on AIDS-related health issues, according to selected background characteristics, Zambia 1996 Can a healthy-looking Is AIDS person have the AIDS vlrus~ a fatal disease9 Can AIDS be cured9 Can AIDS be transmitled from mother to child? Do you know someone with AIDS9 Background Don't Don't Don't Don't Don't Number characteristic Yes No know Yes No know Yes No know Yes No know Yes No know of women Age 15-19 75 0 19 0 5.9 84.9 13.4 1.6 4.0 93.2 2.0 82.5 9.8 7.5 59.0 38.7 2.4 1,989 20-24 82.7 13.6 3.7 87.9 ll.3 0.8 2.5 96.1 0.9 90.2 5.7 3.7 65.1 33.3 1.5 1,826 25-29 86.3 10.9 2.8 87.4 I 1.5 1.0 3.1 95.2 1.3 91.6 4.8 3.2 70.8 27.8 1.4 1,282 30-39 86.0 10.0 4.0 87.3 ll.9 0.7 3.4 94.9 1.5 91.8 4.6 3.4 71.6 27.1 1.2 1,834 40-49 80.3 13.0 6.7 88.0 10.4 1.5 3.8 93.6 2.3 89.7 6.0 3.9 72.9 25.5 1.5 1,055 Marital duration Never married 78.0 17.1 4.9 85.3 13.3 1.3 4.3 93.5 1.4 84.2 9.1 6.3 60.9 37.0 2.0 2,014 Cun'enfly married 83.2 12.6 4.2 87.7 11.3 1.0 2.7 95.3 1.6 90.3 5.5 3.9 69.4 29.0 1.5 4,888 Formerly married 82.6 11.9 5.5 86.7 12.0 1.3 4.2 93.6 1.9 90.4 5 I 4.1 67.4 31.0 1.6 1,081 Residence Urban 89.8 8.3 1.9 85.9 13.2 0.9 4.3 93.9 1.2 92.0 5.3 2.4 68.3 30.3 1.4 3,599 Rural 75.2 18.0 6.8 87.8 10.8 1.3 2.6 95.2 1.9 86.2 7.2 6.2 65.9 32.2 1.9 4,386 Province Central 78.4 18.1 3.5 81.0 16.8 2.0 2.8 93.7 3.1 90.4 5 2 4.0 74.3 24.9 0.6 651 Copperbelt 88.9 8.8 2.3 81.2 17.8 1.0 4.2 93.8 0.9 91.0 5.7 3.2 71.0 27.3 1.5 1,588 Eastern 80.5 10.1 9.4 98.1 1.4 0.5 2.3 95.9 1.2 86.9 5.0 7.7 53.8 43.8 2.4 1,059 Luapula 73.0 24.4 2.6 95.3 4.4 0.2 1.0 97.9 0.8 85.8 10.1 3.8 82.8 15.2 2.0 725 Lusaka 92.8 5.3 1.8 89.7 9.3 0.9 3.9 94.4 1 4 92.3 4.6 2.8 60.4 38.4 1.2 1,400 Northern 78.6 15.8 5.6 83.7 14.3 L9 3.6 93.9 2.4 87.2 7.1 5.4 68.2 28.0 3.8 868 North-Western 66.4 33.6 0.0 94.2 5.7 0.0 4.8 94.5 0.0 95.2 4.6 0.2 83.7 16.3 0.0 285 Southern 82.7 12.4 5.0 81 4 17.7 0.9 4.0 94.6 1.4 87.4 7.4 4.7 57.7 41.9 0.4 813 Western 64.6 23.2 12.3 81 1 16.2 2.6 2.9 93.2 3.6 81.4 9.9 8.3 70.8 27.6 1.5 596 Education No education 70.4 18.0 11.6 88.5 9.4 2.0 3. I 93.0 3.3 80.8 9.1 10.0 56.7 40.0 3.3 1,047 Primary 79.0 16.2 4.8 86.8 12.0 1.2 2.9 95.1 1.6 88.3 6.9 4.5 67.3 31.0 1.7 4,707 Secondary 92.4 6.6 1.0 87.1 12.3 0.6 4.5 94.2 0 8 93.4 4.3 1 9 70.4 28.7 0.8 2,005 Higher 98.7 1.3 0.0 81.8 17.9 0.3 4.7 94.8 0.5 96.0 1.7 1.7 79.4 20.6 0.0 226 Total t 81.8 13.6 4.6 87.0 11.9 1.1 3.3 94.6 1.6 88.8 6.4 4.5 67.0 31.3 1.6 7,986 Note: Figures may not add to 100.0 due to rounding and missing data. I Total includes one woman wxth missing information on education. U. Table 11.8.2 Awareness of AIDS-related health issues: men Percent distribu6on of men who have heard of AIDS by responses to questions on AIDS-related health issues, according to selected background characteristics, Zambia 1996 Can a healthy-looking Is AIDS person have the AIDS virus? a fatal disease9 Can AIDS be cured9 Can AIDS be transmttled from mother to child? Do you know someone with AIDS? Background Don't Don't Don't Don't Don't Number characteristic Yes No know Yes No know Yes No know Yes No know Yes No know of men Age 15-19 80.5 10.6 20-24 89.1 5.6 25-29 94.6 4.1 30-39 90.8 5.9 40-49 88.2 7.7 50-64 83.4 11.0 Marital duration Never married 83.5 8.9 Currently married 91.4 5.7 Formerly married 86.2 8.6 Residence Urban 91.5 6.6 Rural 84.3 7.8 8.9 88.6 9.0 2.4 3.3 86.9 9.4 70.6 11.1 17.4 54.1 40.6 5.3 453 5.2 89.5 8.4 1.9 3.4 91.6 4.2 79.3 6.6 13.9 67.1 29.2 3.7 4~ 1.2 88.4 11.3 0.3 5.7 92.6 1.6 88.3 4.1 7.7 77.0 21.3 1.8 254 3.3 91.5 8.5 0.0 4.8 93.1 1.8 87.8 4.5 7.0 80.4 17.6 2.0 408 4.1 91.0 8.3 0.6 2.5 94.0 3.2 90.3 4.3 5.5 77.5 21.1 1.5 203 5.6 92.7 6.5 0.8 6.5 86.0 6.2 79.1 7.7 13.2 72.0 26.0 2.0 117 7.6 89.7 8.5 1.7 3.7 88.1 7.5 74.3 8.9 16.1 59.5 36.0 4.5 8~ 2.8 90.2 9.0 0.8 3.9 93.9 2.0 87.9 4.6 7.2 77.1 20.9 2.0 ~2 5.2 89.2 10.8 0.0 10.0 83.6 5.0 78.4 8.7 13.0 83.5 14.8 1.6 91 1.8 87.9 11.8 0.3 4.1 93.6 1.4 91.4 4.6 3.8 67.4 29.5 3.1 850 7.8 91.7 6.4 1.9 4.1 88.4 7.3 72.9 8.6 17.9 71.6 25.3 3.1 990 Province Cenlral 88.8 8.6 2.6 Coppcrbelt 91.3 7.7 1.0 Eastem 92.4 5.7 1.8 Luapula 86.2 9.7 4.1 Lusaka 91.8 5.2 2.9 Northern 75.0 6.6 18.4 North-Wes~m 98.9 1.1 0.0 Southern 94.1 1.7 4.1 Western 66.7 19.9 13.4 93.3 5.3 1.5 2.1 91.1 6.8 90.9 2.6 6.5 73.8 25.0 1.2 157 78.7 19.6 1.8 7.4 91.0 0.3 92.8 5.4 1.8 72.6 23.8 3.6 396 98.5 1.1 0.4 1.1 97.5 0.7 88.9 7.2 2.9 74.9 23.3 1.8 254 97.9 2.1 0.0 2.1 95.4 2.5 84.7 5.1 10.2 81.5 9.7 8.8 150 90.9 9.1 0.0 3.1 95.0 1.4 93.0 4.2 2.2 54.6 43.5 1.9 314 92.5 4.8 2.7 2.8 77.2 20.0 63.2 3.7 32.0 67.7 30.4 2.0 218 97.9 2.1 0.0 0.0 100.0 0.0 97.7 1.1 1.2 62.7 37.3 0.0 47 90.3 9.2 0.5 8.6 87.1 4.3 59.8 7.6 32.6 74.8 19.6 5.6 172 84.4 I 1.6 3.5 5.1 85.8 8.6 43.6 28.1 27.3 67.3 30.1 2.6 132 Education No education Primary Secondary Higher 74.4 15.0 10.5 93.3 84.5 8.7 6.8 90.3 93.6 4.3 2.1 89.1 93.5 4.2 2.2 87.7 5.1 1.5 3.2 91.1 5.6 70.4 12.5 16.4 53.1 43.2 3.7 125 8.0 1.7 3.8 89.1 6.5 74.3 8.6 16.4 68.7 27.9 3.5 931 10.2 0.6 4.3 93.0 2.1 91.6 3.4 5.0 71.7 25.6 2.6 686 12.3 0.0 6.7 91.2 2.1 93.6 4.4 2.0 85.7 12.1 2.2 98 Total 87.7 7.3 5.1 89.9 8.9 1.2 4.1 90.8 4.6 81.5 6.7 11.4 69.7 27.2 3.1 1,839 Table 11.9 Perception of the risk of eettin~r AIDS Percent distribution of women and men who know about AIDS by their perception of the risk of getting AIDS, according to selected background characteristics, Zambia 1996 Background characteristic Perceived risk of getting AIDS: women Perceived risk of getting AIDS: men No Number No risk Mod- Has Don't of risk Mod- Don't Number atall Small crate Great AIDS know Total women at all Small crate Great know Total of men Age 15-19 64.4 22.0 8.9 4.6 0.0 0.1 100.0 1,989 69.7 22.2 5.4 2.3 0.4 100.0 453 20-24 40.5 26.1 24,0 9.4 0.0 0.0 100.0 1,826 57.0 29.5 9.0 4 6 0.0 100.0 404 25-29 37.9 26.3 25.3 10.5 0.0 0.0 100.0 1,282 44.7 35.9 13.3 6.1 0.0 100.0 254 30-39 34.9 24.5 27.8 12.6 0.1 0.0 100.0 1,834 52.4 33.9 10.9 2.6 0.2 100.0 408 40-49 43.9 22.8 22.1 11.0 0.2 0.0 100.0 1,055 50.0 32.6 15.8 1.6 0.0 100.0 203 50-59 NA NA NA NA NA NA NA NA 64.4 26.2 7.5 1.9 0.0 100.0 117 Marital status Never married 65.3 22.9 8.2 3.5 0.0 0.1 100.0 2,014 64 4 25.7 7 0 2.7 0.2 100.0 806 Currently roamed 36.9 24.4 26.8 11.9 0.0 0.0 100.0 4,888 52.0 33.2 12.0 2.7 01 100.0 942 Formerly married 45.7 26.5 18.8 8.6 0.4 0.1 100.0 1,081 44.9 29.7 11 3 14.2 00 100.0 91 No. of sexual part- nets other than spouse in last 12 months 0 46.3 23.6 20.6 9.4 0.1 0.0 100.0 6,679 64.7 27.8 6.0 1.4 0.1 100.0 1,110 1 41.6 30.0 20.8 7.4 0.1 0.0 100.0 1,027 48.5 35.7 11.0 4.6 0.2 100.0 363 2-3 30.4 19.0 35.4 15.3 0,0 0.0 100.0 201 45.1 30.8 18.3 5.8 0.0 100.0 246 4+ (30.6) (13.7) (32.7) (23.0) (0.0) (0.0) 100.0 29 35.0 28.0 24.2 12.0 0.8 100.0 112 Residence Urban 46.9 27.0 19.3 6.7 0.1 0.0 i00.0 3,599 49.6 34.5 11.6 4.2 0.1 100.0 850 Rural 43.8 22.1 22.5 11.5 0.1 0.0 100.0 4,386 63.6 25.6 8.2 2.5 0.2 1000 990 Province Central 51.2 13.0 29.0 6.8 0.1 0.0 100.0 651 50.5 35.5 9.8 4.2 00 100.0 157 Copperbelt 58.5 10.7 27.9 2.9 0.0 0.0 100.0 1,588 59.4 21.7 15.5 3.5 0.0 100.0 396 Eastern 568 11.9 22.8 8.5 0.0 0.0 100.0 1,059 58.2 35.5 4.1 1.5 0.7 I00.0 254 Luapula 41.6 27.4 7.0 23.9 0.0 0.0 109.0 725 60.0 36.9 1.5 1.6 0.0 100.0 150 Lusaka 36.2 46.7 10.5 6.5 0.0 0.1 100.0 1,400 38.1 49.7 9.8 2.4 0.0 100.0 314 Northern 41.4 27.5 19.0 11.8 0.4 0.0 100.0 868 88.3 5.6 3.0 3.0 0.0 1000 218 North-Western 28.2 32.0 33.3 66 0.0 0.0 100.0 285 69.0 20.5 9.2 1.2 0.0 1000 47 Southern 38.3 29.8 21,5 10,3 0.2 0.0 100.0 813 36.9 39.1 18.5 5.5 0.0 1000 172 Western 31.5 22,8 29.6 15,8 0.1 0 1 100.0 596 68.4 10.7 12.9 7.6 0.5 100.0 132 Education No education 45.9 22 8 20.2 11 1 0.0 0 0 100.0 1,047 52.4 34.7 7.3 4.2 1.4 100.0 125 Primary 44.3 23.4 22.2 10.0 0.1 0.0 100.0 4,707 61.9 27.2 7.9 3.0 0.0 100.0 931 Secondary 49.6 25.1 18.6 6.7 0.0 0.0 100.0 2,005 55.2 30.4 II.0 3.4 0.1 1000 686 Higher 23.4 44.0 22.1 10.5 0.0 0.0 100.0 226 31.3 41.7 22.7 4.3 0.0 100 0 98 Total I 45.2 24.3 21.1 9.3 0.1 0.0 100.0 7,986 57.1 29.7 9 8 3 3 0.1 100 0 1,839 1 Total includes one woman with missing information on education. Figures in parentheses are based on 25-49 women. NA = Not applicable 152 Table 11.10.1 Reason for nerceotion of smalllno dsk of ~ettin~ AIDS Among women and men who think they have small or no risk of getting AIDS, the percentage giving specific reasons for that perception, by marital status, Zambia 1996 One sex Spouse No No Abstain partner/ has no Avoid homo- blood No Number from Use limit other prost i - sexual trans- injec- of men,' Marital status sex condoms partners partner titutes contact fusions tions Other women WOMEN Never married 68.8 6.2 25.5 0.7 0.0 0.0 1.4 0.9 2.9 1,776 Currently married 1.7 1.4 92.7 12.2 0.0 0.0 0.7 0.5 3.1 2,995 Formerly married 67.7 6.8 26.1 0.9 0,0 0.0 0.8 0.6 3.6 780 Total 32.4 3.7 61.8 6.9 0.0 0.0 1.0 0.7 3 1 5,552 MEN Never married 53.8 24.0 34.2 1.4 6.9 0.1 2.0 2.5 5.6 726 Currently mamed 5.3 8.2 93.3 13.9 7.7 0.0 4.5 3.0 4.8 802 Formerly manied 36.8 16.7 48.6 3.8 8.8 0.0 1.1 1.9 9.8 68 Total 28.7 15.7 64.5 7.8 7.4 0.0 3.2 2.7 5.4 1,597 Table I 1.10.2 Reason for oerceotion of moderate/~reat risk of ~ettin~ AIDS Among women and men who think they have moderate or great risk of getting AIDS, the percentage giving specific reasons for that perception, by marital status, Zambia 1996 Spouse Don't Multiple has Have Had use sex multiple sex with blood Had Marital status condom partners partners prostitutes transfusion injections Other Number WOMEN Never married 14.5 22.1 54.5 0.0 1.0 2.5 12.4 236 Currently married 5.2 5.5 91.4 0.0 0.8 1.7 2.7 1,893 Formerly married 15.7 21.6 55.1 0.0 1.7 4.2 14.8 297 Total 7.4 9.1 83.4 0.0 0.9 2.1 5.1 2,426 MEN Never married 29.5 60.9 17.9 7.6 0.0 4.2 7.8 78 Currently married 8.5 61.4 31.8 0.0 3.4 10.8 6.9 139 Formerly married * * * * * * * 23 Total 15.1 60.6 27.4 4.2 2.5 7.6 8.3 240 Note: An asterisk inthcates that a figure is based on fewer than 25 respondents and has been suppressed. 153 Table 11.11.1 AIDS nrevantion behaviour: women Percentage of women who have heard of AIDS by changes in behaviour in order to avoid AIDS, according to perception of AIDS risk and selected background characteristics, Zambia 1996 Change in behaviour to avoid AIDS Asked No Began Restricted spouse Other Non- Number Background change in Kept Stopped using to one Fewer to be sexual sexual of characteristic behaviour virginity sex condoms partner partners fanhful behaviour behavlour women Perception of AIDS risk Among those who believe AIDS always fatal Small/no risk 19.8 13.9 12.4 2,3 51,9 1.6 8,1 0.2 21.3 4,796 Moderate risk 21.0 0.4 3.3 2.1 67.5 3.8 15.3 0.4 22.2 1,489 Great risk/has AIDS 23.7 0.7 7.8 2.8 61.2 4.6 I 1.2 0.2 24.5 658 Among those who do not believe AIDS always fatal, or don't know Small/no risk 15.8 17.3 11,9 3.0 55.1 1.5 8.7 0.4 17.1 755 Moderate risk 17,8 0.4 2,9 3.7 67,7 8,8 10.0 0.0 18.4 192 Great risk/has AIDS 14.7 0.9 5.7 0.0 75.5 9.6 11.8 0.0 16.1 93 Age 15-19 19.2 35.6 9.5 2.7 34.8 2.8 3.5 0.1 20.9 1,989 20-24 18.2 4.9 10.2 3.2 62.2 2.7 11.8 0.3 19.2 1,826 25-29 18.8 0.6 8.0 2.8 67.0 2.8 12.7 0.4 20.3 1,282 30-39 20.2 0.3 8.9 1.7 66.2 2.3 13.4 0.3 21.5 1,834 40-49 24.5 0.2 14.6 1.2 58.1 1.6 8.9 0.1 25.7 1,055 Marital status Never married 17.2 40.0 16.5 4.5 25.0 3.4 1.1 0.2 18.9 2,014 Currently married 21.7 0.1 0.7 0.9 73.5 1.6 15.3 0.2 22,8 4,888 Formerly married 16.4 0.4 39.3 5.3 38.4 5.0 1.8 0.3 18.2 1,081 Residence Urban 14.0 13.3 12.5 3.8 54.7 2.9 10.3 0.2 15.4 3,599 Rural 24,7 7.6 7.9 1.2 58,0 2.2 9,5 0,2 25.9 4,386 Province Central 14.9 8.7 10.9 2.3 66.1 4.4 1.4 0.2 16,3 651 Copperbelt 12.2 13.4 12.6 3.8 54.6 4.1 12.5 0.4 14.1 1,588 Eastern 56.1 3.4 2.8 0,5 34,2 0,4 2,7 0.0 56.5 1,059 Luapula 9.7 15.0 10.3 0.6 68.7 0.8 6.1 0.0 11.6 725 Lusaka 15.0 13.6 11.4 4.0 53.8 1.2 9.9 0.0 15,7 1,400 Northern 13.1 12.2 15.8 1.2 56,1 1,8 18.0 0.4 14.3 868 North-Western 17.0 4.6 8.0 1.4 68.3 7,4 48.6 0,9 23,4 285 Southern 17.1 7.5 6.0 1.6 67.1 2.8 4.2 0.2 17.3 813 Western 20.5 4.8 8.4 4.1 62.9 3.4 6.8 0.4 21.5 596 Education No education 31.9 3.5 6.7 0.3 54.9 1.6 8.1 0.1 32.6 1,047 Primary 20,5 9,2 8.9 1.8 58,5 2.5 10.3 0.2 21.4 4,707 Secondary 12.3 16.6 13.6 4.1 52,4 3.1 10,2 0.3 14.6 2,005 Higher 19.4 5.8 14.7 9.0 59.8 1.2 6.7 0.6 22.7 226 Total I 19.9 10.2 9.9 2.4 56.5 2,5 9,9 0.2 21.2 7,986 Note: The "no change" category includes those who say they "don't know." Total ncludes two women who d d not know about their risk status and one woman with missing information on education. 154 Table 11.11.2 AIDS t3revention behaviour: men Percentage of men who have heard of AIDS by changes in behaviour in order to avoid AIDS, according to perception of AIDS risk and selected background characteristics, Zambia 1996 Change in behaviour to avoid AIDS Asked No Began Restricted spouse Background changein Kept Stopped using toone Fewer tobe characterisuc behaviour virginity sex condoms partner partners faithful Avoid sex wtth Other Non- Number prosti- sexual sexual of titutes behaviour behaviour men Perception of AIDS risk Among those who believe AIDS always fatal Small/no risk 5.0 l l . l l l .9 18.0 51.3 16.6 10,6 10.6 4,4 20.1 1,447 Moderate risk 6.7 0.0 3.8 33.0 40.9 38.1 6,1 16.7 4.9 16.4 152 Great risk/has AIDS 5.0 0.0 5.3 29.4 34.2 36.6 5.7 6.5 1.2 21.7 53 Among those who do not believe AIDS always fatal, or don't know Small/no risk 13.8 12.3 8.4 11,2 39.6 14.8 7.3 12.9 8.4 14.7 149 Moderate risk 7.1 0.0 7.7 44.3 14.1 49.8 13,5 9.7 3.0 11.1 28 Great risk/has AIDS * * * * * * * * * * 7 Age 15-19 7.3 29.9 20.2 17.6 18.0 16.3 1.0 6.4 3.8 17.9 453 20-24 4.6 10,0 12.7 28,6 38.1 25.3 5.7 10,5 3.9 19.3 404 25-29 3.5 0,8 6,7 28.6 58.0 26.2 11.7 10,5 5.8 18.5 254 30-39 4.4 0.5 5.2 16.5 69,5 17.0 15.0 15.2 6.0 22.7 408 40-49 6,9 0,0 3,5 8.8 68.9 18.6 20.4 12.4 5.3 16,9 203 50-64 13.3 0.0 7.9 4.5 70.2 7.2 19,5 17.8 2.1 18.5 117 Marital status Never married 6.2 22.3 20.2 25.0 21.6 20.6 1,6 7.6 3,7 16.8 806 Currently married 6.0 0.0 1.6 13.4 71.8 17.7 17.9 14.1 5,5 22.1 942 Formerly married 2,3 0,0 21.5 34.3 41.0 27.1 1.4 13.6 4.2 12.6 91 Residence Urban 6.8 8.3 14.8 23.5 48.5 17.0 10.2 8.5 5.8 12.3 850 Rural 5.1 11.0 7,3 16.0 48.2 21.5 9.7 13.6 3.7 25.3 990 Province Central 10,6 1.5 12.3 23.2 38.2 15.0 0.0 0.5 4.3 12.4 157 Copperbelt 8.5 7.6 20.7 19.3 46,3 18,6 4.4 11.6 8,9 12.9 396 Eastern 1,8 5.5 5.7 21.3 51.6 31.1 1.1 6.4 4.4 58,6 254 Luapula 2.0 9.2 10,3 20,0 62,0 19,5 8.8 3.6 6.1 9.7 150 Lusaka 4.7 10.8 8,3 29,7 56.3 15.5 18.8 1.8 3.3 6.5 314 Northern 1,0 27.8 7.8 6.7 45.6 17.4 21,2 13.1 3.0 14.4 218 North-Western 0.0 14.2 3.5 8.6 71,1 4.2 19.3 69,6 2.1 26.0 47 Southern 2,2 10.5 5.2 22.9 35.5 23.1 9,5 33.0 2,2 17.8 172 Western 22.1 0.5 9.6 7.7 38.3 18.4 14,2 11.3 1.0 19.9 132 Education No education 10,2 6.8 4.7 15.9 43.6 26.1 7.0 7.5 2.1 31.3 125 Primary 5.6 13.5 8.7 15.7 46.2 20.3 9.6 12.5 3.2 20.1 931 Secondary 4.3 6.5 14.7 24.5 50.6 17.9 10.5 10.7 7.0 16.0 686 Higher 14.0 1.5 9,7 24.5 58,4 13.6 12.9 7.8 5.6 19.8 98 Total I 5.9 9.8 10.7 19.5 48.3 19,4 9.9 11.2 4,7 19.3 1,839 Note: The "no change" category includes those who say "don't know." An asterisk indicates that a figure is based on fewer than 25 respondents and has been suppressed. I Total includes three men who did not know about their risk status. 155 Data regarding knowledge of condoms as a disease-prevention measure are presented in Table 11.12. Knowledge of condoms by women and men is nearly universal. Women are more likely to obtain information about condoms through public sources (54 percent) than men (38 percent). Over 25 percent of women and 17 percent of men had knowledge of condoms but could not identify a source for them. ZDHS respondents who had had sexual intercourse in the 12 months preceding the survey were asked if they had used a condom for family planning, for disease prevention, or both and whether they had used a condom the last time they had sex (Tables 11.3.1 and 11.13.2). The results show that condoms are used both for family planning and as a prophylactic against disease. More men (46 percent) had used condoms as a form of family planning than women (21 percent). This suggests that men may use condoms with partners apart from their spouse to avoid unwanted pregnancies as well as STDs. However, when asked if a condom was used during the last intercourse, less than 5 percent of women and 6 percent of men stated that they used it. It is interesting to note that women and men are more likely to have used condoms with their spouses than with other partners. 156 Table 11.12 Knowledze of condoms Among women and men who have heard of AIDS and who have had sexual intercourse, the percentage who know about condoms and the percent distribution by knowledge of a source for condoms, according to selected background characteristics, Zambia 1996 Source for condoms: women Source for condoms: men Don't Don't Know Private know a Number Know Private know a Background about Publ ic medical Private Other source/ of about Pubhc medical Private Other source/ Number characteristic condonm I sector sector pharmacy source missing Tota l women condoms sector sector pharmacy source trussing Total of men Age 15-19 94.2 41.3 6.9 1.8 17.0 20-24 97.6 55.9 10.0 1.9 12.0 25-29 98.6 60.9 10.4 2.0 10.2 30-39 97.2 58.9 9.0 1.7 8.4 40-49 89.8 45.0 6.9 1.4 6.6 50-59 NA NA NA NA NA Marital status Never raamed 95.3 42.6 6.5 3.5 19.9 Currently roamed 96.1 55.9 9.8 1.3 8.7 Formerly married 95.6 53.7 6.7 2.0 11.0 Resideaee Urban 98.3 51.8 7.2 3.3 17.1 Rural 94.1 54.9 10.0 0.5 5.9 Province Central 97.9 52.7 4.7 3.4 11.0 Copperbelt 98.0 36.8 13.5 2.0 22.4 Eastern 90.6 52.7 5.4 0.2 7.5 Luapula 96.3 53.2 16.7 0.1 5.4 Lusakn 97.8 60.6 3.0 5.1 9.6 Northern 95.0 52.8 6.2 0.0 8.2 North-Western 96.1 61.2 18.6 1 0 4.2 Southern 96.3 58.4 12.3 1.1 9.0 Western 94.5 72.6 5.9 0.2 5.2 Education No education 87.1 43.6 7. I 0.5 4.7 Primary 96.4 54.3 8.3 1.0 9.8 Secondary 99.7 56.6 10.7 3.6 16.2 Higher 99.4 61.0 11.7 7.5 16.3 33.0 100.0 1,162 99.1 32.4 4.7 2.2 42.4 18.4 100.0 301 20.2 100.0 1,732 1000 42.2 6.9 4.9 35.1 10.8 100.0 361 16.6 I00.0 1,275 99.5 45.9 8.0 4.4 34.7 6.9 100.0 253 22.0 100.0 1,829 99.5 38.1 10.6 5.1 31.4 14.7 100.0 405 40.1 100.0 1,055 98.7 37.9 12.3 5.2 21.2 23.3 100.0 203 NA 100.0 96.0 24.9 7.2 5.9 16.9 45.0 100.0 117 27.5 100.0 1,081 99.4 32.1 5.5 4.6 43.1 14.7 100.0 607 24.2 100.0 4,888 99.1 42.2 10.3 4.4 25.1 18.0 100.0 942 26.7 100.0 1,081 99.1 37.7 5.8 4.9 37.3 14.3 100.0 91 20.5 100.0 3,069 99.8 25.9 5.9 9.3 48.2 10.6 100.0 767 28.6 100.0 3,984 98.6 49.0 10.3 0.3 18.6 21.8 100.0 873 28.1 100.0 591 100.0 30.0 5.6 2.0 44.7 17.8 100.0 150 25.2 100.0 1,356 100.0 22.3 11.2 11.8 41.3 13.4 100.0 357 34.2 100.0 973 98.5 64.2 1.1 0.0 21.0 13.7 100.0 240 24.6 100.0 614 100.0 48.5 20.8 0.0 25.6 5.1 100.0 137 21.7 100.0 1,196 99.5 26.5 1.1 7.5 54.5 10.4 100.0 277 32.7 100.0 754 98.5 40.1 7.5 0.5 14.1 37.8 I00.0 156 15.0 100.0 266 100.0 79.8 7.4 2.8 1.2 8.8 100.0 40 19.2 100.0 744 98.4 38.6 14.8 3.1 24.1 19.4 100.0 154 16.1 100.0 558 97.4 42.0 12.0 1.0 16.7 28.2 100.0 130 44.0 100.0 1,001 95.8 38.4 4.7 4.3 15.7 36.9 100.0 116 26.5 100.0 4,203 99 1 42.0 8 0 1.7 26.0 22 3 100.0 794 12.8 100.0 1,635 99.8 33.9 8.8 7.7 42.0 7.6 100.0 635 3.5 100.0 213 100.0 35.3 11.4 6.5 42.8 4.0 4.0 95 Total 95.9 53.5 8.8 1.8 10.8 25.1 100.0 7,052 99.2 38 2 8.3 4.5 32.5 16.6 100.0 1,640 t Includes knowledge of condoms for either family planning or disease prevention Table 11.13.1 Useofcondoms: women Among women who had sexual intercourse in the 12 months preceding the survey, the percentage who have ever used condoms for family planning or to avoid STDs, and the percentage who used a condom during last sexual intercourse with a spouse/partner in the four weeks preceding the survey, according to selected background characteristics, Zambia 1996 Ever used condom for: Used condom during last sexual intercourse with: To Number Number Number Number Background Family avoid Either of of of Any of characteristic planning STDs reason women Spouse women Other women partner women Perception of AIDS risk Among those who believe AIDS always fatal Small/no risk 20.2 15.8 26.6 3,244 4.9 2,502 1.4 767 4.1 3,244 Moderate risk 24A 18.8 30.9 1,366 5,5 1,138 3.2 256 5.2 1,366 Great risk/has AIDS 16.2 13.4 22.0 581 5.0 487 2.0 104 4.5 581 Among those who do not believe AIDS always fatal, or don't know Small/no task 18.7 16,7 26.0 488 6,5 374 1.1 117 5.3 488 Moderate risk 22.8 18.1 31.2 179 3.1 139 (4.3) 47 3.5 179 Great risk/has AIDS 17.8 14.5 23,0 83 3.0 69 * 16 5.4 83 Age 15-19 21.9 23.1 30.5 954 7.6 487 0.8 474 4.1 954 20-24 28.0 21.1 36.2 1,459 7.0 1,165 2.4 318 6.1 1,459 25-29 27.1 17.9 32.7 1,121 4.8 939 2.4 198 4.4 1,121 30-39 16.5 12.6 22.6 1,577 5.2 1,380 2.9 215 5.0 1,577 40-49 5.5 5.5 8.5 830 0.7 738 4.7 102 1.2 830 Marital status Never married 29.5 38.6 43.3 717 * 0 0.0 717 0.0 717 Currently married 19.0 11.7 23.9 4,711 5.1 4,709 35.6 76 5.6 4,711 Formerly married 23.9 28.5 34.7 513 * 0 0.0 513 0.0 513 Residence Urban 28.7 22.7 36.6 2,549 6.9 1,921 2.6 658 5.8 2,549 Rural 14.6 11.7 20.1 3,392 3.8 2,788 1.6 649 3.5 3,392 Province Central 23.7 16.0 29.5 515 5.5 412 4.2 116 5.1 515 Copperbelt 25.5 18.6 32.4 1,132 5.6 888 3.8 263 5.3 1,132 Eastern 17.9 16.9 25.6 847 4.2 724 2.2 129 3.9 847 Luapula 5.0 7.3 10.5 522 2.5 445 1.0 81 2.3 522 Lusaka 28.6 23.3 36.2 1,000 7.8 779 1.2 231 6.4 1,000 Northern 18,8 6,0 22.1 585 4.5 497 0.0 88 3.8 585 North-Western 17.0 8.0 19.0 219 4.4 182 0.0 41 3.7 219 Southern 18.1 18.6 27.8 670 5.2 505 1.8 172 4,4 670 Western 18.7 19.8 23.2 452 3.3 277 1.5 185 2.6 452 Education No education 7.3 7.2 11.7 847 2.2 751 2.1 108 2.2 847 Primary 16.8 13.4 23.0 3,606 4.3 2,932 2.7 722 4.0 3,606 Secondary 35.9 28.0 44 8 1,315 9.4 907 0.9 420 6.7 1,315 Higher 50.7 35.0 55.2 173 11.1 119 2.4 55 8.4 173 Change in sexual behaviour No change 16.0 7,6 18.9 1,238 3.6 1,024 2,7 228 3.5 1,238 Kept virginity 13.2 27.5 * 5 * 2 * 3 * 5 Stopped sex 16.7 22.5 27.7 191 (8.6) 27 0.8 166 1.9 191 Began using condoms 77.5 100.0 10(3.0 170 (41.1) 42 3.6 133 13.0 170 Restricted self to one partner 20.1 16.3 26.9 4,187 5.4 3,474 1.3 746 4.7 4,187 Fewer partners 25.3 38. l 44.5 182 2.8 75 5.4 131 4.4 182 Asked spouse to be faithful 23.6 8.3 26.1 750 5.2 718 (1.9) 37 5.1 750 Other sexual behaviour 25.9 27.6 * 10 * 9 * 1 * 10 Non-sexual behaviour 16.2 7.7 19.2 1,301 3.7 1,072 2.5 245 3.5 1,301 Total 20.7 16.4 27.2 5,941 5.1 4,709 2.1 1,307 4.5 5,941 Note: Figures in parentheses are based on 25 to 49 women; an asterisk indicates a figure is based on fewer than 25 women and has been suppressed. 158 Table 11.13.2 Useofcondoms: men Among men who had sexual intercourse in the 12 months preceding the survey, the percentage who have ever used condoms for family planning or to avoid STDs, and the percentage who used a condom daring last sexual intercourse with a spouse/partner in the four weeks preceding the survey, according to selected background characteristics, Zambia 1996 Ever used condom for: Used condom during last sexual intercourse with: Family To Number Number Num- Some- Num- Num- Background plan- avoid Either of of Regular berof one berof Any berof characteristic ning STDs reason men Spouse men partner men else men panner men Perception of AIDS risk Among those who believe AIDS always fatal Small/no risk 44.3 46.8 53.1 1,117 7.2 694 2.7 149 3,4 274 5.7 1,117 Moderate risk 56.3 58.6 63.6 149 13.8 80 6.9 30 6.3 39 10.5 149 Great risk/has AIDS 46.2 60.5 63.0 52 * 20 * 21 * 12 1.3 52 Among those who do not believe AIDS always fatal, or don't know Small/no risk 42,4 39.5 51.0 113 12.0 69 9.7 19 * 24 9.0 113 Moderate risk 68.0 66.9 75.7 28 * 18 0.0 6 * 4 * 28 Great risk/has AIDS 80.5 91.2 * 7 * 2 0.0 1 * 3 * 7 Age 15-19 44.0 50.1 51.2 231 * 5 0.0 68 0.0 158 0.0 231 20-24 61.0 65.3 69.9 314 17,5 103 0.8 101 1.3 I l0 6.4 314 25-29 59.7 59.7 67.7 243 7.3 163 (5.8) 33 (9.2) 48 7.5 243 30-39 46.2 47.3 56.8 384 8,5 331 (21.3) 25 * 28 10.2 384 40-49 26.5 28,0 35.9 192 4.2 177 0.0 2 * 13 4.3 192 50-64 10.7 11.7 17.2 106 4.9 105 * 0 * l 4.9 106 Marital status Never married 55,8 62.0 64.0 475 * 2 0.0 182 0.0 291 0.0 475 Currently married 40.4 40.3 49.4 916 8.2 866 * 17 (38.2) 33 9.9 916 Formerly married 54.7 62.9 65.7 78 * 16 (0.0) 28 (0.0) 34 0.0 78 Residence Urban 56.1 59.0 66.2 674 10.5 379 4.0 130 1.8 165 7.1 674 Rural 37.7 39.7 45.5 795 6.1 506 2.7 98 4.9 192 5.4 795 Province Central 51.9 58.5 66.8 135 7.8 78 (2.1) 36 * 21 5.9 135 Copperbelt 43.9 50.6 55.3 306 10.2 161 (10.5) 68 1.7 77 8.1 306 Eastern 50.0 43,5 5t.3 223 9.0 142 (0.0) 30 3.5 51 6.5 223 Luapula 27.6 38.2 43.2 123 2,0 78 * 5 1.9 41 1.9 123 Lusaka 69.9 65,8 74.8 257 12.2 159 (0.0) 38 (1,8) 61 7.9 257 Northern 20,6 30.8 36.5 123 4.8 96 * 4 * 23 5.6 123 North-Western 24.2 35.4 42.5 37 (6.4) 32 * 1 * 4 8.3 37 Southern 48.6 46.7 53.0 143 4.3 89 (0.0) 26 (9.1) 27 4.4 i43 Western 36.3 39.7 42.4 122 (8.3) 49 (0.0) 21 1.2 52 3.9 122 Education No education 27.5 31.5 34.9 106 5.0 61 * 12 (2.3) 33 3.6 106 Primary 36.7 40.6 45.6 713 6.4 421 4.4 106 2.6 186 5.1 713 Secondary 59.8 61.0 68.4 560 9.0 328 3.0 107 5.5 125 7.1 560 Higher 57.9 54.3 68.6 89 14.9 74 * 2 * 13 12.3 89 Change in sexual behaviour No change 34.5 25.7 39.2 81 7,2 51 0.0 8 0.0 21 4.5 81 Kept virginity 0.0 0.0 * 1 * 0 * 0 * 1 * l Stopped sex 40.0 44,7 51,2 84 * 18 * 17 (0.0) 48 0,0 84 Began using condoms 89.2 100.0 100.0 342 17,0 l l0 3,9 101 5,5 131 8.7 342 Restricted self to one partner 41.6 41,8 49.8 854 7.8 658 1.4 97 4.0 99 6,6 854 Fewer partners 54.2 60.3 63.5 348 7.2 138 7.0 75 3.4 134 5.7 348 Asked spouse to be faithful 36.8 36.9 45.5 177 6.8 157 * 10 * i1 8.0 177 Avoid sex with prostitutes 37.6 41.2 48.8 179 5.4 124 0.0 25 4.4 30 4.5 179 Other sexual behaviour 45.8 50.4 58.9 70 4.1 51 * 9 * 11 6.8 70 Non-sexual behaviour 43.6 45.9 51.2 294 9.2 190 3.4 39 4.8 65 7.5 294 Total 46.1 48,5 55.0 1,469 8.0 884 3.5 228 3.5 357 6.2 1,469 Note: Figures in parentheses are based on 25 to 49 men; an asterisk indicates a figure is based on fewer than 25 men and has been suppressed. 159 REFERENCES Central Statistical Office (CSO) [Republic of Zambia]. 1974. 1969 Population and Housing Census of Zambia: Final report. Vol.3, Demographic Analysis. Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1985a. 1980 Population and Housing Census of Zambia: Final report. Vol.2, Demographic and socio-economic characteristics of Zambia. Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1985b. 1980 Population and Housing Census of Zambia: Final report. Vol.4. Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1992. Priority Survey 1: Tabulation report. Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1993. Household food security, nutrition and health monitoring report. Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1994. Priority Survey 2: Tabulation report, Zambia, Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1995a. 1990 Census of Population, Housing and Agriculture Analytical Report. Vol. 10. Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1995b. 1990 Census of Population, Housing and Agriculture: Demographic Projection 1990-2015. Lusaka: Central Statistical Office. Central Statistical Office (CSO) [Republic of Zambia]. 1996. Gender statistics report. Lusaka: Central Statistical Office. Galsie, K. Cross, A. and Nsemukila, G. 1993. Zambia Demographic and Health Survey, 1992. Columbia, Maryland: Macro International Inc. Hambayi, M.N., P. Kasonde, C. Kaite, and S. Kumor. 1995. The nutrition and household food security analysis of Zambia. Lusaka: The Study Fund Social Recovery Project. Ministry of Finance and Economic Development (MoFED) [Republic of Zambia]. 1996a. Draft National Population and Development Programme of Action. Lusaka: MoFED. Ministry of Finance and Economic Development (MoFED) [Republic of Zambia]. 1996b. Draft Revised National Population Policy. Lusaka: MoFED. Ministry of Finance and Economic Development (MoFED) [Republic of Zambia]. 1996c. Economic report Republic of Zambia. Lusaka: MoFED. Ministry of Health (MOH) [Republic of Zambia]. 1992. National health policies and strategies (health reforms). Lusaka: Ministry of Health, Planning Unit. National AIDS/Sexually Transmitted Diseases/Tuberculosis and Leprosy Program (NASTLP) [Republic of Zambia]. 1994. Sentinel Survey. Lusaka: NASTLP. 161 National Commission for Development Planning (NCDP) [Republic of Zambia]. 1984. The Third National Development Plan 1984-88. Lusaka: NCDP. National Commission for Development Planning (NCDP) [Republic of Zambia]. 1989. The Fourth National Development Plan 1989-93. Lusaka: NCDP. National Commission for Development Planning (NCDP) [Republic of Zambia]. 1994. Economic report. Lusaka: NCDP. National Food and Nutrition Commission (NFNC)/BASICS, 1995. Infant feeding practices in urban Lusaka, 1995 study findings. Lusaka: NFNC/BASICS. National Food and Nutrition Commission (NFNC), Tropical Diseases Research Centre (TDRC), and UNICEF. 1995. 1994/5 Malnutrition case fatality in Zambian hospitals. Lusaka: NFNC. Nsemukila, Geoffrey. 1994. Maternal and childhood mortality in Zambia: Determinants and trends 1965- 1992. UNICEF Monograph No.1. Lusaka: UNICEF Zambia. Republic of Zambia. 1992. Budget address. Lusaka: Government Printer. Rutenberg, Naomi and Jeremiah M. Sullivan. 1991. Direct and indirect estimates of maternal mortality from the sisterhood method. In Proceedings of the Demographic and Health Surveys World Conference, Vol. 3. Columbia, Maryland: IRD/Macro International Inc. 1669-1696. Rutstein, Shea Oscar and George T. Bicego. 1990. Assessment of the quality of data used to ascertain eligibility and age in the Demographic and Health Surveys. In An assessment of DHS-I data quality. DHS Methodological Reports No. 1. Columbia, Maryland: Institute for Resource Development/Macro Systems. 3- 37. UNICEF. 1995. Zambia: Putting children first. Lusaka: UNICEF. (Factsheet/brochure). Westoff, Charles and Luis Femando Ochoa, 1991. Unmet need and the demand for family planning. DHS Comparative Studies No. 5. Columbia, Maryland: Institute for Resource Development~Macro Systems. World Health Organization (WHO). 1996. Revised 1990 estimates of maternal mortality: A new approach by WHO and UNICEF. Geneva: WHO. 162 APPENDIX A SURVEY DESIGN APPENDIX A SAMPLE DES IGN A.1 Introduction The 1996 ZDHS covered the population residing in private households in the country. The design for the ZDHS called for a representative probability sample of approximately 8,000 completed individual interviews with women between the ages of 15 and 49. It is designed principally to produce reliable estimates for the country as a whole, for the urban and the rural areas separately, and for each of the nine provinces in the country. In addition to the sample of women, a sub-sample of about 2,000 men between the ages of 15 and 59 was also designed and selected to allow for the study of AIDS knowledge and other topics. A.2 Sampling Frame Zambia is divided administratively into nine provinces and 57 districts. For the Census of Population, Housing and Agriculture of 1990, the whole country was demarcated into census supervisory areas (CSAs). Each CSA was in turn divided into standard enumeration areas (SEAs) of approximately equal size. For the 1992 ZDHS, this frame of about 4,200 CSAs and their corresponding SEAs served as the sampling frame. The measure of size was the number of households obtained during a quick count operation carried out in 1987. These same CSAs and SEAs were later updated with new measures of size which are the actual numbers of households and population figures obtained in the census. The sample for the 1996 ZDHS was selected from this updated CSA and SEA frame. A.3 Characteristics of the ZDHS Sample The sample for ZDHS was selected in three stages. At the first stage, 312 primary sampling units corresponding to the CSAs were selected from the frame of CSAs with probability proportional to size, the size being the number of households obtained from the 1990 census. At the second stage, one SEA was selected, again with probability proportional to size, within each selected CSA. An updating of the maps as well as a complete listing of the households in the selected SEAs was carried out. The list of households obtained was used as the frame for the third-stage sampling in which households were selected for interview. Women between the ages of 15 and 49 were identified in these households and interviewed. Men between the ages of 15 and 59 were also interviewed, but only in one-fourth of the households selected for the women's survey. A.4 Sample Allocation Table A.I and A.2 show the distribution of the population in Zambia as projected to 1996 to the nine provinces and by urban and rural areas. The provinces, stratified by urban and rural areas, were the sampling strata. There were thus 18 strata. A proportional allocation of the target number of 8,000 women to the 18 strata would yield the sample distribution presented in Table A.3. The proportional allocation would result in a completely self-weighting sample but would not allow for reliable estimates for at least three of the nine provinces, namely Luapula, North-Western and Western. Results of other demographic and health surveys show that a minimum sample of 800-1,000 women is required in order to obtain estimates of fertility and childhood mortality rates at an acceptable level of sampling errors. It was decided to allocate a sample of 1,000 women to each of the three largest provinces, and a sample of 800 165 women to the two smallest provinces. The remaining provinces got samples of 850 women. Within each province, the sample was distributed approximately proportionally to the urban and rural areas. Table A.4 shows the proposed sample allocation. Table A.I Projected population to 1996 Province Urban Rural Total Central 276,926 657,729 934,655 Copperbelt 1 ,429,128 185,476 1,614,604 Eastern 117,703 1,200,323 1,318,026 Luapula 117,913 520,444 638,357 Lusaka 1,191,573 163,985 1,355,558 Northern 126,197 928,510 1,054,707 North-Western 75,686 407,365 483,051 Southern 269,465 882,334 1,151,799 Western 78,363 652,775 731,138 Table A.2 Population distribution Province Urban Rural Total Central 29.6 70.4 I 0.1 Copperbelt 88.5 I 1.5 17,4 Eastern 8.9 91.1 14.2 Luapula 18.5 81.5 6.9 Lusaka 87.9 12.1 14.6 Northern 12.0 88.0 11,4 North-Western 15.7 84.3 5.2 Southern 23.4 76.6 12.4 Western 10.7 89.3 7.9 Zambia 3,682,954 5,598,941 9,281,895 Zambia 39.7 60.3 100.0 Table A.3 Proportional sample allocation Table A.4 Proposed non-proportional sample allocation Province Urban Rural Total Central 239 567 806 Copperbelt 1,232 160 1,392 Eastern 101 1,035 1,136 Luapula 102 448 550 Lusaka 1,027 141 1,168 Northern 109 800 909 North-Western 65 351 416 Southern 232 761 993 Western 67 563 630 Zambia 3,174 4,826 8,000 Province Urban Rural Total Central 252 598 850 Copperbelt 885 115 1,000 Eastern 89 911 1,000 Luapula 148 652 800 Lusaka 879 121 1,000 Noahern 102 748 850 North-Western 126 674 800 Southern 199 651 850 Western 91 759 850 Zambia 2,771 5,229 8,000 The number of households that would yield the target number of 8,000 women with complete interviews was calculated as follows: Number of women Number of HHs = Number of women per HH x Overall response rate According to the results of the 1992 ZDHS, the number of women age 15-49 was estimated to be 1.4 per urban household, and 1.0 per rural household. The overall response rate found in the same survey was about 93 percent. A more conservative overall response rate of 90 percent (95 percent for households and 95 percent for women) would be more appropriate. Using these two parameters in the above equation, it was expected that approximately 8,000 households would be selected in order to yield the target sample of women, distributed as in Table A.5. The number of sample points (or clusters) to be selected for each stratum was calculated by dividing the number of women in the stratum by the average take in the cluster. Analytical studies of surveys of the same nature suggest that the optimum number of women to be interviewed is around 20-25 in each urban 166 cluster and 30-35 in each rural cluster. If on average 20 women were to be selected in each urban cluster and 30 women in each rural cluster (i.e., selecting on average 16 households in each urban cluster and 34 households in each rural cluster), the distribution of sample points would be as in Table A.6. Table A.5 Number of households to yield target of women Province Urban Rural Total Central 200 664 864 Copperbelt 702 128 830 Eastern 71 1,012 1,083 Luapula 117 714 841 Lusaka 698 134 832 Northern 81 831 912 North-Western 100 749 849 Southern 158 723 881 Western 72 843 915 Zambia 2,199 5,808 8,007 Table A.6 Number of sample points Province Urban Rural Total Central 13 20 33 Copperbelt 44 4 48 Eastern 4 30 34 Luapula 7 21 28 Lusaka 44 4 48 Northern 5 24 29 North-Western 6 22 28 Southern 10 21 31 Wes~rn 5 25 30 Zambia 138 171 309 While examining these figures, it was noticed that because of rounding errors, the number of clusters in some provinces would yield a slightly smaller number of women than expected. The number of clusters were then rearranged in each stratum so that (1) it was an even number, but in such a way that (2) the sample size in each province did not fall short of the recommended size. The even number of clusters is recommended for the purpose of calculating sampling errors in which the first step is to form pairs of homogeneous clusters (Table A.7). Table A.7 Proposed number of sample points Province Urban Rural Total Central 12 20 32 Copperbelt 44 4 48 Eastern 4 30 34 Luapula 8 22 30 Lusaka 44 4 48 Northern 6 24 30 North-Western 8 22 30 Southern l0 20 30 Western 6 24 30 Zambia 142 170 312 Table A.8 Number of households to be selected Province Urban Rural Total Central 192 680 872 Copperbelt 704 136 840 Eastern 64 1,020 1,084 Luapula 128 748 876 Lusaka 704 136 840 Northern 96 816 912 North-Western 128 748 876 Southern 160 680 840 Western 96 816 912 Zambia 2,272 5,780 8,052 Tables A.8 and A.9 show the resulting number of households to be selected and the number of women with completed interviews when the number of clusters to be selected is as proposed in Table A.7. 167 Table A.9 Expected number of women with completed interviews Province Urban Rural Total Central 242 612 854 Copperbelt 887 122 t ,009 Eastern 82 918 1,000 Luapula 161 673 834 Lusaka 887 122 1,009 Northern 121 734 855 North-Western 161 673 834 Southern 202 612 814 Western 121 734 855 Zambia 2,864 5,200 8,064 A.5 Stratification and Systematic Selection of Clusters A cluster is the ultimate area unit retained in the survey. In the 1992 ZDHS and the 1996 ZDHS, the cluster corresponds exactly to an SEA selected from the CSA that contains it. In order to decrease sampling errors of comparisons over time between 1992 and 1996--it was decided that as many as possible of the 1992 clusters be retained. After carefully examining the 262 CSAs that were included in the 1992 ZDHS, locating them in the updated frame and verifying their SEA composition, it was decided to retain 213 CSAs (and their corresponding SEAs) ~. This amounted to almost 70 percent of the new sample. Only 99 new CSAs and their corresponding SEAs were selected. As in the 1992 ZDHS, stratification of the CSAs was only geographic. In each stratum, the CSAs were listed by districts ordered geographically. The procedure for selecting CSAs in each stratum consisted of: (1) calculating the sampling interval for the stratum: EM 1- i a where 2~ is the size of the stratum (total number of households in the stratum according to the sampling frame) and a is the number of CSAs to be selected in the stratum; (2) calculating the cumulated size of each CSA; (3) calculating the series of sampling numbers R, R+I, R+21, . R+(a-1)l, where R is a random number between 1 and 1; (4) comparing each sampling number with the cumulated sizes. ~The reasons for not retaining the remaining 49 CSAs are as followed: (1) the urban sample of Copperbelt Province is smaller in the 1996 ZDHS than in the 1992 ZDHS so that all clusters in urban Copperbelt are not needed; (2) the SEA composition of certain CSAs was changed during the actual census; and (3) there were errors in the old frame concerning the urban/rural specifications. 168 The CSA to be selected was the first CSA whose cumulated size was greater or equal to the sampling number. In each CSA, only one SEA was selected at random (using a random number between 1 and the number of SEAs in the CSA.) The final sample of CSAs (and their corresponding SEAs) shows that of the 57 districts that exist in the country, 55 will be covered by ZDHS. A.6 Sampling Probabilities The sampling probabilities were calculated separately for each sampling stage, and independently for each stratum. We use the following notations: el: P2: P3: first-stage sampling probability (CSAs) second-stage sampling probability (SEAs) third-stage sampling probability (households) Let ah be the number of CSAs selected in stratum h, Mh~ the size (population according to the census frame) of the i n CSA in stratum h, and 23/h, the total size of stratum h (population according to the census frame). The probability of inclusion of the i n CSA in the sample is calculated as follows: ahMhi Plhi = ~'~Mhl i In the second stage, we selected one SEA in each CSA. The probability of selection of thej lh SEA in the i th CSA is: mh,j P2h~j = ~mh, j where mr# is the size of thej ~ SEA according to the census frame. In order for the sample to be self-weighting within stratum h, the overall probabilityfh = Psh,.P2h,j.P3ht, must be the same for each household within the stratum, wherefh is the sampling fraction calculated separately for stratum h. n h where n h is the number of households selected in the stratum, and N h is the estimated number of households that exist in the stratum in 1996, at the time of fieldwork. The selection of the households is systematic with equal probability and the selection interval will be calculated as follows: ]hq = 1 = Plhi.P2hij P3h,j fh Because of the non-proportional distribution of the sampling to the different strata, sampling weights were required to ensure the actual representativity of the sample at the national level. 169 A.7 Sample Implementation A team of 11 listers, 11 mappers and 9 supervisors, all were staff of the Central Statistical Office (CSO), were trained to conduct a mapping and household listing operation in all selected sample areas. One mapper, a lister and a supervisor were assigned to each province, except in Copperbelt and Lusaka Provinces where two mappers and two listers were assigned. Mapping and household listing was carded out in March through July 1996. Not more than fifty days were spent on mapping and households listing in each province. However, the starting times differed in each province, and in some provinces work was disrupted more often than in others. In Copperbelt, Eastern, Lusaka, Central and Northern Provinces, household mapping and listing was completed in May, in Luapula and North-Western Provinces in June, and in Southern and Western Provinces, in July. Once the households in each selected cluster were mapped and listed, the maps and lists were sent to the CSO central office in Lusaka where they were checked for completion. Discrepancies between the actual and listed number of households were evaluated. In most of the clusters, the number of households listed was less than expected. After evaluation, households to be interviewed for the women's and men's surveys in each cluster were selected by two persons trained for the purpose. Results of the sample implementation by province and urban and rural residence are presented in Tables A. 10.1 and A. 10.2. The results indicate that of the 8,016 households selected in the survey, 91 percent were successfully interviewed. Four percent of the dwellings were found vacant or destroyed, 4 percent of the households were not at home, and in one percent of the households there was no competent respondent. The response rate at the household level is 99 percent. In these households, there were 8,298 women age 15-49, 97 percent of whom were successfully interviewed. The response rate for the women survey is 96 percent. There is some variation in response rate by province and urban/rural areas. The rate is 95 percent or lower in Northern, Copperbelt, Noah-Western, Lusaka, and Central Provinces, and 98 percent or higher in Eastern and Luapula Provinces. Table A. 10.2 presents the results for the men's survey. The overall response rate is lower than that for women (90 percent). The rates range from 80 percent in Lusaka to 95 percent in Eastern province. A.8 F ie ldwork All questionnaires were translated into seven major languages spoken in Zambia, namely Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja and Tonga. Pretest training and fieldwork took place from April 23 to May 17, 1996. During a three-week period, 12 male and 19 female interviewers were trained to carry out the pretest. Two teams were formed, each consisting of a supervisor, a field editor, four male interviewers and four female interviewers. The pretest fieldwork was conducted for eight days, during which approximately 150 interviewers were completed. Discussions with the pretest field staff were held, and necessary modifications to questionnaires were made based on the experience of the pretest exercise. For the main survey fieldwork, 63 nurses/midwives were recruited through the Provincial Medical Officers. All of the 31 male field staff were from CSO. The survey field staff were selected based on, among others, their ability to conduct interviews in one or more major languages. Fourteen of the nurses/midwives participated in the 1992 ZDHS. Training of the field staff for the main survey took place for four weeks between June 18 and July 10, 1996. Following the DHS guidelines, the training course consisted of instructions regarding interviewing techniques and field procedures, a detailed review of the items on the questionnaires, instruction and practice in weighing and measuring children and women. Mock interviews were conducted among the trainees, and with men and women of eligible age in areas outside the ZDHS sample points. Interviewers were selected on the basis of their overall performance in class, scores on the tests given in class and performance during practice field interviews. From among those selected, candidates suitable as field editors and supervisors were selected. The supervisors and field editors were given additional training in coordination of fieldwork, methods of field editing and data quality control procedures. 170 Table A. I 0.1 Sample implementation: women Percent distribution of households and eligible women in the ZDHS sample by results of the interviews and household, el igible women, and overall response rates, according to region and residence, Zambia 1996 Region Residence Copper- North- Result Central belt Eastern Luapula Lusaka Northern Western Southern Western Urban Rural Total Selected households Completed© 92.7 95.1 95.9 90.5 94.2 85.1 79.6 96.1 88.7 947 89.3 90.9 Household present but no competent respondent at home (HP) 0.3 0.5 0.4 0.1 1.5 0.7 0.7 0.3 0.8 0.9 0.5 0 6 Refused(R) 0.0 0.0 0.0 0.0 0.3 0,0 0.1 0,0 0.0 0.1 0.0 0.0 Dwelhng not found (DNF) 0.3 0.0 0 2 0.6 0.0 0.9 0.0 0 3 0.8 0.0 0.5 0.3 Household absent (HA) 2.2 1.7 1.0 3.6 1.3 5.2 14.3 0 6 2.6 1.2 4.5 3.6 Dwelling vacant (DV) 3.5 1.4 1 4 3.3 2.2 6.7 2.7 2.7 5.9 2.4 3.7 3 3 Dwelling destroyed (DD) 0.7 0,8 06 1.6 0.2 1.1 2.4 0.1 1.0 0.4 1.2 1.0 Other (O) 0.2 0.5 0.4 0 2 0.2 0.3 0 2 0.0 0.2 0.2 0.3 0 3 Total percent 100.0 100.0 100,0 1000 100.0 100.0 100.0 100.0 100.0 1000 100.0 100.0 Number 861 845 1,154 866 867 941 861 711 910 2,329 5,687 8,016 Household response rate (HRR) I 99.3 99 5 99.4 99.2 98.1 98.2 99.0 99.4 98.3 98 9 98.9 98.9 El ig ib le women Completed (EWC) 95.5 95.0 99.0 98.6 96.6 95.0 95.6 96.5 97.5 96.1 97.0 96 7 Not at home (EWNH) 2.9 4.0 0.6 1.0 1.9 3 8 3.5 2.3 1.7 3.0 2.0 2.3 Postponed (EWP) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0 0.1 0.0 0.0 0.0 Refused (EWR) 0.0 0.3 0.3 0.0 0.8 0.5 0.7 0 1 0.0 0.4 0.2 0.3 Partly completed (EWPC) 0. I 0.2 0 0 0.0 0.2 0.0 0.0 0.0 0.0 0. I 0.0 0. l incapacitated (EWI) 0 8 0.3 0.1 0 3 0.5 0.7 0.2 1.0 0.3 0.4 0.5 0 5 Other (EWO) 0.6 0.2 0.0 0.1 00 0.0 0.0 0.1 0.3 0.1 02 0.1 Totalpercent 100,0 IQO.O 100 .0 I00.0 1000 100.0 IO0.O 100.0 100.0 I00.0 1000 I00.0 Number 783 1,189 1,129 909 1,112 824 593 877 882 3,124 5,174 8,298 Eligible woman response rate (EWRR) 2 95,5 95.0 99.0 98,6 96 6 95.0 95.6 96.5 97.5 96.1 97 0 96.7 Overall r~ponse rate (ORR) 3 94.8 94.5 98.4 97.8 94.7 93.3 94.6 95.9 95.8 95.0 96 0 95.6 Note' The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found. The aliglble woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, [~athally completed, incapacitated and "other." The overall response rate is the product of the household and woman response rates. Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C C+HP+R+DNF 2 Usmg the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC EWC + EWNH + EWP + EWR + EWPC + EWI + EWO The overall response rate (ORR) is calculated as: ORR = HRR * EWRR 171 Table A.10.2 Samnle imolementation: men Percent distribution of households and eligible men in the ZDHS sample by results of the interviews and household, eligible men, and overall response rates, according to region and residence, Zambia 1996 Region Restdence Copper- North- Result Central belt E~tern Luapula Lusaka Northern Western Southern Western Urban Rural Total Selected households Completed © 94.4 92.2 96.8 92 1 Household present but no competent respondent at home (HP) 0.0 0.0 0.4 Refused IR) 0.0 0.0 0 0 Dwelhng not found (DNF) 0.5 0.0 0 4 0.5 Household absent (HA) 2 3 3.2 1 1 2.8 Dwelling vacant (DV) 1 9 2 8 1.4 3.3 Dwelling destroyed (DD) 0.9 1.4 0.0 0.9 Other (O1 0 0 0.5 0.0 0.0 Total percent 100 0 100 0 100 0 100 0 Number 216 217 285 214 940 892 81.9 944 884 95.2 90.0 91,6 0.5 1.4 0.4 09 0,0 0,4 0.8 0.3 0.4 0.0 0,9 00 0.5 0.0 0.0 03 0.1 01 00 0.4 0,0 0.0 09 00 0.4 0.3 05 3.3 139 0.6 2.1 05 4.4 3.3 2.8 5.4 2.3 5.1 7.3 2.7 3.9 3.5 0,5 12 0.5 0.0 0.4 0.3 08 0.6 0.0 0.0 0.0 0.0 0.4 00 0.1 0,1 1~.0 100.0 I00.0 I00.0 1000 100.0 I000 1000 216 241 216 178 233 589 1,427 2,016 Household response rate (HRR/t 99.5 100.0 99.3 99,0 97.6 99.1 98 3 100 0 98,6 98.8 99,2 99.0 El ig ible men Completed (EMC) 88.5 88.9 95.8 95.6 81.5 89.5 88 7 94 0 92 9 87 9 92.2 90 5 Not at home (EMNH) 8.1 8.6 3.5 2 9 12 6 10.5 6 6 3,0 4,7 S 3 6.1 7 0 Postponed (EMP) 0 0 0.3 0.0 0.0 0.4 0.0 0,0 0 5 0 0 0 1 0.2 0.1 Refused (EMR) 0.0 0.3 0.0 0.0 I 9 0.0 0 0 0.5 0.5 0.9 0 1 0.4 Partly completed (EMPC) 0.0 0.0 0.0 0.0 0,0 0 0 0 0 0.5 0.0 0.1 0 0 0.0 lncapacuated (EMIl 1.9 0.9 0.3 1.0 I 1 0.0 0,9 1.5 1.9 0.9 1.1 I 0 Other (EMO) 1 4 0.9 0.3 0.5 2,6 0.0 3.8 0.0 0.0 1.8 0.4 0.9 Total percent 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 209 324 288 205 270 229 106 201 211 794 1.249 2,043 Eligible man response rate (EMRR) z 88 5 88 9 95 8 95.6 81.5 89.5 88.7 94.0 92.9 87 9 92 2 90 5 Overall r~ponse rate (ORR) 3 88.1 88 9 95.1 94.6 79.5 88.7 87.2 94 0 91 6 86.8 91.4 89 6 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelhng not found. The eligible man response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated and "other." The overall response rate is the product of the household and man n~sponse rates. Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as C C+HP+R+DNF 2 Using the number of eligible men falling into specific response categones, the ehgible man response rate (EMRR) is calculated as: EMC EMC + EMNH + EMP + EMR + EMPC + EMI + EMO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EMRR The ZDHS fieldwork was carried out by 11 teams, each consisting of one team leader, one female field editor, four female interviewers, one male interviewer and a driver. Data collection took place over a five- month period from July 15, 1996 to January 6, 1997. 172 A.9 Data Processing The completed questionnaires were returned to the CSO headquarters for data processing. The data processing staff first checked whether all household and individual questionnaires for selected households and eligible women and men were indeed present for all clusters, along with field control forms. Missing information was relayed to the respective team. They then edited the questionnaires, coded open-ended questions, entered the data, and ran the secondary editing program. The data were processed by a team consisting of five data entry clerks, three office editors, and one data entry supervisor. Data processing was accomplished using a computer program developed for DHS surveys, Integrated System for Survey Analysis (ISSA). 173 APPENDIX B ESTIMATES OF SAMPLING ERRORS APPENDIX B ESTIMATES OF SAMPLING ERRORS The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors am the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the ZDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the ZDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the ZDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the ZDHS is the ISSA Sampling Error Module. This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: var(r)- -~ h=l mh-1 m h in which Zhi = Yh i - r .Xh i , and Z h = Yh- r .Xh where h represents the stratum which varies from 1 to H, 177 m h yh, xh, f is the total number of clusters selected in the h a' stratum, is the sum of the values of variable y in the ith cluster in the ha" stratum, is the sum of the number of cases in the i th cluster in the h 'h stratum, and is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo-independent replications are thus created. In the ZDHS, there were 312 non-empty clusters. Hence, 312 replications were created. The variance of a rate r is calculated as follows: SEe(R) = var ( r ) - 1 k Z(r i - r ) 2 k(k-1) i=1 in which r i = k r - (k -1 ) r ( i ) where r r m k is the estimate computed from the full sample of 312 clusters, is the estimate computed from the reduced sample of 311 clusters (i 'h cluster excluded), and is the total number of clusters. In addition to the standard error, ISSA computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFt value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. ISSA also computes the relative error and confidence limits for the estimates. Sampling errors for the ZDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for the nine provinces. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B. 1. Tables B.2 to B.13 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R+2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known unweighted value for woman-years of exposure to child-bearing. The confidence interval (e.g., as calculated for children ever born to women aged 15-49) can be interpreted as follows: the overall average from the national sample is 3.037 and its standard error is .038. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.037+2x.038. There is a high probability (95 percent) that the true average number of children ever born to all women aged 15 to 49 is between 2.961 and 3.113. Sampling errors are analyzed for the national sample and for two separate groups of estimates: (1) means and proportions, and (2) complex demographic rates. The relative standard errors (SE/R) for the 178 means and proportions range between 0.2 percent and 20 percent with an average of 3.5 percent; the highest relative standard errors are for estimates of very low values (e.g., currently using injections among women who were currently using a contraceptive method). If estimates of very low values (less than 10 percent) were removed, than the average drops to 2.1 percent. So in general, the relative standard errors for most estimates for the country as a whole is small, except for estimates of very small proportions. The relative standard error for the total fertility rate is small, 2 percent. However, for the mortality rates, the average relative standard error is somewhat higher, 4.6 percent. There are differentials in the relative standard error for the estimates of sub-populations. For example, for the variable secondary education or higher, the relative standard errors as a percent of the estimated mean for the whole country, for the rural areas, and for Northern Province are 4 percent, 7.8 percent, and 13.5 percent, respectively. For the total sample, the value of the design effect (DEFT), averaged over all variables, is 1.27 which means that, due to multi-stage clustering of the sample, variance is increased by a factor of 1.6 over that in an equivalent simple random sample. Finally, the 1996 ZDHS sample consisted mostly of the same enumeration areas selected for the 1992 ZDHS; therefore, there was a strong interest in the calculation of sampling errors for the change in rates between the two surveys. Because the two samples were not independent, it is possible to detect change in a particular rate during the period between the two surveys with a smaller sample than if the two samples had been independent. To obtain a measure of the sampling error of the difference in rates between the two surveys, say, for example, the contracepfve prevalence rate, it is necessary to calculate the correlation between the values of the contraceptive prevalence rate for the two surveys at the cluster level and then apply the following formula to calculate the corresponding sampling error: se(p , -P 2) =~se 2(p l ) + se 2(p2) -2 *p , ~se 2(pl) * se 2(p2) Sampling errors of the difference in knowledge and use of contraception for married women interviewed in the 1992 and 1996 ZDHS surveys are given in Table B.14. 179 Table B.1 List of selected variables for samolin~ errors. Zambia. 1996 Variable Description Base populauon WOMEN No educatton Proportion With secondary education or higher Proportion Never married (in union) Proportion Currently married (m union) Proportion Married before age 20 Proportion Had first sexual intercourse before 18 Proportion Children ever born Mean Chddren ever born to women over 40 Mean Chddren surviving Mean Knowing any contraceptive method Proportion Knowing any modem contraceptive method Proportion Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modern method Proportion Currently using pill Proportion Currently using rejections Proportion Currently using condom Proportion Currently using female sterilisation Proportion Currently using periodic abstinence Proportion Currently using withdrawal Proportion Using public sector source Proportion Want no more children Proportion Want to delay at least 2 years Proportion Ideal number of children Mean Mothers received tetanus injection Proportion Mothers received medical care at birth Proportion Had diarrhoea in the last 2 weeks Proportion Treated with ORS packets Proportion Consulted medical personnel Proportion Having health card, seen Proportion Received BCG vaccination Proportion Received DPT vaccination (3 doses) Proportion Received poho vaccination (3 doses) Proportion Received measles vaccination Proportion Fully immumsed Proportion Wetght-for-height (< -2 SD) Proportion Height-for-age (< -2 SD) Proportion Weight-for-age (< -2 SD) Proportion Total fertility rate (3 years) Rate Neonatal mortality rate Rate Postneonatal mortality rate Rate Infant mortality rate Rate Child mortality rate Rate Under-f ive mortality rate Rate All women 15-49 All women 15-49 All women 15-49 All women 15-49 Women 25-49 Women 25-49 All women 15-49 Women aged 40-49 All women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently mamed women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently married women 15-49 Currently mamed women 15-49 Currently married women 15-49 Current users of modem method Currently married women 15-49 Currently married women 15-49 All women 15-49 Births in last 5 years Births in last 5 years Chddren under 5 Children under 5 with diarrhoea in last 2 weeks Children under 5 with diarrhoea in last 2 weeks Children 12-23 months Chddren 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Chddren 12-23 months Children under 5 who were measured Children under 5 who were measured Children under 5 who were measured Women-years of exposure to child-bearing Number of births exposed to risk of dying Number of births exposed to risk of dying Number of births exposed to risk of dying Number of births exposed to risk of dying Number of births exposed to risk of dying MEN No education Proportion With secondary education or higher Proportion Never mamed (in union) Proportion Currently married (in union) Proportion Knowing any contraceptive method Proportion Knowing any modem contraceptive method Proportion Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modern method Proportion Currently using pill Proportion Currently using injections Proportion Currently using condom Proportion Currently using female sterilisation Proportion Currently using periodic abstinence Proportion Currently using withdrawal Proportion Want no more children Proportion Want to delay at least 2 years Proportion Ideal number of children Mean All men 15-59 All men 15-59 All men 15-59 All men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently mamed men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently mamed men 15-59 Currently married men 15-49 Currently married men 15-59 Currently married men 15-59 All men 15-59 I For total (0°4 years) 180 Table B.2 ~amrflin~ errors - National samole: Zambia 1996 Number of eases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Varmble (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.133 0.008 8021 8021 2.158 0.060 0117 0.149 With secondary education or higher 0.278 0.011 8021 8021 2.125 0.040 0.256 0.300 Never married (in umon) 0.253 0.006 8021 8021 1.168 0.024 0241 0.265 Currently married (in union) 0.611 0.007 8021 8021 1.288 0.011 0.597 0 625 Married before age 20 0.694 0.008 6039 6018 1.388 0.012 0.678 0.710 Had first sexual intercourse before 18 0.695 0.008 6039 6018 1.344 0.012 0.679 0.711 Chddren ever born 3.037 0.038 8021 8021 1.119 0.013 2.961 3.113 Children ever born to women over 40 7.314 0.097 1085 1062 1.062 0.013 7.120 7.508 Chddren survwing 2.465 0.030 8021 8021 1.070 0.012 2.405 2.525 Knowing any contraceptive method 0.984 0.002 4949 4902 1.016 0.002 0.980 0.988 Knowing any modern method 0.977 0.002 4949 4902 1.062 0.002 0.973 0.981 Ever used any contraceptive method 0.594 0.011 4949 4902 1.630 0.019 0.572 0.616 Currently using any method 0.259 0.008 4949 4902 1.272 0.031 0.243 0.275 Currently using a modem method 0.144 0.006 4949 4902 1.237 0.042 0.132 0.156 Currently using pill 0.072 0.005 4949 4902 1.237 0.069 0.062 0.082 Currently using injections 0.010 0.002 4949 4902 1.507 0.200 0.006 0.014 Currently using condom 0 035 0.003 4949 4902 1.212 0.086 0.029 0.041 Currently using female sterilisation 0.020 0.002 4949 4902 1.163 0.100 0.016 0.024 Currently using periodic abstinence 0.019 0002 4949 4902 1.167 0.105 0.015 0.023 Currently using withdrawal 0.045 0.003 4949 4902 1.184 0.067 0.039 0.05 I Using public sector source 0.599 0 024 830 901 1.431 0.040 0.551 0.647 Want no more children 0.264 0.008 4949 4902 1.254 0.030 0.248 0.280 Want to delay at least 2 years 0.388 0.008 4949 4902 1.137 0.021 0.372 0 404 Ideal number of children 5.320 0.040 7603 7602 1.536 0.008 5 240 5.400 Mothers recetved tetanus injection 0.845 0.008 7248 7159 1.597 0.009 0.829 0.861 Mothers received medical care at birth 0.465 0.015 7248 7159 2.009 0.032 0.435 0.495 Had diarrhoea in the last 2 weeks 0.235 0.006 6177 6109 1.113 0.026 0.223 0.247 Treated with ORS packets 0.539 0.014 1431 1435 1.032 0.026 0.511 0.567 Consulted medical personnel 0.440 0.018 1431 1435 1.272 0.041 0.404 0.476 Having health card, seen 0.818 0.011 1348 1347 1.018 0.013 0.796 0.840 Received BCG vaccination 0.974 0.005 1348 1347 1 063 0.005 0.964 0.984 Received DPT vaccmatmn (3 doses) 0.857 0.013 1348 1347 1.337 0.015 0.831 0.883 Received poho vaccination (3 doses) 0.844 0.013 1348 1347 1.249 0.015 0.818 0.870 Received measles vaccination 0.865 0.011 1348 1347 1 163 0.013 0.843 0.887 Fully lmmumsed 0.783 0.014 1348 1347 1.265 0.018 0.755 0.811 Weight-fur-height 0.042 0.003 5503 5443 1.170 0071 0.036 0.048 Height-for-age 0.424 0.008 5503 5443 1.213 0.019 0.408 0.440 Weight-for-age 0.235 0.006 5503 5443 1.057 0.026 0.223 0 247 Total fertility rate (3 years) 6.080 0.119 NA 22190 1.278 0.020 5 842 6.318 Neonatal mortality rate (0-4 years) 35.361 2.395 7387 7290 1.018 0.068 30.571 40.151 Postneonatal mortality rate (0-4 years) 73.512 3.649 7426 7330 1.122 0.050 66.214 80.810 Infant mortahty rate (0-4 years) 108 873 4.166 7428 7332 1.054 0.038 100.541 117.205 Child mortahty rate (0-4 years) 98.423 4.307 7587 7491 1.092 0.044 89.809 107.037 Under-five mortahty rate (0-4 years) 196.580 5.465 7630 7536 1.081 0.028 185.650 207.510 MEN No education 0.069 0.007 1849 1849 1.246 0.101 0.055 0083 With secondary education or higher 0.424 0.014 1849 1849 1.216 0.033 0.396 0 452 Never mamed (in umon) 0.440 0.013 1849 1849 1.122 0.030 0.414 0.466 Currently married (in union) 0.510 0.013 1849 1849 1.083 0.025 0.484 0.536 Knowing any contraceptive method 0.990 0.003 964 944 1.018 0.003 0.984 0.996 Knowing any modem method 0.986 0.004 964 944 1.012 0.004 0.978 0.994 Ever used any contraceptive method 0.725 0.014 964 944 0.967 0.019 0.697 0.753 Currently using any method 0.371 0.014 964 944 0.914 0.038 0.343 0.399 Currently using a modern method 0.210 0.013 964 944 0.955 0.062 0.184 0.236 Currently using pill 0.109 0.009 964 944 0.908 0.083 0.091 0.127 Currently using injections 0.004 0.002 964 944 1.163 0.500 0.000 0.008 Currently using condom 0.077 0.009 964 944 1.017 0.117 0.059 0.095 Currently using female sterilisation 0.014 0.004 964 944 0.936 0.286 0.006 0 022 Currently using periodic abstinence 0.069 0.010 964 944 1.205 0.145 0 049 0.089 Currently using withdrawal 0.047 0.007 964 944 1.010 0.149 0.033 0.061 Want no more children 0.198 0.014 964 944 1.075 0.071 0.170 0.226 Want to delay at least 2 years 0.373 0 015 964 944 0.967 0 040 0.343 0.403 Ideal number of children 5.865 0.084 1779 1793 1.168 0.014 5.697 6.033 NA = Not applicable 181 Table B.3 SamDlin~ errors - Urban samtJle: Zambia 1996 Number of eases Standard Design Relative Confidence hmlts V~lue error Unwelghted Weighted effect error Varmble (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.056 0.005 3001 3604 With secondary education or higher 0.463 0.019 3001 3604 Never married (in union) 0.308 0.009 3001 3604 Currently married (in union) 0.547 0.011 3001 3604 Married before age 20 0.607 0.015 2202 2648 Had first sexual intercourse before 18 0.627 0.013 2202 2648 Children ever born 2 656 0.060 3001 3604 Children ever born to women over 40 7 108 0.153 352 424 Children surviving 2.221 0.048 3001 3604 Knowing any contraceptive method 0.991 0.002 1634 1972 Knowing any modem method 0.989 0.002 1634 1972 Ever used any contraceptive method 0.709 0.015 1634 1972 Currently using any method 0 333 0.014 1634 1972 Currently using a modem method 0.236 0.011 1634 1972 Currently using piU 0.122 0.009 1634 1972 Currently using injections 0.022 0.004 1634 1972 Currently using condom 0.047 0.006 1634 1972 Currently using female sterilisation 0.033 0.005 1634 1972 Currently using periodic abstinence 0.030 0.005 1634 1972 Currently using withdrawal 0.030 0 005 1634 1972 Using public sector source 0.579 0.031 502 614 Want no more children 0.331 0.015 1634 1972 Want to delay at least 2 years 0.367 0.014 1634 1972 Ideal number of children 4.579 0 050 2885 3463 Mothers received tetanus injection 0.880 0.008 2389 2858 Mothers received medical care at birth 0.769 0 016 2389 2858 Had dtarrhoea in the last 2 weeks 0.238 0.010 2045 2445 Treated with ORS packets 0.584 0.023 478 581 Consulted methcal personnel 0.453 0.029 478 581 Hawng health card. seen 0.821 0.018 449 532 Received BCG vaccination 0.994 0.003 449 532 Received DPT vaccination (3 doses) 0.902 0.017 449 532 Received polio vaccination (3 doses) 0.892 0.019 449 532 Received measles vaccination 0.897 0.015 449 532 Fully smmumsod 0.834 0.022 449 532 Weight-for-height 0.031 0.004 1812 2159 Height-for-age 0.327 0.013 1812 2159 Weight-for-age 0.165 0.008 1812 2159 Total fertility rate (3 years) 5.082 0.163 NA 9920 Neonatal mortality rate (0-9 years) 32.252 2.705 4327 5172 Postneonatal mortality rate (0-9 years) 59.677 4.265 4334 5181 Infant mortality rate (0-9 years) 91.929 5.232 4335 5182 Child mortality rate (0-9 years) 89.556 6.242 4366 5217 Under-five mortality rate (0-9 years) 173.252 7.830 4375 5228 I 248 0 089 0 046 0 066 2.053 0.041 0.425 0.501 1. I 16 0.029 0.290 0.326 1.158 0.020 0.525 0,569 1.433 0 025 0,577 0 637 1.296 0.021 0601 0653 1.137 0 023 2 536 2 776 0.934 0 022 6.802 7 414 1.073 0022 2.125 2317 0.861 0 002 0.987 0 995 0.886 0.002 0.985 0 993 1.319 0.021 0679 0.739 1.221 0.042 0,305 0 361 1.065 0047 0214 0258 1.114 0,074 0 104 0 140 1.184 0.182 0014 0030 1.139 0.128 0.035 0.059 1.120 0.152 0.023 0.043 I. 178 0,167 0,020 0.040 I. 162 0.167 0 020 0.040 1.419 0.054 0,517 0.641 1 285 0.045 0 301 0.361 1.142 0.038 0.339 0.395 1 351 0.011 4,479 4.679 I. 134 0.009 0.864 0 896 I 579 0021 0.737 0801 1 009 01142 0.218 0 258 0,979 0.039 0.538 0,630 1.215 0.064 0.395 0511 0.982 0.022 0.785 0.857 0905 0003 0988 I 000 I 208 0019 0.868 0936 1,289 0,021 0.854 0930 1.015 0017 0.867 0927 1,264 0.026 0.790 0 878 0 977 0 129 0.023 0 I)39 1 134 0(140 0.301 0,353 0.853 0048 0 149 0 181 1.195 0 032 4 756 5 408 0 897 0.084 26.842 37.662 1.106 0.071 51.147 68.207 1.086 0.057 81.465 102.393 1.217 0070 77072 102.040 1.183 0.045 157592 188.912 MEN No education 0.027 0.007 698 852 1.103 0 259 With secondary education or higher 0.624 0.022 698 852 1.174 0.035 Never married (in union) 0.467 0.018 698 852 0.970 0 039 Currently married (in union) 0.470 0.018 698 852 0.926 0 038 Knowing any contraceptive method 0,996 0.004 327 401 1.107 0 004 Knowing any modem method 0.993 0.005 327 401 1.077 0.0~5 Ever used any contraceptive method 0.854 0.021 327 401 1.067 0 025 Currently using any method 0.475 0.025 327 401 0.910 0.053 Currently using a modern method 0.303 0.023 327 401 0.901 0 076 Currently using pill 0.174 0.018 327 401 0.868 0103 Currently using injections 0 010 0.006 327 401 1.042 0.600 Currently using condom 0 088 0.015 327 401 0,967 0.170 Currently using female stefilisation 0.017 0.006 327 401 0.838 0 353 Currently using periodic abstinence 0 096 0.019 327 401 1.155 0.198 Currently using withdrawal 0 043 0.012 327 401 1.045 0 279 Want no more children 0.278 0.024 327 401 0.979 0,086 Want to delay at least 2 years 0 353 0.026 327 401 0.979 0 074 Ideal number of children 5.070 0.109 692 844 1.193 0.021 0.013 0.041 0 580 0 668 0.431 0.503 0.434 0.506 0988 1 000 0.983 1 000 0.812 0.896 0.425 0.525 0.257 0.349 0 138 0,210 0.000 0.022 0058 0118 0 005 0 029 0.058 0 134 0019 0067 0.230 0 326 0.301 0.405 4.852 5 288 NA = Not applicable 182 Table B.4 Samtfl ine errors - Rural samole: Zambia 1996 Number of eases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SF,/R) R-2SE R+2SE WOMEN No education 0.196 0.014 5020 4417 2,513 0.071 0.168 0.224 Wrth secondary educauon or higher 0.128 0.010 5020 4417 Z087 0.078 0.108 0.148 Never married (in union) 0.208 0.007 5020 4417 1.157 0.034 0194 0.222 Currently married (in union) 0.663 0.009 5020 4417 1.357 0.014 0 645 0.681 Married before age 20 0.763 0.008 3837 3369 1,159 0.010 0.747 0.779 Had first sexual intercourse before 18 0.749 0.010 3837 3369 1.369 00 l 3 0.729 0.769 Children ever born 3.347 0.044 5020 4417 1.005 0.013 3.259 3.435 Children ever born to women over 40 7.451 0.125 733 638 1.135 0.017 7201 7.701 Children surviving 2.663 0.035 5020 4417 0.970 0.013 2593 2.733 Knowing any contraceptive method 0 979 0.003 3315 2930 1.077 0.003 0.973 0 985 Knowing any modern method 0.968 0.003 3315 2930 I. 119 0.003 0 962 0 974 Ever used any contraceptive method 0.517 0.016 3315 2930 1.893 0.031 0 485 0.549 Currently using any method 0 209 0.009 3315 2930 1.329 0.043 0.191 0.227 Currently using a modem method 0.082 0.007 3315 2930 1.526 0.085 0.068 0.096 Currently using pill 0.039 0.005 3315 2930 1.365 0.I28 0.029 0.049 Currently using injections 0.003 0.002 3315 2930 2.553 0.667 0.000 0.007 Currently using condom 0.027 0.003 3315 2930 1.239 0.111 0.021 0 033 Currently using female sterilisation 0.012 0.002 3315 2930 1.078 0.167 0008 0.016 Currently using periodic abstinence 0.011 0.002 3315 2930 0.933 0.182 0.007 0.015 Currently using withdrawal 0.055 0.005 3315 2930 1.220 0.091 0.045 0.065 Using public sector source 0.641 0.036 328 287 1.349 0.056 0.569 0.713 Want no more children 0.219 0.009 3315 2930 1.188 0.041 0.201 0.237 Want to delay at least 2 years 0.402 0.010 3315 2930 1.122 0.025 0.382 0 422 Ideal number of chddren 5.941 0.056 4718 4139 1.685 0009 5.829 6.053 Mothers received tetanus injection 0.822 0.012 4859 4301 1.821 0 015 0.798 0.846 Mothers received medical care at birth 0.264 0.018 4859 4301 2.463 0.068 0.228 0 300 Had diarrhoea in the last 2 weeks 0.233 0.008 4132 3664 1.191 0.034 0.217 0.249 Trealed with ORS packets 0.509 0.018 953 854 1.060 0.035 0.473 0.545 Consulted medical personnel 0.431 0,022 953 854 1.307 0.051 0.387 0.475 Having health card, seen 0.816 0.013 899 814 1.046 0.016 0.790 0.842 Received BCG vaccination 0.961 0.007 899 814 1.152 0 007 0.947 0.975 Received DPT vaccination (3 doses) 0.827 0.018 899 814 1.442 0.022 0.791 0.863 Received poho vaccination (3 doses) 0.812 0.017 899 814 1.261 0.021 0.778 0.846 Rece:ved measles vaccination 0.845 0.016 899 814 1275 0019 0813 0.877 Fully immunised 0.750 0.019 899 814 1.312 0.025 0.712 0788 Wetght-for-helght 0.048 0.005 3691 3284 1 289 0.104 0.038 0.058 Height-for-age 0.487 0.011 3691 3284 1.315 0 023 0.465 0.509 Weight-for-age 0.280 0.009 3691 3284 1.169 0.032 0.262 0.298 Total fertility rate (3 years) 6.861 0.137 NA 12270 1.234 0.020 6.587 7.135 Neonatal mortahty rate (0-9 years) 38.585 2.617 8960 7920 1.139 0.068 33.351 43.819 Postneonatal mortality rate (0-9 years) 79.348 3.784 8989 7946 1,205 0.048 71.780 86.916 Infant mortality rate (0-9 years) 117.933 4.497 8990 7946 1.167 0.038 108 939 126 927 Child mortahty rate (0-9 years) 98.131 4,275 9076 8025 1.119 0.044 89.581 106.681 Under-five mortahty rate (0-9 years) 204.491 5.798 9107 8052 1.147 0.028 192.895 216.087 MEN No education 0.104 0.012 1151 997 1.360 0.115 0.080 0.128 With secondary education or higher 0.253 0.015 1151 997 1.170 0.059 0.223 0.283 Never roamed (m umon) 0.417 0.018 1151 997 1.271 0.043 0.381 0.453 Currently married (in umon) 0.545 0.018 1151 997 1.239 0.033 0.509 0.581 Knowing any contraceptive method 0.985 0.005 637 543 1.032 0.005 0.975 0.995 Knowing any modem method 0.981 0.005 637 543 1.013 0.005 0.971 0.991 Ever used any contraceptive method 0.629 0.018 637 543 0.923 0.029 0.593 0 665 Currently using any method 0.294 0.017 637 543 0.936 0.058 0 260 0.328 Currently using a modem method 0.142 0.014 637 543 0.994 0.099 0.114 0 170 Currently using pill 0.062 0.009 637 543 0.928 0.145 0.044 0.080 Currently using injections 0.000 0.000 637 543 Und Und 0.000 0 000 Currently using condom 0.069 0.010 637 543 1.016 0.145 0.049 0.089 Currently using female sterilisation 0.012 0.004 637 543 1,000 0.333 0 004 0.020 Currently using periodic abstinence 0.049 0.010 637 543 1.188 0.204 0029 0.069 Currently using withdrawal 0.049 0.008 637 543 0.955 0.163 0.033 0.065 Want no more children 0.139 0.015 637 543 1.127 0.108 0.109 0.169 Want to delay at least 2 years 0.389 0.018 637 543 0.934 0.046 0.353 0 425 Ideal number of children 6.573 0.116 1087 949 1.137 0.018 6341 6.805 NA -- Not apphcable Und = Undefined 183 Table B.5 Samoline errors - Central orovince: Zambia 1996 Number of cases Standard Value error Unweighted Weighted Variable (R) (SE) (N) (WN) WOMEN Design Relative Confidence limits effect error (DEFT) (SE/R) R-2SE R+2SE No education 0.079 0.011 748 653 With secondary education or higher 0.306 0.025 748 653 Never married (m union) 0.228 0.015 748 653 Currently married (in union) 0.641 0.022 748 653 Married before age 20 0.702 0.021 578 502 Had first sexual intercourse before 18 0.679 0.019 578 502 Children ever born 3.033 0.112 748 653 Children ever born to women over 40 7.236 0.326 I01 85 Children surviving 2.562 0.098 748 653 Knowing any contraceptive method 0.998 0.002 491 419 Knowing any modem method 0.995 0.003 491 419 Ever used any contraceptive method 0.527 0.024 491 419 Currently using any method 0.174 0.022 491 419 Currently using a modem method 0.130 0.019 491 419 Currently using pill 0.067 0.014 491 419 Currently using injections 0.000 0.000 491 419 Currently using condom 0.051 0.011 491 419 Currently using female sterilisation 0.010 0.004 491 419 Currently using periodic abstinence 0.007 0.006 491 419 Currently using withdrawal 0.017 0.005 491 419 Using public sector source 0.629 0.048 71 67 Want no more children 0.309 0.022 491 419 Want to delay at least 2 years 0.313 0.010 491 419 Ideal number of children 5.175 0.118 627 553 Mothers receLved tetanus injection 0.834 0.018 687 587 Mothers received medical care at birth 0.379 0 030 687 587 Had diarrhoea in the last 2 weeks 0.237 0.021 595 508 Treated with ORS packets 0.490 0 045 143 120 Consulted medical personnel 0.198 0.038 143 120 Having health card, seen 0.722 0 033 104 88 Received BCG vaccination 0.974 0.006 104 88 Received DPT vaccination (3 doses) 0.816 0.038 104 88 Received polio vaccinatton (3 doses) 0 761 0.052 104 88 Received measles vaccination 0.863 0.044 104 88 Fully immunised 0.718 0.055 104 88 Weight-for-height 0.061 0.015 536 458 Height-for-age 0.381 0.021 536 458 Weight-for-age 0.199 0.016 536 458 Total fertility rate (3 years) 6.251 0.452 NA 1827 Neonatal mortality rate (0-9 years) 29.604 6.305 1254 1071 Postoeonatal mortality rate (0-9 years) 64.949 8.996 1261 1077 Infant mortality rate (0-9 years) 94.553 9.664 1261 1077 Child mortality rate (0-9 years) 77.264 10.167 1267 1081 Under-five mortahty rate (0-9 years) 164.511 14.122 1274 1087 1.115 0.139 0.057 0.101 1.510 0.082 0.256 0.356 0.978 0.066 0.198 0.258 1.272 0.034 0.597 0.685 1.094 0.030 0.660 0.744 0.980 0.028 0.641 0.717 1.029 0.037 2.809 3.257 1.133 0.045 6.584 7.888 1.031 0.038 2.366 2.758 0.948 0.002 0.994 1.000 1.011 0 003 0,989 1.000 1.043 0.046 0.479 0.575 1.256 0.126 0.130 0.218 1.266 0.146 0.092 0.168 1.241 0 209 0.039 0.095 Und Und 0.000 0.000 1.128 0.216 0.029 0.073 0.920 0.400 0002 0018 1.510 0.857 0.000 0019 0.903 0.294 0.007 0.027 0 823 0.076 0.533 0.725 1.045 0.071 0.265 0.353 0.473 0.032 0.293 0 333 1.315 0.023 4.939 5 411 1,i11 0.022 0.798 0870 1.329 0.079 0.319 0439 1.172 0089 0.I95 0.279 0.993 0.092 0.400 0.580 1.042 0.192 0.122 0.274 0.742 0.046 0.656 0 788 0.406 0 006 0.962 0.986 0.985 0 047 0.740 0 892 1.219 0.068 0.657 0 865 1.278 0.051 0.775 0 951 1.215 0.077 0.608 0.828 1 407 0.246 0.031 0.09 I 0.911 0.055 0.339 0.423 0900 0.080 0.167 0.231 1.456 0.072 5.347 7.155 1.214 0.213 16.994 42.214 1.173 0.139 46.957 82.941 1.065 0.102 75.225 113 881 1 050 0.132 56.930 97.598 1.178 0.086 136.267 192.755 MEN No education 0.072 0.015 185 157 0.808 With secondary education or higher 0.493 0.038 185 157 1.021 Never married (in union) 0.393 0.042 185 t 57 1.177 Currently married (in union) 0.528 0.039 185 157 1.073 Knowing any contraceptive method 1.000 0.000 97 83 Und Knowing any modem method 1.000 0.000 97 83 UOd Ever used any contraceptive method 0.810 0.038 97 83 0.949 Currently using any method 0.391 0.052 97 83 1.053 Currently using a modem method 0.220 0.051 97 83 1.214 Currently using pill 0.111 0.038 97 83 I. 180 Currently using injections 0.000 0.000 97 83 Und Currently using condom 0.109 0.029 97 83 0.900 Currently using female stenlisation 0.000 0.000 97 83 Und Currently using periodic abstinence 0.081 0.038 97 83 1 350 Currently using withdrawal 0.054 0.025 97 83 1.068 Want no more children 0.202 0.055 97 83 1 339 Want to delay at least 2 years 0.325 0.045 97 83 0.934 Ideal number of children 6.143 0.209 184 156 0.906 0.208 0.042 0.102 0.077 0.417 0.569 0.107 0.309 0.477 0.074 0.450 0.606 0.000 1.000 1.000 0.000 1.000 1.000 0 047 0 734 0.886 0.133 0287 0495 0.232 0.118 0 322 0.342 0.035 0.187 Und 0.000 0.000 0266 0.051 0.167 Und 0.000 0 000 0.469 0.005 0.157 0.463 0.004 0 104 0.272 0.092 0.312 0.138 0.235 0.415 0.034 5.725 6.561 NA = Not applicable Und = Undefined 184 Table B.6 Samolin~errors - ConDerbelt nrovince: Zambia 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE /R) R-2SE R+2SE WOMEN No education With secondary education or higher Never roamed (in union) Currently married (in union) Married before age 20 Had first sexual intercourse before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any contraceptive method Knowing any modem method Ever used any contraceptive method Currently using any method Currently using a modem method Currently using pill Currently using rejections Currently using condom Currently using female sterilisation Currently using periodic abstinence Currently using withdrawal Using public sector source Want no more children Want to delay at least 2 years Ideal number of children Mothers received tetanus injection Mothers received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Consulted medical personnel Having health card, seen Received BCG vaccinatnon Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully tmmumsed Weight- for-height Height-for-age Weight-for-age Total fertthty rate (3 years) Neonatal mortality rate (0-9 years) Postaeonatal mortality rate (0-9 years) Infant mortality rate (0-9 years) Child mortality rate (0-9 years) Under-five mortality rate (0-9 years) 0.058 0.014 1129 1588 2.077 0.241 0.030 0.086 0.434 0.026 1129 1588 1.778 0.060 0.382 0.486 0.293 0.014 1129 1588 1.008 0.048 0.265 0.321 0.573 0.015 1129 1588 1.017 0.026 0.543 0.603 0.666 0.020 820 1158 1.218 0.030 0.626 0.706 0.642 0.024 820 1158 1.425 0.037 0.594 0.690 2.821 0.087 1129 1588 0.972 0.031 2.647 2.995 7.566 0.233 137 196 0.923 0.031 7.100 8.032 2.354 0.072 1129 1588 0.949 0.031 2.210 2.498 0.997 0.002 641 910 0.963 0.002 0.993 1.000 0.996 0.003 641 910 0.970 0.003 0.990 1.000 0.685 0.031 641 910 1.697 0.045 0.623 0.747 0.298 0.018 641 910 1.011 0.060 0.262 0.334 0.201 0.017 641 910 1.052 0.085 0.167 0.235 0.093 (3.011 641 910 0.983 0.118 0.07l 0.115 0.013 0.005 641 910 1.096 0.385 0.003 0.023 0.038 0.009 641 910 1.230 0.237 0.020 0.056 0.053 0.010 641 910 1.124 0.189 0.033 0.073 0.026 0.006 641 910 0.971 0.231 0.014 0.038 0.032 0.009 641 910 1.281 0.281 0.014 0.050 0.416 0.062 165 227 1.617 0.149 0.292 0.540 0.324 0.020 641 910 1.081 0.062 0.284 0.364 0.343 0.016 641 910 0.867 0.047 0.311 0.375 4.694 0.110 1055 1482 1.926 0.023 4.474 4.914 0.886 0.012 954 1347 1.010 0.014 0.862 0.910 0.752 0.034 954 1347 2.052 0.045 0.684 0.820 0.208 0.014 828 1171 1.006 0.067 0.180 0.236 0.551 0.034 171 244 0.894 0.062 0.483 0.619 0.307 0.043 171 244 1.214 0.140 0221 0.393 0.859 0.024 173 247 0.885 0.028 0.811 0.907 0.995 0.005 173 247 0.981 0.005 0.985 1.(300 0.916 0.024 173 247 1.163 0.026 0.868 0.964 0.916 0.019 173 247 0.924 0.021 0.878 0.954 0895 0.023 173 247 1.009 0.026 0.849 0.941 0.841 0.026 173 247 0.926 0.031 0789 0.893 0.043 0.008 741 1051 1.055 0.186 0.027 0.059 0314 0.021 741 1051 1.165 0.067 0.272 0.356 0.172 0.015 741 1051 1.017 0.087 0.142 0.202 5.587 0.240 NA 43695 1.038 0.043 5.107 6.067 28.666 4.577 1685 2374 0.958 0.160 19.512 37.820 53.255 7.497 1688 2379 1.316 0.141 38.261 68.249 81.921 7.914 1689 2380 1.108 0.097 66093 97.749 101.782 10.266 1700 2396 1.192 0.101 81.250 122.314 175.365 11.413 1705 2404 1.074 0.065 152.539 198.191 MEN No education With secondary education or higher Never married (in union) Currently married (in union) Knowing any contraceptive method Knowing any modem method Ever used any contraceptive method Currently using any method Currently using a modern method Currently using pill Currently using rejections Currently using condom Currently using female sterihsation Currently using periodic abstinence Currently using withdrawal Want no more children Want to delay at least 2 years Ideal number of children 0.028 0.007 288 396 0.739 0.250 0.014 0.042 0.597 0.033 288 396 I. 148 0.055 0.531 0 663 0.500 0.028 288 396 0.945 0.056 0.444 0.556 0.440 0.027 288 396 0.934 0.061 0.386 0.494 1.000 0.000 128 174 Und O,O00 1.000 1.000 0.992 0.008 128 174 0.978 0.008 0.976 1.000 0.799 0.032 128 174 0.886 0.040 0.735 0.863 0.396 0.038 128 174 0.873 0.096 0.320 0.472 0.298 0.031 128 174 0.759 0.104 0.236 0.360 0.177 0.023 128 174 0.683 0.130 0.131 0.223 fi 008 0.007 128 174 0.970 0.875 0.000 0.022 0.076 0.023 128 174 0.981 0.303 0.030 0.122 0.030 0.011 128 174 0.694 0.367 0.008 0.052 0.076 0.024 128 174 1.036 0.316 0.028 0.124 0.023 0.013 128 174 0.990 0.565 0.000 0.049 0.298 0.031 128 174 0.765 0.104 0.236 0.360 0.393 0.042 128 174 0.972 0.107 0.309 0477 5.183 0.152 286 394 1.121 0.029 4.879 5.487 NA = Not applicable Und = Undefined 185 Table B.7 Samol in~ errors - Eastern orovince: Zambia 1996 Number of cases Standard Des,gn Relative Confidence limits Value error UnweJghted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No educaaon 0.327 With secondary education or higher 0.089 Never married (m umon) 0.177 Currently married (in union) 0.711 Mamed before age 20 0.790 Had first sexual intercourse before 18 0.690 Children ever born 3.512 Children ever born to women over 40 7 488 Children surviving 2.654 Knowing any contraceptive method 0.956 Knowing any modern method 0.943 Ever used any contraceptive method 0.463 Currently using any method 0.21 l Currently using a modern method 0.106 Currently using pill 0.055 Currently using rejections 0.003 Currently using condom 0.039 Currently using female sterilisation 0.008 Currently using period,c abstinence 0 0 l0 Currently using withdrawal 0.057 Using pubhc sector source 0.685 Want no more chddren 0.215 Want to delay at least 2 years 0 414 Ideal number of chddren 5 778 Mothers received tetanus injection 0 864 Mothers received medical care at b,rth 0.330 Had diarrhoea m the last 2 weeks 0 270 Treated with ORS packets 0.487 Consulted medical personnel 0.529 Having health card. seen 0.814 Received BCG vaccination 0.975 Received DPT vaccination (3 doses) 0.845 Received polio vaccination (3 doses) 0.837 Received measles vaccination 0.866 Fully immunised 0.773 Weight-for-height 0.027 Height- for-age 0 481 Weight-for-age 0.260 Total fertthty rate (3 years) 7.058 Neonatal mortahty rate (0-9 years) 49 676 Postneonatal mortality rate (0-9 years) 81 428 Infant mortality rate (0-9 years) 131.104 Chdd mortahty rate (0-9 years) 120.001 Under-five mortality rate (0-9 years) 235.372 0.037 1118 1075 2.644 0.113 0.253 0.401 0.017 1118 1075 1.980 0.191 0.055 0.123 0.011 1118 1075 0.940 0.062 0.155 0.199 0.018 1118 1075 1 333 0.025 0.675 0.747 0 013 874 840 0.959 0.016 0.764 0 816 0 013 874 840 0.836 0.019 0.664 0.716 0.103 1118 1075 1 094 0.029 3.306 3.718 0.249 170 161 1.020 0.033 6 990 7.986 0 075 1118 1075 1.032 0.028 2.504 2.804 0007 796 764 0.974 0.007 0.942 0.970 0 008 796 764 1006 0.008 0.927 0.959 0.028 796 764 1.590 0 060 0.407 0.519 0.020 796 764 1.404 0.095 0.171 0.251 0.014 796 764 1.280 0.132 0.078 0 134 0.010 796 764 1.240 0 182 0 035 0 075 0.000 796 764 0 116 0 000 0.003 0.003 0.010 796 764 1.453 0.256 0.019 0 059 0.1303 796 764 1 030 0 375 0 002 0.014 0.004 796 764 1.178 0.400 0 002 0 018 0.010 796 764 1.260 0.175 0 037 0.077 0.063 97 96 1.338 0 092 0 559 0.811 0.015 796 764 1.060 0 070 0 185 0.245 0.023 796 764 1.333 0.056 0 368 0 460 0 092 1098 1056 1.372 0.016 5 594 5.962 0.011 1149 1103 0.974 0.013 0 842 0 886 0.037 1149 1103 2.250 0.112 0.256 0.404 0 016 981 941 1.100 0.059 0.238 0.302 0 034 264 254 I 048 0.070 0.419 0.555 0.043 264 254 1.310 0 081 0.443 0 615 0.025 235 226 0 997 0 031 0.764 0 864 0.010 235 226 0.967 0.010 0.955 0.995 0 031 235 226 1.263 0.037 0.783 0.907 0 022 235 226 0.883 0.026 0.793 0 881 0 023 235 226 1.012 0 027 0 820 0 912 0 029 235 226 1.040 0.038 0 715 0 831 0.008 902 866 1 444 0 296 0.011 0.043 0.021 902 866 1.244 0.044 0 439 0 523 0.013 902 866 0.857 0.050 0.234 0.286 0.245 NA 3010 1.081 0.035 6.568 7.548 4.583 2174 2084 0.821 0 092 40.510 58 842 5.564 2187 2097 0.880 0.068 70 300 92 556 7.105 2187 2097 0.881 1J.054 116.894 145.314 8.682 2209 2118 1.044 0 072 102.637 137 365 9.123 2222 2130 0 861 0.039 217.126 253 618 MEN No education 0 192 0.039 With secondary education or higher 0 221 0 034 Never ,named (m union) 0.398 0.032 Currently married (m umon) 0.590 0 034 Knowing any contraceptive method 1.000 0.000 Knowing any modern method 0.988 0.008 Ever used any contraceptive method 0.831 0 035 Currently using any method 0.443 0.034 Currently using a modern method 0.236 0.034 Currently using pill 0.079 0 020 Currently using mjecuons 0.007 0.007 Currently using condom 0.137 0.028 Currently using female stefihsation 0.012 0.009 Currently using periodic abstinence 0.081 0 025 Currently using withdrawal 0 054 0 017 Want no more children 0 142 0.029 Want to delay at least 2 years 0.343 0.024 Ideal number of chddren 6.046 0.287 276 254 276 254 276 254 276 254 164 150 164 150 164 150 164 150 164 150 164 150 164 150 164 150 164 150 164 150 164 150 164 150 164 150 260 239 1.623 0.203 0 114 0 270 1.358 0.154 0.153 0289 1 071 0.080 0.334 0.462 1.135 0.058 0.522 0658 Und 0 000 1.000 1.000 0.980 0.008 0.972 1.000 1.204 0.042 0.761 0901 0 878 0 077 0.375 0 511 I 025 0.144 0.168 0.304 0.955 0.253 0.039 0 119 1 115 1000 0000 0021 I 052 0204 0.081 0.193 I 016 0750 0.000 0.030 1.170 0309 0031 0 131 0.942 0.315 0020 0088 1.061 0 204 0 084 0.200 0.638 0.070 0.295 0.391 1.569 0 047 5.472 6.620 NA -- Not apphcable Und = Undefined 186 Table B.8 Samolin~ errors - Luaoula orovince: Zambia 1996 Number of cases Standard Design Relative Confidence limits Vidue error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.156 0.027 896 726 2.196 0.173 0,102 0.210 With secondary education or higher 0.181 0.033 896 726 2.579 0.182 0.115 0.247 Never married (in umon) 0.249 0.011 896 726 0.780 0.044 0.227 0.271 Currently married (in union) 0.617 0.014 896 726 0.835 0.023 0.589 0.645 Married before age 20 0.813 0.018 654 529 1.150 0.022 0.777 0.849 Had first sexual intercourse before 18 0.750 0.014 654 529 0.805 0.019 0.722 0.778 Chddren ever born 3.317 0.114 896 726 1 028 0.034 3 089 3.545 Children ever born to women over 40 7.872 0.383 127 103 1.379 0 049 7.106 8 638 Children surviving 2.546 0.090 896 726 1.008 0.035 2 366 2.726 Knowing any contraceptive method 0.996 0.002 554 448 0.957 0 002 0.992 1 000 Knowing any modem method 0.989 0.005 554 448 1.039 0 005 0.979 0.999 Ever used any contracepDve method 0.248 0.033 554 448 1.819 O. 133 0.182 0.314 Currently using any method 0.109 0.021 554 448 1.616 0 193 0.067 0.151 Currently using a modem method 0.067 0.015 554 448 1.444 0.224 0.037 0.097 Currently using pill 0.039 0.010 554 448 1.213 0.256 0.019 0.059 Currently using injections 0.000 0.000 554 448 Und Und 0.000 0 000 Currently using condom 0.012 0.006 554 448 1.208 0.500 0 000 0.024 Currently using female sterilisation 0.014 0.005 554 448 1.001 0,357 0.004 0.024 Currently using periodic abstinence 0.015 0.004 554 448 0.690 0.267 0.007 0.023 Currently using withdrawal 0.007 0.004 554 448 0.984 0.571 0.000 0.015 Using public sector source 0.698 0.072 39 32 0.963 0.103 0.554 0.842 Want no more children 0.190 0.022 554 448 1.296 0.116 0.146 0.234 Want to delay at least 2 years 0.433 0.024 554 448 1.134 0.055 0.385 0.481 Ideal number of children 6.173 0.093 784 635 1.237 0.015 5.987 6.359 Motbers received tetanus injection 0.855 0.029 830 671 2.016 0.034 0.797 0.913 Mothers received methcal care at birth 0.270 0 035 830 671 1.895 0.130 0.200 0.340 Had diarrhoea in the last 2 weeks 0.209 0.017 675 545 1.059 0.081 0.175 0.243 Treated with ORS packets 0.548 0.042 141 114 0.967 0.077 0 464 0,632 Consulted medical personnel 0.262 0 035 141 114 0.897 0.134 0 192 0.332 Having health card, seen 0.847 0.028 150 121 0.937 0.033 0.791 0 903 Received BCG vaccination 0.987 0.009 150 121 1.001 0.009 0.969 1.000 Received DPT vaccination (3 doses) 0 908 0.037 150 121 1.556 0.041 0.834 0.982 Received polio vaccination (3 doses) 0.901 0.042 150 121 1.737 0.047 0.817 0985 Received measles vaccination 0.907 0.026 150 121 1.091 0.029 0.855 0959 Fully immunlsed 0.881 0.038 150 121 1.428 0.043 0805 0.957 Weight-for-beight 0065 0.014 616 498 1.398 0.215 0.037 0.093 Height-for-age 0.577 0.014 616 498 0.750 0.024 0.549 0 605 Weight-for-age 0.327 0.019 616 498 0.952 0.058 0289 0.365 Total fertihty rate (3 years) 6.832 0.248 NA 1952 1.099 0.036 6 336 7.328 Neonatal mortality rate (0-9 years) 32.937 4510 1528 1236 0.898 0.137 23.917 41957 Postneonatal mortality rate (0-9 years) 124.834 12.319 1530 1238 1.275 0099 100.196 149472 Infant mortality rate (0o9 years) 157.771 11.600 1530 1238 1.081 0.074 134.571 180.971 Child mortality rate (0-9 years) 114.462 12.852 1554 1258 1.246 0.112 88758 140.166 Under-five mortahty rate (0-9 years) 254.175 15.612 1556 1259 1.129 0.061 222.951 285.399 MEN No education 0.051 0.015 196 151 0.930 0294 0.021 0.081 With secondary education or higher 0.302 0.045 196 151 1.358 0.149 0.212 0.392 Never married (in umon) 0.449 0.045 196 151 1.259 O. 100 0.359 0 539 Currently married (in union) 0.515 0.042 196 151 I. 177 0 082 0.431 0.599 Knowing any contraceptive method 1.000 0.000 101 78 Und 0.000 1.000 1.000 Knowing any modem method 1.0490 0.000 101 78 Und 0.000 1.000 1.000 Ever used any contraceptive method 0.634 0.064 101 78 1.321 0.101 0.506 0.762 Currently using any method 0.268 0 059 101 78 1.324 0.220 0.150 0.386 Currently using a modern method 0.069 0.020 101 78 0.784 0.290 0.029 0.109 Currently using pill 0 049 0.020 101 78 0.924 0.408 0.009 0.089 Currently using injections 0.000 0.000 101 78 Und Und 0.000 0.000 Currently using condom 0.010 0.010 101 78 1.013 1.000 0.000 0.030 Currently using female sterihsatlon 0.010 0.010 101 78 1.004 1.000 0,000 0.030 Currently using periodic abstinence 0.060 0.025 101 78 1.046 0.417 0.010 0.110 Currently using withdrawal 0.030 0.016 101 78 0.937 0.533 0.000 0.062 Want no more children 0.169 0.039 101 78 1.041 0231 0.091 0.247 Want to delay at least 2 years 0.337 0.052 101 78 1.102 0.154 0.233 0.441 Ideal number of chxldren 6.088 0.283 183 141 I 562 0.046 5.522 6.654 NA = Not applicable Und = Undefined 187 Table B.9 Samt~lin~ errors - Lusaka province: Zambia 1996 Number of cases Standard Design Relanve Confidence thmts Value error Unweighted Weighted effect error Variable (R) (SE) IN) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.078 0 009 1074 1403 1.045 0.115 0 060 0.096 With secondary education or higher 0.441 0.033 1074 1403 2 178 0.075 0.375 0 507 Never manhed (in union) 0.285 0.018 1074 1403 1.273 0.063 0.249 0321 Currently married (m umon) 0.568 0.020 1074 1403 1.302 0.035 0528 0 608 Married before age 20 0 569 0.030 800 1045 1.692 0.053 0.509 0.629 Had first sexual intercourse before 18 0.622 0.024 800 1045 1.383 0.039 0.574 0.670 Children ever born 2.545 0.116 1074 1403 1.370 0.046 2.313 2.777 Children ever born to women over 40 6.788 0.215 125 164 0.752 0.032 6,358 7.218 Children surviving 2.145 0.092 1074 1403 1.267 0.043 1.961 2.329 Knowing any contraceptive method 0,982 0.004 613 796 0.784 0.004 0 974 0.990 Knowing any modem method 0 980 0.005 613 796 0.810 0,005 0 970 0.990 Ever used any contraceptive method 0 690 0.024 613 796 1.271 0 035 0.642 0.738 Currently using any method 0 353 0.025 613 796 1.293 0 071 0.303 0,403 Currently using a modem method 0.274 0.019 613 796 1.054 0.069 0.236 0 312 Currently using pdl 0 139 0.015 613 796 1.071 0.108 0.109 0 169 Currently using injections 0.039 0.01l 613 796 l 377 0.282 0.O17 0061 Currently using condom 0.053 0.009 613 796 0.940 0,170 0.035 0.07 I Currently using female sterilisation 0.020 0.005 613 796 0.878 0 250 0.010 0 030 Currently using periodic abstinence 0.035 0.009 613 796 1.242 0 257 0.017 0.053 Currently using withdrawal 0.021 0.006 613 796 0 978 0 286 0.009 0,033 Using public sector source 0.649 0.036 219 287 1.119 0.055 0.577 0.721 Want no more children 0.328 0 027 613 796 1 415 0.082 0.274 0.382 Want to delay at least 2 years 0.388 0.026 613 796 I 296 0.067 0,336 0.440 Ideal number of children 4435 0.099 1064 1389 1.567 0.022 4,237 4.633 Mothers received tetanus injection 0.852 0.019 830 1076 1.352 0.022 0,814 0.890 Mothers received medical care at brtth 0 742 0.035 830 1076 1.922 0,047 0 672 0.812 Had diarrhoea in the last 2 weeks 0 287 0.017 700 909 0.949 0 059 0 253 0.321 Treated with ORS packets 0.566 0.035 200 261 0.964 0.062 0.496 0.636 Consulted medical personnel 0.552 0.045 200 261 1.209 0 082 0.462 0.642 Having health card, seen 0 808 0.034 154 200 1.065 0,042 0 740 0 876 Received BCG vaccination 1,000 0.000 154 200 Und 0.000 1,000 1 000 Received DPT vaccination 13 doses) 0.877 0.031 154 200 1.157 0.035 0.815 0939 Received polio vaccination (3 doses) 0.837 0.041 154 200 1.358 0.049 0 755 0 919 Received measles vaccination 0 882 0.024 154 200 0.903 0 027 0 834 0 930 Fully immumsed 0 790 0 045 154 200 1.371 0,057 0.7011 0 880 Weight-for-height 0.030 0.006 606 786 0 924 0 2011 0 018 0 042 Height-for-age 0.302 0 019 606 786 I 011 0 063 0.264 0 340 Weight-for-age 0.155 0.015 606 786 I 000 0.097 0.125 0 185 Total fertility rate (3 years) 4.870 0.346 NA 3892 1.305 0,071 4.178 5 562 Neonatal mortality rate (0-9 years) 35.470 5.817 1513 1962 1.116 0.164 23836 47 104 Postneonatal mortality rate (0-9 years) 64.817 6,146 1514 1963 0.889 0.095 52.525 77,109 lnfant mortality rate (0-9 years) 100.287 8.453 1514 1963 0.986 0.084 83.381 117.193 Child mortality rate (0-9 years) 82.062 8.855 1524 1976 1,048 0.108 64.352 99.772 Under-five mortality rate (0-9 years) 174 120 12.620 1525 1977 1.098 0.072 148.880 199 360 MEN No educauon 0.052 0.014 220 316 0,925 0269 0.024 0.080 With secondary educanon or higher 0.566 0.034 220 316 1.017 O 060 0.498 0.634 Never married (in union) 0.422 0.032 220 316 0.967 11.076 0.358 0 486 Currently married (m umon) 0.504 0 027 220 316 0 796 0.054 0.450 0.558 Knowing any contracepuve method 0.991 0.009 112 160 1.035 0.009 0 973 1.000 Knowing any modern method 0.991 0.009 112 160 1.035 0.009 0.973 1.000 Ever used any contraceptive method 0.900 0.026 112 160 0.898 0.029 0 848 0.952 Currently using any method 0.505 0.036 112 160 0.758 0.071 0.433 0.577 Currently using a modem method 0.254 0.037 112 160 0.897 0.146 0.180 0.328 Currently using pif 0137 0.027 112 160 0.835 0.197 0.083 0.191 Currently using injections 0.009 0.009 I 12 160 1.025 1.000 0.000 0,027 Currently using condom 0.072 0.024 112 160 0.958 0 333 0.024 0.120 Currently using female stenlisation 0.016 0.012 112 160 0.977 0,750 0 000 0 040 Currently using periodic abstinence 0.121 0.035 112 160 1.128 0.289 0.051 0.191 Currently using withdrawal 0.070 0.024 112 160 1.008 0 343 0.022 0 118 Want no more children 0.233 0.044 112 160 1087 0.189 0.145 0.321 Want to delay at least 2 years 0.335 0039 112 160 0873 0116 0.257 0.413 Ideal number of children 4.955 O. 176 218 313 0 966 0.036 4 603 5.307 NA = Not applicable Und = Undefined 188 Table B. I0 Samolin~ errors - Northern orovince: Zambia 1996 Number of eases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE /R) R -2SE R+2SE WOMEN No education O.t 18 0.019 783 872 With secondary educaaon or higher 0.163 0.022 783 872 Never married (in union) 0.230 0.017 783 872 Currently married (in union) 0.634 0.021 783 872 Married before age 20 0.771 0.016 579 645 Had first sexual intercourse before 18 0.633 0.021 579 645 Children ever born 3.298 0.093 783 872 Children ever born to women over 40 7.911 0.358 100 111 Children surviving 2.636 0.080 783 872 Knowing any contraceptive method 0 996 0.004 493 552 Knowing any modern method 0 981 0.006 493 552 Ever used any contraceptive method 0.840 0.027 493 552 Currently using any method 0.330 0.022 493 552 Currently using a modern method 0.080 0.016 493 552 Currently using pill 0.049 0.016 493 552 Currently using injections 0.005 0.004 493 552 Currently using condom 0.020 0.007 493 552 Currently using female sterilisation 0.006 0.003 493 552 Currently using periodic abstinence 0.008 0.004 493 552 Currently using withdrawal 0.126 0.013 493 552 Using public sector source 0.727 0.079 48 49 Want no more chddren 0.206 0.021 493 552 Want to delay at least 2 years 0.450 0.024 493 552 Ideal number of children 5.694 0.088 711 789 Mothers received tetanus injection 0.762 0.044 769 863 Mothers received medical care at birth 0.240 0.045 769 863 Had diarrhoea in the last 2 weeks 0.218 0.020 664 744 Treated with ORS packets 0.468 0.041 144 162 Consulted medical personnel 0.212 0.050 144 162 Having bealth card, seen 0.716 0.043 164 183 Received BCG vaccination 0.887 0.029 164 183 Received DPT vaccination (3 doses) 0.695 0.053 164 183 Received polio waccination (3 doses) 0.678 0.046 164- 183 Received measles vaccination 0.714 0.048 164 183 Fully lmmunised 0.585 0.046 164 183 Weight-for-height 0.048 0.009 598 671 Height-for-age 0.573 0.028 598 671 Weight-for-age 0.315 0.019 598 671 Total fertihty rate (3 years) 7.227 0.353 NA 2399 Neonatal mortality rate (0-9 years) 36.506 4.979 1403 1573 Posmeonatal mortahty rate (0-9 years) 88.776 7.078 1406 1576 Infant mortahty rate (0-9 years) 125.282 9.121 1406 1576 Child mortahty rate (0-9 years) 85.679 9.554 1425 1598 Under-five mortahty rate (0-9 years) 200.227 14.112 1428 1601 1.670 0,16t 0.080 0,156 1.677 0.135 0 119 0.207 1.133 0.074 0.196 0.264 1,215 0,033 0 592 0.676 0.896 0.021 0.739 0.803 1.072 0.033 0.591 0,675 0.822 0.028 3.112 3.484 1.445 0.045 7.195 8.627 0.858 0.030 2.476 2.796 1.471 0.004 0988 1.000 1.024 0.006 0.969 0.993 1.633 0.032 0.786 0.894 1.020 0 067 0.286 0.374 1.304 0.200 0.048 0.112 1.622 0.327 0.017 0.081 1.186 0.800 0000 0.013 1.192 0.350 0.006 0.034 1.020 0.500 0.000 0.012 1 005 0.500 0.000 0.016 0.845 0.103 0.100 0.152 1.213 0.109 0.569 0.885 1.152 0.102 0.164 0.248 1.058 0.053 0.402 0.498 1.080 0.015 5.518 5.870 2.371 0.058 0.674 0.850 2.342 0.188 0.150 0 330 1.254 0.092 0.178 0.258 0.931 0088 0.386 0.550 1.421 0.236 0.112 0.312 1.187 0.060 0.630 0.802 1.164 0.033 0 829 0.945 1.427 0.076 0.589 0.801 1.222 0.068 0.586 0.770 1.319 0.067 0.618 0.810 1.159 0.079 0.493 0.677 1.022 0 188 0.030 0.066 1.354 0 049 0.517 0.629 0.935 0.060 0 277 0.353 1.151 0.049 6521 7.933 0.919 0.136 26.548 46.464 0.922 0.080 74 620 102.932 0.955 0.073 107 040 143.524 1.084 0,112 66.571 104.787 1.103 0.070 172.003 228.451 MEN No education 0.021 0.008 205 221 0.757 With secondary education or htgher 0.333 0.023 205 221 0.700 Never mamed (in union) 0.484 0.043 205 221 1.232 Currently married (in union) 0.507 0.041 205 221 1.181 Knowing any contraceptive method 0.969 0.017 102 I 12 0.976 Knowing any modem method 0.969 0.017 102 112 0.976 Ever used any contraceptive method 0 387 0.044 102 112 0,910 Currently using any method 0.176 0031 102 112 0.813 Currently using a modem method 0.075 0.019 102 112 0.722 Currently using pill 0.030 0.016 102 112 0.937 Currently using injections 0.000 0.000 102 112 Und Currently using condom 0.045 0.021 102 112 1.033 Currently using female sterilisation 0.000 0.000 102 I 12 Und Currently using periodic abstinence 0 031 0.017 102 112 0.976 Currently using withdrawal 0.069 0.023 102 112 0.902 Want no more children 0.165 0.040 102 112 1.089 Want to delay at least 2 years 0.529 0 037 102 112 0.737 Ideal number of children 6818 0.245 205 221 1.127 0.381 0.005 0.037 0.069 0.287 0.379 0.089 0.398 0 570 0.081 0.425 0 589 0.018 0.935 1 000 0.018 0.935 1.000 O. 114 0.299 0.475 0176 0.114 0238 0.253 0.037 0.113 0.533 0 000 0.062 Und 0.000 0.000 0.467 0.003 0 087 Und 0.000 0.000 0.548 0.000 0.065 0.333 0.023 0.115 0 242 0.085 0.245 0.070 0.455 0.603 0.036 6.328 7.308 NA = Not applicable Und = Undefined 189 Table B. 11 Samolimz errors - North-Western orovince: Zambia 1996 Number of cases Standard Design Relateve Confidence limits Value error Unwetghted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.185 0.024 567 288 With secondary education or higher 0.208 0.034 567 288 Never mamed (in union) 0.173 0.018 567 288 Currently married (m union) 0.683 0.023 567 288 Married before age 20 0.779 0.023 453 230 Had first sexual intercourse before 18 0.894 0.013 453 230 Chddren ever born 3 304 0.151 567 288 Children ever born to women over 40 7.363 0.535 76 39 Children surviving 2.809 0.121 567 288 Knowing any contraceptive method 0.987 0.005 386 197 Knowing any modern method 0.966 0 010 386 197 Ever used any contraceptive method 0.763 0.030 386 197 Currently using any method 0.417 0 024 386 197 Currently using a modern method 0.113 0 012 386 197 Currently using pill 0.031 0 009 386 197 Currently using injections 0,000 0.000 386 197 Currently using condom 0 036 0.011 386 197 Currently using female sterihsation 0.047 0.012 386 197 Currently using periodic abstinence 0.018 0.006 386 197 Currently using withdrawal 0.071 0.015 386 197 Using public sector source 0.445 0.100 58 29 Want no more chddren 0.219 0.022 386 197 Want to delay at least 2 years 0.420 0.020 386 197 Ideal number of chddren 5.757 0.124 566 287 Mothers received tetanus injectlon 0.817 0.024 565 287 Mothers received medical care at birth 0.563 0.044 565 287 Had d~arrhoea m the last 2 weeks 0.174 0017 495 252 Treated with ORS packets 0 595 0.076 86 44 Consulted medical personnel 0.619 0.070 86 44 Having health card, seen 0.829 0.043 93 47 Received BCG vaccination 0.990 0.010 93 47 Received DPT vaccination (3 doses) 0.837 0.042 93 47 Received polio vaccination (3 doses) 0 869 0 042 93 47 Receeved measles vaccination 0 903 0.050 93 47 Fully lmmtmised 0 805 0.053 93 47 Weeght-for-helght 0.023 0 009 440 224 Hetght-lbr-age 0.474 0 030 440 224 Weight-for-age 0.271 0.024 440 224 Total fertlhty rate (3 years) 6.226 0 341 NA 812 Neonatal mortahty rate (0-9 years) 32 818 5.749 1013 515 Postneonatal mortahty rate (0-9 years) 58.311 10.256 1015 516 In fant mortahty rate (0-9 years) 91.128 12.224 1016 517 Child mortahty rate (0-9 years) 68.098 9 247 1021 519 Under-five mortality rate (0-9 years) 153.021 13.643 1025 521 1.460 0.130 0 137 0.233 1.997 0.163 0 140 0.276 1.125 0.104 0.137 0209 I. 188 0.034 0.637 0 729 1.190 0.030 0733 0.825 0.877 0 015 0 868 0.920 1.210 0.046 3.002 3.606 1.466 0 073 6.293 8.433 1.097 0.043 2.567 3 051 0 938 0 005 0.977 0 997 I 124 0.010 0.946 0.986 1.376 0.039 0 703 0.823 0.968 0.058 0.369 0.465 0.747 0.106 0.089 0.137 1.053 0.290 0.013 0 049 Und Und 0 000 0.000 1.217 0.306 0014 0.058 1.126 0255 0023 0.071 0.919 0333 0006 0.030 1.126 0.211 0.041 0 101 I 521 0225 0.245 0645 I 026 0.100 0.175 0.263 0.786 0.048 0 380 0.460 1.298 0 022 5 509 6.005 1 320 0 029 0 769 0.865 1.762 0 078 0.475 0 651 0.985 0.098 0.140 0208 1.354 0.128 0.443 0.747 1.260 0 113 0479 0.759 I 098 0.052 0.743 0.915 0987 0010 0970 1.000 1.083 0.050 0.753 0 921 1212 0.048 0785 0953 1.613 0.055 0 803 I 000 1.279 0 066 0 699 0.911 1 305 0 391 03)05 0,041 1.187 0.063 0.414 0534 I 039 0089 0.223 0 319 I 161 0.055 5.544 6,908 0.940 0.175 21.320 44316 1.204 0.176 37.799 78 823 1 171 0134 66680 115.576 1061 0.136 49604 86592 I 056 0089 125.735 180.307 MEN No education 0.031 0.017 94 48 0932 0548 With secondary education or higher 0.333 0.063 94 48 1.279 0 189 Never married (in union) 0.194 0 035 94 48 0 854 0.180 Currently marrmd (m umon) 0.753 0.033 94 48 0.740 0.044 Knowing any contraceptive method 1,000 0.000 71 36 Und 0.000 Knowing any modem method 0.986 0 014 71 36 0.977 0.014 Ever used any contraceptive method 0.749 0.064 71 36 I 235 0 085 Currently using any method 0.526 0 055 71 36 0.926 0.105 Currently using a modem method 0.250 0.041 71 36 0.784 0.164 Currently using pdl 0.090 0.028 71 36 0.811 0.311 Currently using injections 0.000 0.0O0 71 36 Und Und Currently using condom 0.145 0 036 71 36 0.843 0 248 Currently using female sterilisation 0 014 0.013 71 36 0 964 0 929 Currendyusingpenodicabstmence 0014 0014 71 36 1017 1.000 Currently using wtthdrawal 0.112 0.039 71 36 1.041 0.348 Want no more children 0 200 0.053 71 36 1 100 0 265 Want to delay at least 2 years 0.533 0.073 71 36 1 220 0 137 Ideal number of children 6.300 0 250 89 45 0 940 0.040 0,000 0.065 0 207 0 459 0.124 0264 0.687 0.819 1.000 1.000 0958 1 000 0.621 0 877 0.416 0636 0168 0332 0.034 0.146 0000 0000 0073 0217 0.000 0.040 0.000 0042 0034 0.190 0 094 0,306 0 387 0.679 5.800 6.800 NA = Not apphcable Und = Undefined 190 Table B.12 Samolin~ errors - Southern orovince: Zambia 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education With secondary education or higher Never married (in union) Currently married (in union) Married before age 20 Had first sexual intercourse before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any contraceptive method Knowing any modern method Ever used any contraceptive method Currently using any method Currently using a modem method Currently using pill Currently using injections Currently using condom Currently using female sterilisation Currently using periodic abstinence Currently using withdrawal Using pubhc sector source Want no more chddren Want to delay at least 2 years Ideal number of children Mothers received tetanus injection Mothers received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Consulted medical personnel Having health card, seen Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully ,mmunlsed Weight-for-height Height-for-age Weight-for-age Total fertdlty rate (3 years) Neonatal mortality rate (0-9 years) Posmeonatal mortality rate (0-9 years) Infant mortahty rate (0-9 years) Child mortality rate (0-9 years) Under-five mortahty rate (0-9 years) 0.100 0.016 846 816 1.561 0.160 0.068 0.132 0.215 0.031 846 816 2.219 0.144 0.153 0.277 0.245 0.014 846 816 0.966 0.057 0.217 0.273 0.635 0.021 846 816 1.276 0.033 0.593 0.677 0.695 0.020 641 621 1.080 0.029 0.655 0.735 0.797 0.022 641 621 1.374 0.028 0.753 0.841 3.146 0.092 846 816 0.902 0.029 2.962 3.330 6.841 0.254 102 101 0.857 0.037 6.333 7.349 2.649 0.068 846 816 0.788 0.026 2.513 2.785 0.975 0.004 547 518 0.583 0.004 0.967 0.983 0.972 0.005 547 518 0.669 0.005 0.962 0.982 0.574 0.037 547 518 1.742 0.064 0.500 0.648 0.219 0.020 547 518 1.106 0.091 0.179 0.259 0.090 0010 547 518 0.816 0.111 0.070 0.110 0.048 0.007 547 518 0.756 0.146 0.034 0.062 0.005 0.005 547 518 1.667 1.000 0.000 0.015 0.029 0.007 547 518 1.026 0.241 0.015 0.043 0.004 0.003 547 518 1.069 0.750 0.000 0010 0.023 0.006 547 518 0.909 0.261 0.01 I 0 035 0.039 fi.011 547 518 1.341 0.282 0.017 0.061 0.650 0 095 66 67 1.613 0.146 0.460 0.840 0.249 0.019 547 518 1.007 0.076 0.211 0.287 0.418 0.025 547 518 1.178 0 060 0.368 0.468 5 576 0.066 842 812 0.846 0.012 5.444 5.708 0.828 0.016 805 764 1.074 0 019 0.796 11.860 0.278 0.035 805 764 1.845 0.126 0.208 0348 0.224 0.019 693 657 1.183 0085 0.186 0.262 0 649 0.041 155 147 1.038 0.063 0.567 0 731 0.722 0.043 155 147 1.167 0.060 0.636 0.808 0.907 0.021 161 153 0.921 0.023 0865 0949 0.994 0.006 161 153 1.031 0.006 0.982 1.000 0.942 0.032 161 153 1.734 0.034 0 878 1 000 0.948 0.031 161 153 1.745 0.033 0 886 1.000 0.968 0.015 161 153 1 093 0.015 0.938 0.998 0.910 0.044 161 153 1.952 0.048 0.822 0.998 0 035 0 007 597 564 0.922 0.200 0.021 0.049 0.395 0.023 597 564 1.108 0.058 0.349 0.441 0211 0.022 597 564 1.226 0.104 0 167 0255 6.162 0.313 NA 2257 1.162 0.051 5 536 6 788 26.019 4 355 1501 1427 1.021 0.167 17.309 34.729 40221 5.186 1503 1429 0.944 0.129 29849 50593 66.240 7.376 1503 1429 1.044 0.11 I 51.488 80.992 87.934 9.783 1512 1438 1.176 0.111 68.368 107.500 148.349 10.890 1514 1441 1.099 0.073 126.569 170.129 MEN No education With secondary education or higher Never married (in umon) Currently married (m umon) Knowing any contraceptive method Knowing any modem method Ever used any contracepuve method Currently using any method Currently using a modern method Currently using pill Currently using injections Currently using condom Currently using female stenlisatmn Currently using penodic abstinence Currently using withdrawal Want no more children Want to delay at least 2 years Ideal number of children 0.056 0.020 189 173 1.163 0.357 0.016 0.096 0.336 0.040 189 173 1.164 0.119 0.256 0.416 0.401 0.045 189 173 1.258 0.112 0.311 0.491 0.551 0.047 189 173 1.305 0.085 0.457 0645 0.974 0.015 106 95 0.979 0.015 0944 I 000 0.974 0.015 106 95 0.979 0.015 0.944 1.000 0.638 0.041 106 95 0.870 0.064 0556 0720 0.296 0.034 106 95 0.760 0.115 0228 0364 0.178 0.039 106 95 1.040 0.219 0.100 0256 0.116 0.028 106 95 0.888 0.241 0 060 0 172 0.000 0.000 106 95 Und Und 0.000 0000 0.040 0022 106 95 1.171 0.550 0.000 0.084 0 009 0.009 106 95 0.970 1.00fi 0 000 0 027 0.052 0.024 106 95 1.094 0.462 0.004 0.100 0 009 0 008 106 95 0.920 0.889 0.000 0 025 0.142 0 029 106 95 0.859 0.204 0.084 0.200 0.298 0.064 106 95 1.444 0.215 0.170 0.426 6.143 0.209 180 166 0888 0.034 5.725 6.561 NA = Not applicable Und = Undefined 191 Table B.13 SamDlin~ errors - Western arovince: Zambia 1996 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE /R) R-2SE R+2SE WOMEN No oducation 0.186 0.030 860 600 2.277 0.161 0.126 0.246 With secondary education or higher 0.201 0.027 860 600 1.944 0.134 0.147 0.255 Never married (in union) 0.328 0.027 860 600 1.665 0.082 0.274 0.382 Currently married (in union) 0.497 0.029 860 600 1.678 0.058 0.439 0.555 Married before age 20 0.573 0.025 640 446 1.288 0.044 0.523 0.623 Had first sexual intercourse before 18 0.812 0.016 640 446 1.056 0.020 0.780 0.844 Children ever born 2.914 0.120 860 600 1.198 0.041 2,674 3.154 Children ever born to women over 40 6.701 0.193 147 103 0.809 0.029 6.315 7.087 Children surviving 2.296 0.083 860 600 1.023 0.036 2.130 2.462 Knowing any contraceptive method 0.974 0.011 428 298 1.454 0.011 0.952 0.996 Knowing any modern method 0.958 0.016 428 298 1.644 0.017 0.926 0.990 Ever used any contraceptive method 0.482 0.026 428 298 1.083 0.054 0.430 0.534 Currently using any method 0.187 0.018 428 298 0.961 0.096 0.15t 0.223 Currently using a modern method 0.087 0.016 428 298 1.158 0.184 0.055 0.119 Currently using pill 0.047 0.011 428 298 1.060 0.234 0.025 0.069 Currently using rejections 0.000 0.0~ 428 298 Und Und 0.000 0.000 Currently using condom 0.019 0.005 428 298 0.813 0,263 0.009 0.029 Currently using female sterilisation 0.019 0.008 428 298 1.190 0.421 0.003 0,035 Currently using periodic abstinence 0 009 0.004 428 298 0.781 0.444 0.001 0.017 Currently using withdrawal 0.051 0.012 428 298 1.136 0.235 0.027 0.075 Using public sector source 0.776 0.065 67 47 1.257 0.084 0.646 0.906 Want no more children 0.246 0.026 428 298 1.259 0.106 0.194 0.298 Want to delay at least 2 years 0.311 0.022 428 298 0.984 0.071 0 267 0.355 Ideal number of children 6.302 0.137 856 597 1.465 0.022 6028 6.576 Mothers received tetanus injection 0.867 0.017 659 460 1.098 0.020 0.833 0.901 Mothers received medical care at birth 0.373 0.037 659 460 1.690 0.099 0.299 0 447 Had diarrhoea in the last 2 weeks 0.233 0.019 546 381 1.062 0.082 0.195 0.271 Treated with ORS packets 0.559 0.043 127 89 0.93t 0.077 0.473 0.645 Consulted medical personnel 0.638 0.063 127 89 1.437 0.099 0 512 0.764 Having health card, seen 0.842 0.026 114 80 0.729 0.031 0.790 0.894 Received BCG vaccination 0.974 0.015 114 80 0.978 0.015 0.944 1.000 Received DPT vaccination (3 doses) 0.842 0.038 114 80 I. 102 0.045 0.766 0 918 Recetved polio vaccination (3 doses) 0 825 0.042 114 80 1.163 0.051 0.741 0.909 Received measles vaccination 0.799 0.049 114 80 1.262 0.061 0,701 0 897 Fully immunised 0.737 0.056 114 80 1.316 0.076 0.625 0.849 Weight-for-beight 0.053 0.008 467 326 0.801 0.151 0.037 0,069 Height-for-age 0,449 0.030 467 326 1.301 0.067 0.389 0.509 Weight-for-age 0.321 0.022 467 326 0.996 0,069 0.277 0.365 Total fertility rate (3 years) 5.532 0.252 NA 1673 1.140 0.046 5,028 6.036 Neonatal mortality rate (0-9 years) 55.785 8.893 1216 848 1.201 0.159 37.999 73.571 Postneonatal mortality rate (0-9 years) 73.347 9.562 1219 850 1.197 0.130 54.223 92.471 Infant mortahty rate (0-9 years) 129.132 13.733 1219 850 1.249 0.106 101.666 156.598 Child mortahty rate (0-9 years) 82.769 8.578 1230 858 0,910 0.104 65.613 99.925 Under-five mortality rate (0-9 years) 201.213 14.776 1233 860 1.124 0.073 171.661 230.765 MEN No education 0.119 0.033 196 132 1.441 0.277 0.053 0.185 With secondary education or higher 0.317 0.044 196 132 1.333 O. 139 0.229 0.405 Never married (in umon) 0.500 0.026 196 132 0.727 0.052 0.448 0.552 Currently marriod (in union) 0.424 0.039 196 132 1,109 0.092 0.346 0.502 Knowing any contraceptive method 0.963 0.018 83 56 0.872 0.019 0.927 0.999 Knowing any modem method 0.963 0.018 83 56 0.872 0.019 0.927 0.999 Ever used any contraceptive method 0.517 0.054 83 56 0.981 0.104 0 409 0.625 Currently using any method 0.250 0.052 83 56 1.077 0.208 0 146 0.354 Currently using a modern method 0.226 0.050 83 56 1.073 0.221 0.126 0.326 Currently using pill 0.141 0.044 83 56 1.137 0.312 0.053 0.229 Currently using injections 0.000 0.000 83 56 Und Und 0.000 0.000 Currently using condom 0.061 0.029 83 56 1.114 0.475 0.003 0.119 Currently using female sterilisation 0.024 0.018 83 56 1.041 0.750 0.000 0.060 Currently using periodic abstinence 0.000 0.000 83 56 Und Und 0.000 0.000 Currently using withdrawal 0.024 0.016 83 56 0.953 0.667 0 000 0.056 Want no more children O. 130 0.045 83 56 1.216 0 346 0.040 0.220 Want to delay at least 2 years 0.339 0.039 83 56 0.739 0.115 0.261 0.417 Ideal number of children 7.225 0.315 174 117 0.831 0.044 6.595 7.855 NA = Not applicable Und = Undefined 192 Table B.14 SamDlin~ errors of differences Sampling errors of the difference between values of selected indicators for currently married women from the 1992 and 1996 ZDHS Coefficient Value Value of corr¢- SE Co1.(7)/ Co1,(6)- Co1.(6)+ R92 SE (R92) Rg~ SE (Rg~) lation R96-R92 (R96-R92) Col.(6) 2(Co1.(7)) 2(Co1.(7)) (I) (2) (3) (4) (5) (6) (7) (8) (9) (10) Know a method Total 0.940 0.005 0.985 0.002 0.103 0.045 0.005 0.111 0.035 0.055 Urban 0.972 0.005 0.990 0.002 0.036 0.018 0.005 0.278 0.008 0.028 Rural 0.913 0.008 0.979 0,004 0.067 0.066 0,009 0,136 0,048 0.084 Central 0.751 0.029 0.997 0,003 0.491 0.246 0.028 0.114 0.190 0.302 Copperbelt 0.992 0.003 0.997 0,002 0,360 0.005 0,003 0.600 -0.001 0.011 Eastern 0.925 0.010 0.960 0,011 0.083 0.035 0.014 0.400 0.007 0.063 Luapula 0.941 0.017 0.997 0.003 0.150 0.056 0.017 0.304 0.022 0,090 Lusaka 0.957 0.008 0.981 0.004 0.053 0.024 0,009 0.375 0.006 0.042 Northern 0.961 0.011 1.000 0,000 0.000 0.039 0.011 0.282 0,017 0,061 North-Western 0.917 0.036 0.980 0.005 -0.333 0.063 0,038 0,603 -0,013 0,139 Southern 0.971 0.007 0.974 0,006 0.299 0,003 0.008 2.667 -0,013 0.019 Western 0.956 0.018 0.967 0.017 0.589 0.011 0.016 1.455 -0.021 0.043 Know a modern method Total 0.908 0.007 0,979 0.002 0.232 0.071 0.007 0.099 0,057 0.085 Urban 0.965 0.005 0,989 0.002 -0.012 0.024 0,005 0.208 0.014 0.034 Rural 0,860 0.011 0.968 0.004 0.213 0.108 0,011 0.102 0.086 0.130 Central 0.720 0.031 0.994 0.005 0.525 0.274 0.029 0.106 0.216 0.332 Copperbelt 0.989 0.004 0.995 0.003 0,239 0.006 0.004 0.667 -0.002 0.014 Eastern 0.897 0.012 0,949 0.011 0.296 0.052 0.014 0.269 0.024 0.080 Luapula 0.888 0.017 0.991 0.005 0.190 0.103 0.017 0.165 0.069 0.137 Lusaka 0.947 0.008 0.979 0.005 0.019 0.032 0.009 0.281 0.014 0.050 Northern 0,839 0.035 0.979 0.005 0.678 0.140 0.032 0.229 0.076 0.204 North-Western 0.909 0.036 0.954 0.009 -0.189 0.045 0.039 0.867 -0.033 0.123 Southern 0.954 0.016 0.974 0.006 0.457 0,020 0.014 0.700 -0.008 0.048 Western 0.854 0.039 0.948 0.023 0,472 0,094 0.035 0.372 0.024 0.164 Ever used a method Total 0.491 0.013 0.614 0.013 0.577 0.123 0.012 0.098 0.099 0.147 Urban 0,592 0.016 0.722 0.016 0.444 0.130 0.017 0.131 0.096 0.164 Rural 0406 0.018 0,495 0.021 0.546 0,089 0,019 0.213 0.051 0.127 Central 0.331 0.029 0.539 0,045 0.453 0.208 0.041 0.197 0.126 0290 Copperbelt 0.594 0.027 0.695 0.032 0.479 0.101 0,030 0.297 0.041 0.161 Eastern 0.386 0.033 0.494 0.026 0.831 0.108 0.018 0.167 0.072 0.144 Luapula 0.186 0,036 0.238 0.059 0.493 0.052 0.052 1.000 -0.052 0.156 Lusaka 0.595 0.022 0.690 0,024 0.426 0.095 0.025 0.263 0.045 0.145 Northern 0.798 0.009 0.864 0.035 -0.234 0.066 0.038 0.576 -0.010 0.142 North-Western 0.481 0.033 0.730 0050 -0.110 0.249 0.063 0.253 0.123 0375 Southern 0.327 0.042 0.549 0.023 0.376 0,222 0.040 0,180 0.142 0.302 Western 0.620 0.033 0.500 0.030 0.136 -0.120 0,041 -0.342 -0.202 -0.038 Currently using a method Total 0.153 0.009 0.275 0.010 0.418 0.122 0.010 0.082 0.102 0.142 Urban 0.208 0.014 0,339 0.015 0.385 0.131 0.016 0.122 0.099 0,163 Rural 0.106 0.011 0.205 0.012 0.258 0.099 0.014 0.141 0.071 0.127 Central 0.093 0.023 0.178 0.041 0.273 0.085 0.041 0.482 0,003 0.167 Copperbelt 0.190 0.016 0.299 0.020 0.415 0.109 0.020 0.183 0.069 0.149 Eastern 0.098 0.027 0.223 0.024 0.548 0.125 0.024 0.192 0.077 0.173 Luapula 0.067 0.025 0.109 0.031 0.678 0.042 0.023 0.548 -0.004 0.088 Lusaka 0.238 0.025 0.355 0.026 0.375 0.117 0.029 0.248 0,059 0.175 Northern 0.209 0 033 0,374 0.031 0.009 0.165 0 045 0.273 0.075 0,255 North-Western 0.095 0.019 0.406 0.035 0,423 0.311 0.032 0.103 0,247 0.375 Southern 0.085 0.018 0.223 0.024 0.731 0.138 0.016 0.t16 0.106 0.170 Western 0.184 0.015 0.178 0.022 -0.009 -0.006 0.027 -4.500 -0,060 0.048 Currently using a modern method Total 0.087 0.007 0.169 0.008 0.513 0.082 0.007 0.085 0.068 0.096 Urban 0.151 0.013 0.245 0.012 0.380 0.094 0.014 0.149 0.066 0 122 Rural 0,032 0.005 0.087 0.011 0.279 0.055 0.011 0.200 0.033 0.077 Central 0.068 0.017 0.150 0.039 0.269 0.082 0.038 0,463 0006 0.158 Copperbelt 0.133 0,019 0.205 0.017 0.489 0,072 0.018 0.250 0.036 0.108 Eastern 0.047 0.013 0.121 0.021 0.437 0.074 0.019 0.257 0036 0,112 Luapula 0.034 0.020 0.064 0.023 0.880 0.030 0.011 0.367 0.008 0052 Lusaka 0,173 0.021 0.273 0.020 0.329 0.100 0.024 0.240 0.052 0.148 Northern 0.038 0.019 0.115 0.024 0.262 0,077 0.026 0.338 0.025 0 129 North-Western 0,059 0,016 0.116 0.020 0.387 0.057 0.020 0.351 0.017 0,097 Southern 0.043 0.011 0.108 0.018 0.683 0,065 0.013 0.200 0.039 0.091 Western 0,029 0.015 0.074 0.018 0.297 0,045 0.020 0,444 0.005 0,085 Note: Values in this table will differ from those in the 1992 and 1996 ZDHS reports because they are based only on the 213 clusters common to both surveys, 193 APPENDIX C DATA QUALITY TABLES APPENDIX C DATA QUALITY TABLES The purpose of this Appendix is to provide the data user with a view of the general quality of the ZDHS data. The tables in this appendix refer to possible non-sampling errors: digit preference, rounding or heaping on certain ages or dates; omission of events occurring further in the past; deliberate distortion of information by some interviewers in an attempt to lighten their workloads; non-cooperation of the respondent in providing information or refusal to be measured and weighed, etc. A description of the magnitude of such non-sampling errors is provided in the following paragraphs. The distribution of the de facto household population by single year of age is presented in Table C. 1. The data show very little preference to report ages that end in zeros and fives (age "heaping" or digit preference) that is commonly found in countries where ages are not known well. There is some evidence of irregularities in the age distribution. However, it is difficult to find any pattern to these results and they may be due to random errors. There is some evidence that interviewers "displaced" women age 15 and 49 years and men age 15 and 59 years outside of the eligible age range (15-49) and (15-59) respectively, presumably in order to avoid the need to interview them. For example, the number of women and men age 15 is substantially lower than the number age 16, 14 and 13. For women, the number reported at age 14 (572) is more than that reported at age 13 (485) and 178 more than that at age 15 (394). At the other end of the range, the number of women age 49 is lower than the number age 50. The number of men age 59 is also lower than the number age 60, implying that interviewers assigned an age of 50 (or 51) and 60 (or 61) to women and men respectively, in order to avoid interviewing them. A comparative study of DHS surveys noted some severe displacement out of the eligible age range (Rutstein and Bicego, 1990). Differential rates of response by age for female and male respondents are also shown in Table C.2. The data do not indicate any strong pattern of response rates by age. The five-year age distribution of respondents is as expected, namely that the percentage of respondents decreases with age. Information on the completeness of reporting selected important variables is provided in Table C.3. Overall, the percentage of cases with missing information is extraordinarily low. Month of birth was missing for one percent of births that occurred in the 15 years before the survey and remarkably, both month and year were recorded for all the cases. Age at death was missing for an infinitesimal proportion of non-surviving births. Only for the size of child at birth and the anthropometric measurements are there sizeable proportions for which data are missing. While about 10 percent of births in the last 59 months have missing information on size at birth, 8 percent of children under five were not measured. The missing information on the size of the child at birth could be attributed to the child not having been weighed at birth or interviewer negligence. The computer programs have treated the "don't know" and "not stated" as missing information. The main reason for not measuring children was that the child was not present, either because he/she did not live with the mother or because he/she was not at home. Very few mothers refused to let their children be measured. According to Table C.4, the information on birth dating is of good quality: both month and year of birth were provided for 98 percent of all births and for 99 percent of surviving children. As expected, information on birth dates is more complete for children who were still living at the time of the survey than for those who had died. Still, both month and year of birth were provided for 97 percent of dead children. Sex ratios are somewhat on the low side; the expected value would be 102 to 103, while those from the ZDHS are often less than 100. This indicates some possible undercounting of male births. 197 There is very little evidence of transference of births out of 1991 to earlier years. In fact, the ratio of births in 1991 to the average of the two adjoining years is 94 which shows fewer births in 1991 than the average births of the two adjoining years. Measurement of childhood deaths through retrospective household surveys often suffers from underreporting of deaths, in particular those deaths which occur very early in infancy. If early neonatal deaths are selectively underreported, the result would be an abnormally low ratio of deaths under seven days to all neonatal deaths and an abnormally low ratio of neonatal to infant mortality. Changes in these ratios over time can be examined to detect the hypothesis that underreporting of early infant deaths is more common for births that occurred longer before the survey. Table C.5 shows the distribution of deaths under one month of age by age at death in days, while Table C.6 shows the distribution of deaths under two years of age by age at death in months. The data suggest that early infant deaths have not been severely underreported in the ZDHS, since the percentage of neonatal deaths occurring in the first 6 days (next-to-last row in Table C.5) and the percentage of infant deaths occurring during the neonatal period (next-to-last row in Table C.6) are reasonable. The former proportions increase over time, implying that some early infant deaths were not reported in the earlier periods; however, much, if not all, of this pattern can be attributed to heaping on 7 days at death, which is more severe for the earlier periods. 198 Table C.I Household a~e distribution Single-year age distribution of the de facto household population by sex (weighted), Zambia 1996 Males Females Males Females Age Number Percent Number Percent Age Number Percent Number Percent <1 741 4.0 712 3.7 0.8 132 0.7 I 658 3.5 719 3.7 1.0 184 0.9 2 654 3.5 678 3.5 0.8 157 0.8 3 607 3.3 665 3.4 0.8 148 0.8 4 627 3.4 618 3.2 0.5 104 0.5 5 560 3.0 590 3.0 0.7 135 0.7 6 661 3.6 683 3.5 0.6 114 0.6 7 574 3.1 544 2.8 0.5 108 0 6 8 589 3.2 544 2.8 0.4 81 0,4 9 559 3.0 574 3.0 0.6 99 0,5 10 584 3.1 630 3.2 0.4 I10 0 6 11 483 2.6 489 2.5 0.5 122 0,6 12 562 3.0 585 3.0 0.5 108 0 6 13 495 2.7 485 2.5 0.4 121 0.6 14 577 3.1 572 2.9 0.3 IOl 0.5 15 409 2.2 394 2.0 0.4 114 0.6 16 435 2.3 470 2.4 0.3 94 0.5 17 400 2.2 400 2.1 0.6 121 0.6 18 420 2.3 461 2.4 0.3 72 0.4 19 381 2.1 405 2.1 0.4 117 0.6 20 422 2.3 455 2.3 0.3 78 0.4 21 331 1.8 373 1.9 0.3 109 0.6 22 340 1.8 353 1.8 0.3 63 0.3 23 310 1.7 387 2.0 0.4 75 0.4 24 337 1.8 399 2.1 0.4 58 0.3 25 244 1.3 275 1.4 0.3 57 0.3 26 301 1.6 308 1.6 0.3 56 0.3 27 263 1.4 273 1.4 0.5 66 0,3 28 336 1.8 334 1.7 0.3 42 0 2 29 185 l.O 185 1.0 0.2 56 0.3 30 223 1.2 247 1.3 0.2 41 0.2 31 174 0.9 246 1.3 0.3 59 0.3 32 287 1.5 274 1.4 0.2 37 0.2 33 189 1.0 182 0.9 1.8 217 1.1 34 199 1.1 207 1.1 0.0 1 0 0 35 162 0.9 154 0 8 36 192 1.0 185 1 0 37 157 38 192 39 143 40 155 41 88 42 123 43 118 44 I00 45 76 46 104 47 77 48 92 49 89 50 72 51 64 52 70 53 58 54 105 55 56 56 72 57 57 58 59 59 63 60 77 61 70 62 47 63 54 64 97 65 57 66 45 67 36 68 56 69 46 70+ 327 Don'tknow/ 1 missing Total 18,575 100.0 19,407 100 0 Note: The de facto population includes all residents and nonresidents who slept in the household the night before the lntervtew. 199 Table C.2 A~e distribution of eligible and interviewed women and men Percent distribution of the de facto household population of women age 10-54 and men age 10-69, five-year age distribution of interviewed women age 15-49 and men age 15-59, and the percentage of eligible women and men who were interviewed (weighted) by five-year age groups, Zambia 1996 Household population Persons interviewed Age Number Percent Number Percent Percent interviewed (weighted) WOMEN 10-14 2,761 NA NA NA NA 15-19 2,129 24.9 2,043 24.7 95.9 20-24 1,967 23.0 1,902 23.0 96.7 25-29 1,375 16.1 1,333 16.1 96.9 30-34 1,156 13.5 1,127 13.6 97.5 35-39 811 9.5 781 9.4 96.2 40-44 609 7.1 583 7.0 95.7 45-49 520 6.1 506 6.1 97.3 50-54 549 NA NA NA NA 15-49 8,568 100.0 8,274 100.0 96.6 MEN 10-14 721 NA NA NA NA 15-19 522 24.3 479 24.8 91.8 20-24 459 21.3 417 21.6 90.8 25-29 316 14.7 274 14.2 86.6 30-34 267 12.4 235 12.2 87.9 35-39 208 9.7 189 9.8 91.1 40-44 147 6.8 130 6.7 88.1 45-49 95 4.4 84 4,3 87.9 50-54 77 3.6 67 3.5 87.8 55-59 60 2.8 56 2.9 93.5 60-64 107 NA NA NA NA 65+ 79 NA NA NA NA 15-59 2,152 100.0 1,932 100,0 89.8 Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. NA -- Not applicable 200 Table C.3 Comoleteness of reoortine Percentage of observations missing information for selected demographic and health questions (weighted), Zambia 1996 Percentage Number missing of Subject Reference group information cases Birth date Births in last 15 years Month only 1.02 17,535 Month and year 0.00 17,535 Age at death 0.19 3,076 Age/date at first union I 0.49 5,989 Respondent's education 0,02 8,021 Child's size at birth 9.53 3,396 Anthropometry 2 Height missing 7.94 6,109 Weight missing 7.35 6,109 Height or weight missing 8,05 6,109 Diarrhoea in last 2 weeks Deaths to births in last 15 years Ever-married women All women Births in last 35 months Living children age 0-35 months Living children age 0-35 months 3.55 6,109 I Both year and age missing 2 Child not measured 201 Table C.4 Births by calendar years Distribution of births by calendar years for living (L), dead (D), and all (T) children, according to reporting completeness, sex ratio at birth, and ratio of births by calendar year, Zambia 1996 Percentage with Sex ratio Number of bmhs complete bmh date t at birth 2 Calendar rauo 3 Male Fem~de Year L D T L D T L D T L D T L D T L D T 96 1.242 241 1.483 99.5 97.7 99.2 93.5 93.2 93.5 NA NA NA 600 116 716 642 125 766 95 1.172 247 1,419 99.7 97.5 99.3 849 110.4 88.9 99.2 96,0 98.6 538 130 668 634 117 751 94 1.121 274 1,395 99.3 98.2 99.1 101 7 124.7 105 8 105.6 123.5 10g 7 565 152 717 556 122 678 93 951 197 1,148 99.7 96.0 99.0 89 1 87.2 88.8 85.6 66.6 816 448 92 540 503 105 608 92 1.100 317 1,417 99.1 98.3 98.9 928 110.3 96.5 117.3 144.5 122.5 530 166 696 571 151 721 91 925 242 1,167 99.2 95.0 98.3 927 124.2 98 5 944 92.8 94.0 445 134 579 480 108 588 90 861 204 1.065 98.6 97.5 98.4 101.5 77.9 96.5 963 94.7 960 434 89 523 427 115 542 89 863 189 1,052 98.8 98.8 98.8 97.4 122.2 101.4 102.2 88.8 995 426 104 530 437 85 522 88 827 222 1,049 99.0 97.7 98.8 104.3 118.8 107.2 100,1 116,5 103.2 422 120 543 405 101 506 87 789 192 980 98.6 97.3 98.3 94.9 122 7 99.8 NA NA NA 384 106 490 405 86 491 92-96 5,586 1.276 6,862 99.5 97.6 99.1 92.3 105.8 94.7 NA NA NA 2.681 656 3,337 2.905 620 3.525 87-91 4,265 1.048 5,313 989 972 98.5 98.0 111.8 100.6 NA NA NA2,111 553 2,664 2.154 495 2,649 82-86 3.299 744 4,043 98.9 95.9 98.3 96.7 101.2 97.5 NA NA NA 1,622 374 1,996 1,677 370 2.047 77-81 2,286 567 2.853 98.2 94.8 97.5 1036 119.8 106.6 NA NA NA 1,163 309 1.472 1.123 258 1.381 <77 1.940 704 2,644 98.3 957 97.6 1129 107.2 1114 NA NA NAI.029 364 1,393 911 340 1.251 All 17,375 4,339 21.715 98.9 96.5 98.4 98.1 108.4 100.1 NA NA NA 8,606 2,257 10,863 8,769 2,(183 10.852 NA =- Not apphcable t Both year and month of birth given 2 * (BtJB I) 100. wbereBn~andBfarethenumbersofmaleandfemalebtrths, respectwely 3 [2Bx/(B~.j+Bx.t)]. 100, where B x is the number of births xn calendar year x 202 Table C.5 Renortin~ ofa~e at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five.year periods preceding the survey, Zambia 1996 Number of years preceding the survey Age at death Total (in days) 0-4 5-9 10-14 15-19 0-19 <1 54 43 42 21 159 1 38 33 15 14 100 2 23 18 10 17 69 3 22 16 17 5 60 4 7 11 7 4 28 5 8 6 5 1 20 6 5 3 1 1 11 7 29 33 30 27 119 8 2 1 3 0 6 9 2 1 1 3 6 10 6 2 0 2 9 11 1 0 0 0 1 12 2 3 1 0 6 13 0 0 1 0 1 14 36 29 21 15 102 15 0 0 1 0 1 16 0 1 0 0 1 17 0 0 1 0 1 18 0 2 0 0 2 19 1 0 0 0 1 20 0 3 1 1 5 21 10 11 i1 8 40 23 1 0 0 0 1 25 0 1 0 0 1 26 0 1 0 0 1 28 1 3 0 1 4 30 2 0 5 1 9 Total 0-30 249 219 174 122 765 Percent early neonatal I 62.8 59.1 56.4 51.8 58.5 l (0-6 days/0-30 days) * 100 203 Table C.6 Renortine ofaee at death m months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at ages under one month, for five-year periods preceding the survey, Zambia 1996 Number of years preceding the survey Age at death Total (in months) 0-4 5-9 10-14 15-19 0-19 <1 a 251 219 174 123 767 1 52 37 32 21 141 2 39 40 31 18 128 3 65 34 20 21 140 4 51 47 27 12 136 5 33 28 18 14 93 6 38 52 39 29 158 7 40 33 13 12 97 8 45 36 40 17 138 9 43 45 20 16 125 10 24 31 7 I1 72 11 33 24 10 4 71 12 41 46 35 21 143 13 12 9 16 3 40 14 16 13 9 6 44 15 17 12 6 5 41 16 16 13 8 4 41 17 8 8 5 2 23 18 22 33 17 19 91 19 II I1 I1 2 36 20 14 14 I1 4 43 21 9 6 6 3 25 22 8 6 4 0 18 23 3 5 5 I 14 24+ 4 3 1 I 10 1 year 50 59 32 38 179 Total 0-11 713 626 430 296 2,065 Percent neonatal b 35.2 35.0 40.5 41.4 37. I a Includes deaths under 1 month reposed in days b (Under 1 month/under 1 year) * 100 204 APPENDIX D PERSONS INVOLVED IN THE ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY APPENDIX D PERSONS INVOLVED IN THE 1996 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY David Diangamo (Director of Census and Statistics) Sam Nyaywa (Chairman, National Health Surveys Management Committee) Emmanuel Silanda (Assistant Director of Census and Statistics) Survey Director Kumbutso Dzekedzeke Assistant Director Margaret Tembo Trainers Kumbutso Dzekedzeke Record Malungo Sikwanda Makono Chipo Sikazwe Wingrey Michelo Augustus Kapungwe Wendy Kalunde Dorothy Namuchimba Guest Lecturer Mwape Lubilo Sampler Batista Chilopa Data Processing Staff Samantha Mulendema George Namasiku Makoselo C. Bowa Norrias Chisamu Kelvin Katungu Jayne Mundia Evans Mwiya Palo Mutale Winter Njapau Boniface Haachongo Shyton Sakala Office Editors Margaret Tembo Elijah Malumo Ivy Dimuna Mukatimui Sifuniso Typists Webster Chileshe Makoselo C. Bowa Anthony Nkelo Data Collection Teams Central Province Supervisor: Alfred M. Kaili Field Editor: Beatrice Shankanga Interviewers: Richard Siakanede Edith Mpukani Majorie K. Chishimba Agatha Chinyimba Caren Wamundila Copperbelt Province I Supervisor: Dick Chitansha Field Editor: Mary N. Benkeni Interviewers: Mike M. Yambwa Charity Banda Nellie Chibamba Melody Kunda Angelina Chipemba Copperbelt Province II Supervisor: Mary C. Mkandawire Field Editor: Batista Chilopa Interviewers: Edward Phiri Annie Nakambale Tasila Mushanga Beatrice L. Nakaanda Juness Kunda 207 Eastern Province Supervisor: Ackim S. Tembo Field Editor: Agnes Zimba Interviewers: Dick M. Phiri Joy C. Mbewe Eneles B. Lukhelo Grace Banda Rosaria Longwa Luapula Province Supervisor: Patrick M. Chewe Field Editor: Miniver Mungolo Interviewers: Webster Malama Annie Kaoma Dorothy L. Machimu Justina M. N. Katebe Victoria C. Chilalika Lusaka Province I Supervisor: Mushota Kabaso Field Editor: Mambwe Nakamba Interviewers: Moses S. Nyirenda Grace Lipalile Margaret Hamayuwa Dorothy Tembo Gwen Mutemwakwenda Lusaka Province II Supervisor: Mary S. Tembo Field Editor: Milika Nyirenda Interviewers: Anderson Ngoma Rosario Ngoma Christine Chuzu Njavwa Nakamba Mary Njovu Boniface Haachongo Northern Province Supervisor: Bupe Musonda Field Editor: Mirriam Nakufa Interviewers: Geofrey Nsama Annie Mhlanga Mercy Nachande Lucy Nachilima Mildred C. Zimba North-Western Province Supervisor: Abiun K. Machona Field Editor: Mary Fweka Interviewers: Justine K. Makasa Riza Sweta Annie Maseka Dorothy Matondo Catherine M.Sakapondi Southern Province Supervisor: Webster Chileshe Field Editor: Agnes Simoonga Interviewers: Steadwell Mulambo Nellie Muchimba Cotridah H. Lweendo Rosemary Chibbonta Dorothy Chilekwa Western Province Supervisor: Joseph N. Sitali Field Editor: Cecilia Kalaluka Interviewers: Chipalo Kaliki Munalula Ilukena Macubeni Mubuyaeta Charity Mutti Harriet K. Kalimukwa Martha B. Mapanza 208 APPENDIX E QUESTIONNAIRE 1996 ZAMBIA DEHOGRAPHIC AND HEALTH SURVEY HOUSEHOLD QUESTIONNAIRE IDENTIFICATION CLUSTER NUHBER . PROVINCE DISTRICT HOUSEHOLD NUMBER . NAME OF HOUSEHOLD HEAD URBAN/RURAL (urban=l, rura[=2) . LUSAKA/OTHER CITY/TOWN/VILLAGE . (Lusaka=l, Other city=2, Town=3, Village=4) HOUSEHOLD SELECTED FOR MEN'S SURVEY? (YES=l, NO=2) . r-1 INTERVIEWER VISITS 1 2 ] FINAL VISIT 'DATE IHTERVIEWERIS NAME RESULT = NEXT VISIT: DATE TIME DAY MONTH YEAR NAHE RESULT TOTAL NUMBER OFVISITS I I *RESULT COOES: 1COHPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COHPETENT RESPONDENT AT HOME AT TIRE OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERICO 4 POSTPONED 5 REFUSED 6 DWELLING VACANT OR ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 D~ELLING NOT FOUND 9 OTHER (SPECIFY) LANGUAGE OF QUESTIONNAIRE: ENGLISH SUPERVISOR NAME ~ NAME DATE DATE FIELD EDITOR [-1-1 TOTAL IN ~ - ~ HOUSEHOLD TOTAL ELIG. ~[~IEN ~ - ~ TOTAL ELIG. MEN LINE NUMBER ~ - ~ OF RESP, TO HOUSE- HOLD SCHEDULE OFFICE KEYED EDITOR BY r-N HEN1 211 t~ t~ HDUSEHOLD SCHEDULE No~ we would Like some information about the people who usually Live in your household or who are staying with you now. PLease give me the What is names of the the persons Hho relation o usually Live ship of in ~r household (NAME) to and guests the heed of the household of the ~a~o stayed household? here Last night, starting with the head of the household. (I) 01 (2) I RESIDENCE J SEX J AGE EDUCATION HARITAL STATUS • IF AGE 6 YEARS OR OLDER IF AGE • ,12 YEARS , Does Did Is Hcea old Has IF ATTENDED SCHOOL ~ OLDER Is INANE) (NAME) :NAME) is -(NAME) (NAHE)'s usuatt stay mate (NAME)? ever I/nat is the IF AGE Is (NAME) natural live here or been highest LESS ~arried, mother here? last female? to [eve[ of THAN living alive? night? school? school 25 !together, (NAME) YEARS ~separated attended? - - divorced, or over ~£nat is the ~arried? highest IS *** grade (NAME) (NAME) still completed in at that school? Level?** (3) (4) (5) (6) (7) (8) (9) (10) (11) m m m m I m m YES NO YES NO M F IN YEARS YES NO LEVEL GRADE YES NO K7 2 212[~,2@~312E] 02 T] 2 2 ,2N- ]12S IT l12 N 03 -~ 2 2 12[~12 El~-~12 B 04 T1 2 212N312Df fN12 D 05 2 2 12~ 3 12 D~ 12 D 06 -~ 2 2 12 ; -~12D~12 D 1,2 121121 112 PARENTAL SURVIVORSHIP AND RESIDENCE J ELIGI" ELIGI" FOR PERSONS LESS THAN 15 YEARS OLD**** 1 BILITY" BILITY 1~OI4EN (12) YES NO DK 1 2 8 iF ALIVE Does (NAHE)Js natural mother live in this household?. IF YES: What is her name? RECORD MOTHERIS LINE NUMBER (13) ~N I(~;~E)'s natural father alive? (14) YES NO DE 2 8 I.IF ALIVE , CIRCLE CIRCLE LINE LINE Does I NUHBER NUMBER ( NAME)ms I;OF ALL OF ALL natural i ~JOMEN MEN father AGE AGE Live in 15-49 15-59 this (IF household? HOUSE- [F YES: HOLD What is FALLS his name? IN RECORD MEN'S FATHER'S SM4- L%RE PLE). NUMBER (15) (16) (16A) 128~ 28~ 12sN~ 28~ 12s~ 28~ 12s~ 2s~ 128~ 28~ 128 a8J 01 01 02 02 03 03 04 04 05 05 06 06 HEN2 EDUCATION (9) LEVEL GRADE [-1 El-- YES NO PARENTAL SURVIVORSHIP AND RESIDENCE (13) YES NO DK 1 2 8 1 2 8 ~--~ 1 2 8 1 2 8 M 1 2 8 M (14) (15) YES NO DK 1 2 8 1 2 8 1 2 8 ~--~ 1 2 8 ~'~ 1 2 8 ~-~ 1 2 8 ~-~ 08 08 09 09 10 10 11 11 12 12 13 13 TICK HERE IF DONTINLIATION SHEET USED [] Just to make sure that I have a complete Listing: 1) Are there any other persons such as small children or infants that we have not Listed?. 2) In addition, are there any other people who may not be members of y~r family, such as domestic servants, lodgers or friends who usually Live here? 3) Are there any guests or temporary visitors staying here, or anyone else who slept here last night that have not been Listed? ** COOES FOR G.9 EDUCATION LEVEL: 09 = OD-MIFE 1 = PRIMARY 10 = OTHER RELATIVE 2 = SECONOARY 11 = ADOPTED~FOSTER~ 3 = HIGHER STEP CHILD 8 : DOR'T KNOW 12 = NOT RELATED 98 = DON'T KXOM EDUCATION GRADE: 00 : LESS THAN 1 YEAR CORPLETED CODES FOR 0.3 RELATIONSHIP TO HE.4~ OF HOUSEHOLD: 01 : HEAD 05 = GRANDCHILD 02 = WIFE OR HUSBANO 06 = PARENT 03 = SON OR DAUGHTER 07 = PARENT-IN-LAW 06 = SCN-IN-LAWOR 08= BROTHER OR SISTER D~RTER* IN-~W YES ~-~ r ENTER EACH IN TABLE NO YES ~-~ r ENTER EACH IN TABLE NO YES r~ *** CI])ES FOR Q.11 MARITAL STATUS 1 : MARRIED 2 = LIVING TDGBTHER 3 = SEPARATED 4 = DIVORCED 5 = ~IDOt~D 6 = NEVER MARRIED '~ ENTER EACH IN TABLE NO **** Q.12 THROUGH G.14: These questions refer to the biological parents of the child. Record BO if parent not member of household. HEN3 E3 I-7 NO. QUESTIONS AND FILTERS 17 What is the main source of drinking water for members of your household? COOING CATEGORIES PIPED WATER PIPED INTO HO~4E OR PLOT . 11 PUBLIC TAP . 12 WELL WATER WELL IN RESIDENCE/YARD/PLOT.21 PUBLIC SHALLOW WELL . 22 PUBLIC TRADITIONAL WELL . 23 PUBLIC BOHEHOLE . 24 SURFACE WATER SPRING . 31 RIVER/STREAM . 32 POND/LAKE . 33 RAINWATER . 41 TANKER TRUCK . 51 BOTTLED WATER . 61 OTHER 96 (SPECIFY) a~ come back? HINUTES . ON PRENISES . . . . . . . . . . . . . . . . . . . 996 19 ~at ki~ of toilet facility does your household have? I GO TO I -----~19 I ~19 ,19 I ~19 I FLUSH TOILET OWN FLUSH TOILET . 11 SHARED FLUSH TOILET . 12 PIT TOLLET/LATRIHE TRADITIONAL PIT TOILET . 21 VENTILATED IHPROVED PIT (VIP) LATRINE . 22 NO FACILITY/BUSH/FIELD . 31 OTHER 96 (SPECIFY) 20 Does your household have: Electricity? I A radio? | A television? I A refrigerator? I YES NO ] ELECTRICITY . 1 2 RADIO . 1 2 TELEVISION . 1 2 REFRIGERATOR . 1 2 21 22 How many rooms in your household are used for steeping? MAIN 14ATERIAL OF THE FLOOR. RECORD OBSERVATION. 23 l Does any member of your household own: I A bicycle? A motorcycle? A car? RO S. . . . . . . . . . . . . . . . NATURAL FLOOR EARTH/SAND/MUD . 11 RUDINENTARY FLOOR WOOD PLANKS/BOARDS . 21 FINISHED FLOOR ~(X~OEN TILE . 31 CERAMIC/TERRAZO/ MARBLE TILE . 32 CEHENT/CONCRETE . 3] OTHER 96 (SPECIFY) YES NO BICYCLE . 1 2 NOTORCYCLE . I 2 CAR . 1 2 24 I We wouLd Like to check whether the salt used in your household is iodized. Nay we see a sample of the salt used to cook meal eaten by members of your household Last night? IOOIZED . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NOT IOOIZED . . . . . . . . . . . . . . . . . . . . . 2 / NOT TESTED . 3 KIND. NO SALT AT HOHE . 4 JORE. I 25 I RECORD IQOATE SCORE 214 0 . 01 25 . 02 50 . 03 75 . 04 100+ . 05 HEN4 1996 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY QUESTIONNAIRE FOR INDIVIDUAL WOHEN IDENTIFICATION CLUSTER NUMBER . PROVINCE DISTRICT HOUSEHOLD NUMBER . NAME OF HOUSEHOLD HEAD URBAN/RURAL (urban=l, ruraL=2) . LUEAKA/OTHER CITY/TO~/N/VILLAGE . (Lusaka=l, Other city=2, Town=3, Vittage=6) NAME AND LINE NUMBER OF ~/OMAN INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE INTERVIEgER~S NAME RESULT* NEXT VISIT: DATE TIME oAY MONTH YEAR NAME RESULT TOTAL NO, OF VISITS [---1 *RESULT CODES: 1 COMPLETED 4 REFUSED 2 NOT AT HONE 5 PARTLY COMPLETED 3 POSTPONED 6 INCAPACITATED 7 OTHER (SPECIFY) LANGUAGE OF QUESTIONNAIRE** ENGLISH LANGUAGE USED IN IMTERVIEW** . RESPOMDENT'S LOCAL LANGUAGE** . TRANSLATOR USED (1=NOT AT ALL; 2=SOHETIHE; 3=ALL THE TIME),, **LANGUAGE COOES: 01 ENGLISH 02 BENBA SUPERVISOR NAME DATE ~ ] 03 EAONDE 05 LUNDA 07 NYANJA 09 OTHER 04 LOZI 06 LUVALE 08 TONGA KEYED BY g EN 1 215 SECTION 1. RESPOHDENT'S BACKGROUND NO. I QUESTIONS AND FILTERS I COOING CATEGORIES I GO TO 102 RECORD THE TIME. J First I would like to ask some questions about I you and your household. For most of the time until you [ | were 12 years old, did you live in e city, in a town, J or tn a vii(age? LUSAKA . I m OTHER CITY . . . . . . . . . . . . . . . . . . . . . . 2 I TOWN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 V ILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . 4 in (N~E OF CURRENT PLACE OF RESIDENCE)? YEARS . ALWAYS . 95 VISITOR . 96 ~105 Ina town, or in a village? OTHER CITY . 2 TOUN . 3 VILLAGE . 4 105 In Met ~nth and year were you ~nn? MONTH . III DON'T KH~ MONTH . 98 YEAR . ~ DOH~T KN~ YEAR . 98 AGE IN C~PLETED YEARS . C~PARE AND CORRECT lOS AND/OR 106 IF INCONSISTENT. lot I Rave you ever attend~ school? I YES . 1 I I I NO . 2----w114 primery, secondary, or higher? SECONDARY . 2 HIGHER . 3 YEARS . COGENT OR ABlE [~ ~113 111 I Are you currently ettending school? IYES . I ~113 NO . 2 I 112 What ~as the mefn reason you stopped attending school? GOT PREGNANT . 01 GOT MARRIED . 02 TO CARE FOR YOUNGER CHILDREN.O3 FAHILY NEEDED HELP ON FARfl OR IN BUSINESS . 04 COULD NOT PAY SCHOOL FEES . 05 NEEDED TO EARN HONEY . 06 GRADUATED/HAD ENOUGH SCHOOLING.D7 DID NOT PASS ENTRANCE EXAJ4S.OB DID NOT LiKE SCHOOL . 09 SCHOOL NOT ACCESSIBLE/TOO FAR.IO OTHER 96 (SPECIFY) DONJT KNOW . 98 WEN2 216 114 I Can you read end understand a letter or newspaper easily, with difficulty, or not at all? I EASILY . 1 I WITH DIFFICULTY . 2 NOT AT ALL . 3 ~116 115 Now often do you usually read a newspaper or magazine? Would you say every day, every other day, at Least once a week, at Least once a month, a few times a year, or never? CIRCLE ONLY ONE ANSWER. EVERYDAY . 1 EVERY OTHER DAY . 2 AT LEAST ONCE A WEEK . 3 AT LEAST ONCE A MONTH . 4 FEb TINES A YEAR . 5 NEVER . 6 116 I How often do you usually Listen to a radio? Would you say every day, every other day, at Least once a week, at Least once e month, a few times • year, or never? CIRCLE ONLY ONE ANSWER. EVERYDAY . 1 EVERY OTHER DAY . 2 AT LEAST ONCE A WEEK . 3 AT LEAST ONCE A MONTH . 4 FEW TIMES A YEAR . 5 NEVER . 6 117 I How often do you usually watch television? Would you say every day, every other day, at Least once a week, at Least once e month, e few times e year, or never? CIRCLE ONLY ONE ANSWER. EVERYDAY . 1 EVERY OTHER DAY . 2 AT LEAST ONCE A WEEK . 3 AT LEAST ONCE A MONTH . 4 FEW TIMES A YEAR . 5 NEVER . 6 118 J What religion are you? CATHOLIC . 1 PROTESTANT . 2 NUSLIN . 3 OTHER 4 (SPECIFY) 119 What tribe do you belong to? CHECK COLUHN (8) INTERVIEWER'S ASSIGNHENT SHEET THE ~IAN INTERVIEWED THE ~I4AN INTERVIEWED IS NOT A USUAL IS A USUAL RESIDENT [~ RESIDENT ~1 ~201 121 Now l would Like to ask about the place in which you usually Live. What is the name of the place in which you usually Live? (NAME OF PLACE) Is that a city, town, or village? LUSAKA . 1 OTHER CITY . 2 TOIJN . 3 VILLAGE . 4 122 In which province is that Located? CENTRAL . 01 COPPERBELT . 02 EASTERN . 03 LUAPULA . 04 LUSAKA . 05 NORTHERN . 06 NORTH-gESTERN . 07 SOUTHERN . 08 WESTERN . 09 OUTSIDE ZANBIA . . . . . . . . . . . . . . . . . 10 WEN 3 217 NO. QUESTIONS AND FILTERS 12] Now I would Like to ask about the household in which you usually Live. What is the main source of drinking water for me~floers of your household? COOING CATEGORIES PIPED WATER PIPED INTO HOME/PLOT . 11 PUBLIC TAP . 12 WELL WATER WELL IN RESIDENCE/YARD/PLOT.21 PUBLIC SHALLOW WELL . 22 PUBLIC TRADITIONAL WELL . 23 PUBLIC BOREHOLE . 24 SURFACE WATER SPRING . 31 RIVER/STREAM . 32 POND/LAKE . 33 RAINWATER . 41 TANKER TRUCK . 51 BOTTLED WATER . 61 OTHER 96 (SPECIFY) and come back? MINUTES . ON PREMISES . 996 125 What kind of toilet facility does your household have? I GO TO I r125 I r125 ,~125 I 125 I FLUSH TOILET OWN FLUSH TOILET . 11 SHARED FLUSH TOILET . 12 PIT TOILET/LATRINE TRADITIONAL PIT TOILET . 21 VENTILATED IMPROVED PIT (VIP) LATRINE . 22 NO FACILITY/BUSH/FIELD . 31 OTHER 96 (SPECIFY) 126 Does your household have: YES NO Etectrtcity? ELECTRICITY . 1 2 A radio? RADIO . 1 2 A television? TELEVISION . 1 2 A refrigerator? REFRIGERATOR . 1 2 are use<] for sleeping? ROOMS . 128 Could you describe the main material of the floor of your home? NATURAL FLOOR EARTH/SAND/MUD . 11 RUDIMENTARY FLOOR ~3(X) PLANKS/BOARDS . 21 FINISHED FLOOR ~OOEN TILE . 31 CERAHIC/TERRAZO/ MARBLE TILE . 32 CEMENT/CONCRETE . 33 OTHER 96 (SPECIFY) 129 I Does any~-q~ber of your household own: A bicycle? A motorcycle? A ear? YES NO BICYCLE . 1 2 MOTORCYCLE . 1 2 CAR . 1 2 WEN 218 SECTION 21 REPROOUCTION NO. I QUESTIONS AND FILTERS I COOING CATEGORIES Ioo TO I Now I would Like to ask about a l l the births you have I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I | I ~206 NO . 2 201 J had during your Life. Have you ever given birth? I I 202 I Do you have any sons or daughters to whom you have given birth who are now living with you? I YES . 1 m NO . 2 =204 I I 2031 Now many sons live with you? I And how many daughters Live with you? IF NONE, RECORD JO0 ~. 204 I Oo y~ have any sons or daughters to wh~ y~ have given birth who are alive but do not live with you? I YES . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 =206 I 205 I HOW many sons are alive bat do not Live ~ith you? I I And how many daughters are alive but do not live with you? IF NONE, RECORD I00~. SONS ELSEWHERE . JJJ OAUGHTERS ELSEWHERE . L ~ 206 Have you ever given birth to a bay or a girl who was barn alive bat later died? IF NO, PROBE: Any baby who cried or showed signs of life bat survived only a few hours or days? YES . 1 J NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ;208 I 207 Row many bays have died? And how many girls have died? IF NONE, RECORD 'OO'. SUH ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. I T°TAL . . . . . . . . . . . . . . . . . . . . . . 209 CHECK 208: Just to make sure that I have this right: you have had in total births during your Life. Is that correct? PROBE AND YES ~ NO ~'~ ~ CORRECT 201-208 AS NECESSARY. NO BIRTHS [--] j~227 I WEN 5 219 211 Now I woutd like to record the names of all your births, whether still alive or not. starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 212 What n~ was given to your (f i rst/next) baby~ (NN4E) o, I o, I o, I o~ 213 216 Were Is any of (NN4E) these a boy births or a twins? girt? SING.1 BOY.1 MULT.2 GIRL.2 SING.1 BOY.1 I'~JLT.2 GIRL,,2 SING.11 BOY.1 MULT.2 I GIRL.2 SING.11 BOY.1 HULT.2 I GIRL.2 SING.11 BOY.1 I~JLT.21 GIRL.2 SING.1 BOY.1 MULT.,2 GIRL.2 SING,.1 BOY.1 NULT.2 GIRL,.2 215 In what month and year was (N~E) born? PROBE: What is his/ her birthday? OR: In what $essoR WaS he/she born? 216 Is (NAME) stiLL alive? 217 IF ALIVE: Now old was (NAHE) at his/her Last birthday? RECORD AGE IN COMPLETED YEARS. YES., ,~ER~, .o.! 219 218 IF ALIVE I s (NN4E) living with you? YES,.1] Wo.211 (HB~:TTH;J[ 219 IF DEAD: HOW old WaS (NAME) when he/she died? IF '1 YR.% PROBE: HOW many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH MONTHS IF LESS THAN TWO YEARS; OR YEARS. DAYS . 1 MONTHS.2 YEARS.3 220 FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH. IS THE DIFFERENCE 6 OR MORE? MONTH.~ YEAR., YES.1 AGE IN YEARS No.! 219 YES.1 NO.2 t DAYS . 1 MONTHS.2 YEARS.,3 iii IIIIIIIILIII i i i iiii!iiii YES . 1 NO . 2 (NEXT J BIRTH) MORTN.~ YES.1RO. ~AER~H YEAR 2!g YES.1] 2:.] 220) DAYS . 1 MONTHS.2 YEARS.3 YES . 1 NO . 2 (NEXT J BIRTH) .ONTH.~ YES, y?R~R Y., ,o.i! YES.1] 220) DAYS . 1 MONTHS.2 YEARS.3 YES . 1 NO . 2 (NEXT ~J BIRTH) .ORT,.~ YES., ;~,R~" YEAR. NO. YES.1] .o21[ DAYS . 1 MONTHS.2 YEARS.3 NO . 2 ~T, . .~ YES., ~[R~, YEAR. NO . 2!9 M YES.,. 1 NO.2] DAYS . I MONTHS.,2 YEARS.3 YES . 1 NO . 2 MONTH.~ YEAR.,. YES.1 AEGER~N No.! 219 YES.1] .o211 I DAYS . 1 MONTHS.2 YEARS.] YES . 1 NO . 2 (NEXT J BIRTH) 221 Were there any other live birth., betwe( (NN4E OF PREVIOL BIRTH', and (NAME', YES.1 NO.2 YES.1 NO.2 YES.1 NO.2 YES.1 NO.2 I YES.11 NO.,.2 B YES.11 NO.2 I 220 w EN 6 212 What name was given to your next baby? (HARE) o, I 222 213 ~ere any of these births twins? SING.1 MULT.2 SING.1 HULT.2 SING.1 NULT.2 SING,.1 MULT.2 214 Is (NARE) s boy or • girt? BOY.1 GIRL.2 215 In what month and year was (NAHE) born? PROBE: What is his/ her birthday? OR: In whet season was he/she born? 216 IS (NAME) stiLl aLive? YES.1 NO.~ BOY.1 GIRL.2 217 IF ALIVE: How Did was (NAHE) st his/her test birthday? RECORD AGE IN COMPLETED YEARS. AGE IN YEARS 218 IF ALIVE Is (NN4E) living with you? 219 IF DEAD: How old was (NAME) when he/she died? IF =1 YR.', PROBE: HOW many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TiJO YEARS; OR YEARS. YES.1] DAYS . 1 N0.211 MONTHS.2 (Goa~o,J I YEARS.3 220 !21 FR(~4 ~ere YEAR OF there BIRTH any OF (NAME) other SUBTRACT live YEAR OF births PREVIOUS betwee~ BIRTH. (NAME OF IS THE )REVIOU: DIFFERENCE BIRTH) 4 OR end MORE? NAME)? YES . 1 YES.1 NO . . . . . 2 NO. .2 (NEXT q] BIRTH) MOHTR ~ YEB, ,~ER~H YEAR. NO. BOY.,.1 GIRL.2 YES.1] DAYS 1 . NO.21 I MONTHS.2 (oo2o, I YEARS 3 YES . 1 NO . 2 (NEXT 4] BIRTH) YES,,1 NO.2 YES, :~:R~N NO.! I--A 219 YES,.1] DAYS 1 . NO.211 MONTHS.2 (°02~,J I YEARS.] BOY.1 MONTH.III YES.1 AGE IN YES.11 DAYS . 1 YEARS t OIRL 2 YEAR HO! NO 20NTHB2 (o IYEARB 3 219 ~2 YES . 1 NO . 2 (NEXT J BIRTH) YES.1 NO.**2 FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH. IS THE DIFFERENCE 4 YEARS OR MORE? YES . 1 YES.1 NO . 2 NO.2 (NEXT ~] BIRTH) YES . 1 ~GO TO 223 NO . 2 ~GO TO 224 YES . 1 NO. . . . 2 223 Have you had any live births since the birth of (NAME OF LAST BIRTH)? 224 COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS E~ NUMBERS ARE ARE BAHE DIFFERENT [-~ r (PROBE AND RECONCILE) / CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR ABE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF NONTHB. B CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1991. IF NONE e RECORD =O=. D 221 WEN7 No. I QUESTIONS AND FILTERS 227 I Are you pregnant now? I I CODING CATEGORIES I GO TO I YE5 . 1 I NO . 2-- 7 UNSURE . 8 ~236 I "°''"' . . . . . . . . . . . . . . . . . . . . . 229 I At the time you became pregnant, did you went to THEN . 1 I become pregnant then, did you went to wait LATER . 2 I until later, or did you not went to NOT WANT MORE CHILDREN . 3 I have anymore children at all? 236 When did your lest menstrual period start? (DATE, IF GIVEN) DAYS AGO . 1 WEEKS AGO . 2 RONTHS AGO . 3 YEARS AGO . 4 IN NENOPAUSE . 994 BEFORE LAST B]RTH . 995 NEVER NENSTRUATED . 996 237 I Between the first day of a woman,s period ar~ the first day of her next period, are there certain times when she has a greater chance of pecoming pregnant than other times? YES . 1 | DON'TNO . . . . . . . KNO~I : : : :~ : :~:~: : : : : :~ -i ~301 I 238 During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant? DURING HER PERIO0 . 01 RIGHT AFTER HER PERIOD HAS ENDED . 02 IN THE RIDDLE OF THE CYCLE . 03 JUST BEFORE HER PERIOD BEGINS.04 OTHER 96 (SPECIFY) DON'T KNOW . 98 WEN8 222 SECTION 3. CONTRACEPTION I ow I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, REAOING THE NN4E AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY° CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303. 301 Which ways or methods have you heard about? 1J PILL Women can take a pitt every day. 2J IUCD Women can have a loop or coil placed inside them by a doctor or a nurse. 3J INJECTIONS women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months. 4J IMPLANTS Women can have severe[ small reds placed in their upper arm by a doctor or nurse which can prevent pregnancy for severaI years. 5J FOM4ING TABLETS/JELLY Women can place a sponge, suRoository, diaphragm, jelly, or cream inside themselves before intercourse. CONDOM Men can put a rubber sheath on their penis during sexual 1 intercourse. 1 71 FEMALE STERILIZATION Women can have an operation to avoid having any more children. 81 MALE STERILIZATION Men can have an operation to avoid having any more children. O • NATURAL FN4ILY PLANNING Couples can avoid having sexual intercourse on the days of the month when the woman is more likely to become pregnant. 10• WITHDRAWAL Men can be careful and putt out before climax. 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? 302 Have you ever heard of (METHOD)? SPONTANEOUS PROBED YES YES NO 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 2 3 2 3 1 2 3 1 2 3 (SPECIFY) (SPECIFY) 303 Have you ever used (METHOD)? YES,,. . .,. . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . I NO . 2 YES . I NO . 2 YES . 1 NO . 2 Have you ever had an operation to avoid having any more children? YES . 1 NO . ,.,,, . ,.,2 Have you ever had a partner who had an operation to avoid having children? YES . 1 NO.,. . ,. . 2 YES . 1 NO . ,,.,. . 2 YES . 1 NO . 2 ] • YES . 1 NO . 2 YES . I NO . 2 AT LEAST ONE "YES" (EVER USED) 223 I GO TO 309 I I WEN9 NO I QUESTIONS AND FILTERS 305 J Have you ever used anything or tried in any way I to delay or avoid getting pregnant? J COOING CATEGORIES I GO TO I Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~331 3°7 I' h" h'v" Y°u us' °r °°n" I I CORRECT 303 AND 304 (AND 302 IF NECESSARY). 309 NON I would like to ask you about the first time that you did s~thing or used a n~thod to avoid getting pregnant. How many Living children did you have st that time, if any? IF NONE, RECORD IOO'. NUMBER OF CHILDREN . . . . . . . . 310 I When you first used family planning, I did you want to have another child but at a later time, J or did you not want to have another child at all? ~]HAN STERILIZED v ~ E~ PREGNANT [~ v ~ 313 1 Are you currently doing something or using any method I to delay or avoid getting pregnant? WANTED CHILO LATER . I DID NOT WANT ANOTHER CHILD . 2 I YES . 1 J ND . ,,,,,.oo . . . . . . . . . . . . . . . Z L I L3141 1___ I L332 1___ ~331 I 314 316A Which n~thod are you using? CIRCLE '07' FOR FEMALE STERILIZATION. PILL . 01 | IUO . OZ INJECTIONS . 03 i L IMPLANTS . 04 , ~326 FOAMING TABLETS/JELLY . 05 | CONDOM . 06 FEMALE STERILIZATION . 077 MALE STERILIZATION . 08 / r318 NATURAL FAHILY PLANNING . 09 r323 ~ITRDRAWAL . . . . . . . . . . . . . . . . . . . . . 10 OTHER 96 ~326 ~ (SPECIFY) I 315A I At the time you first started using the pill, did you I YES . 1 m I consult a doctor or a nurse? J NO . Z I DR . .°.,,**. . 8 315B I At the tirneyou Last got pills, did you consult a doctor J YES . 1 J I or a nurse? I NO . Z I 315c I May i see the package of pills you are non using? RECORD NAME OF BRAND IF PACKAGE IS BEEN. PACKAGE SEEN . . . . . . . . . . . . . . . . . . . . 1 BRAND NAME __~.317 PACIC~GE NOT SEEN . . . . . . . . . . . . . . . . 2 | 316 Do you know the brand name of the pills you are non using? RECORD NAHE OF BRAND. JB.D.E DON~T KNOW . . . . . . . . . . . . . . . . . . . . . 98 317 I How much does one packet (cycte) of pills cost you? I ~ACHA - - 1 COBT . I I I I L ::::::::::::::::::::::::::::::: ~z, WEN 10 224 NO. QUESTIONS AND FILTERS 318 Where did the ¢terft|zatton take place? IF SOURCE IS NOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) GO TO COOING CATEGORIES PUBLIC SECTOR GOVERNMENT HOSPITAL . 11 GOVERNMENT HEALTH CENTER . 12 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 MISSION HOSPITAL/CLINIC . 22 PRIVATE DOCTOR . 23 MOBILE CLINIC . 24 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER 96 (SPECIFY) ~319 DON'T KN(?d . 98 ' 1 OTHERWISE, How tong did to IF LESS (PLACE THAN MENTIONED RECORD 2 it take to travel from your home HOURS, HOURS. IN RECORD 318)? MINUTES. DK MINUTES _ , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , _ 3,8q w. ,, .sy or di.ioo(t to oo, there? I EABY BIFFICULT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 '1 3191 Do you regret that (you/your husband) had the operation I YES . 1 | I not to have any (more) children? NO . 2 ~321 I I PARTNER WANTS ANOTHER CHILD . 2 SIDE EFFECTS . 3 CHILD DIED . 4 OTHER 6 (SPECIFY) 321 I In what month and year was the sterilization performed? MONTH . [~--~327 YEAR . ~ I 323 You said that you have avoided having sexual intercourse on certain days of the month to avoid getting pregnant. How ~ you determine which days of your monthly cycle not to have sexual relations? BASED ON CALENDAR . 1 BASED ON BODY TEMPERATURE . 2 BASED ON CERVICAL MUCUS (BILLINGS METHOD) . ] BASED ON BODY TEMPERATURE AND CERVICAL MUCUS . 4 NO SPECIFIC SYSTEM . 5 OTHER 6 (SPECIFY) 326 For how many months have you been using (METHOD) continuously? IF LESS THAN 1 MONTH, RECORD lOB'. MONTHS . . . . . . . . . . . . . . . . . . . . . I--l--1 I 8 YEARS OR LONGER . 96 WEN 11 225 NO. 327 QUESTIONS AND FILTERS CHECK 314: CIRCLE NETHOO COOE: COOING CATEGORIES ] GO TO PILL . 01 | IUD . 02 I INJECTIONS . 03 INPLAHTS . 04 FOAHING TABLETS/JELLY . 05 COND(~# . 06 FEMALE STERILIZATION . 07 ~328( HALE STERILIZATION . 08 ~334 NATURAL FAHILY PLANNING . 09 WITHDRAWAL . 10 332 OTHER HETHOO . 96 328 Where did you obtain (HETHO0) the Last time? iF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NANE OF THE PLACE. PROSE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE COOE. (NAHE OF PLACE) PUBLIC SECTOR I GOVERNHENT HOSPITAL . 11 GOVERNHENT HEALTH CENTER . 12 FIELDWORKER . 13 ,328C OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 MISSION HOSPITAL/CLINIC . 22 PHARHACY . 23 PRIVATE DOCTOR . 24 MOBILE CLINIC . 25 FIELD WORKER . 26 ,328C OTHER PRIVATE HEDICAL 27 (SPECIFY) OTHER SOURCE SHOP . ]1 -- / FRIENDS/RELATIVES . 3] J OTHER 36 ~328C (SPECIFY) DON'T KNOW . 98 -- I 328A| How long does it take to travel HINUTES . 1 J i l l I from your home to this place? HOURS . 2 IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS. DK . 9998 ~I ' ' '~ -~ °~ °'' '~°'~ ~°''~ ~''~°~ I ~' o,~,~o~' . . ~ 'I ~°1 °'~ ~°~ ~''' ~° ~°u~'° ' '~ '° '~t° '~'~u~ ~'~' I '~ . ' 1 before you started to use it? NO . 2 328D I Did you talk to your husband/partner about (NETHOO) I YES . 1 -3 after you started to use it? I NO . 2 --=-~334 I I WEN 12 226 NO. QUESTIONS AND FILTERS 331 kllat |s the main reason you are not using e method of contraception to avoid pregnancy? CODING CATEGORIES NOT HARRIEO . . . . . . . . . . . . . . . . . . . . 11 FERTILITY-RELATED REASONS NOT HAVING SEX . 21 INFREQUENT SEX . 22 MENOPAUSAL/HYSTERECTOHY . 23 SUBFECUNO/INFECUND . 24 POSTPARTUH/BREASTFEEDING . 25 WANTS (MORE) CHILDREN . 26 PREGNANT . 27 OPPOSITION TO USE RESPONDENT OPPOSED . 31 HUSBAND OPPOSED . 32 OTHERS OPPOSED . 33 RELIGIOUS PROHIBITION . 34 LACK OF KNOWLEDGE KNOUB NO METHOD . 41 KNOWS NO SOURCE . 42 METHOD-RELATED REASONS HEALTH CONCERNS . 51 FEAR OF SIDE EFFECTS . 52 LACK OF ACCESS/TO0 FAR . 5] COST TOO MUCH . 54 INCONVENIENT TO USE . 55 INTERFERES WITH BOOYIS NORMAL PROCESSES . 56 OTHER 96 GO TO (SPECIFY) DON'T KNOW . 98 332 I Do you know of a place uhere you can obtain IYES . 1 I a method of family ptan~ing? NO . 2 ,334 I 353 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAHE OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) PUBLIC SECTOR GOVERNMENT HOSPITAL . 11 GOVERNMENT HEALTH CENTER . 12 FIELD WORKER . 15 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 MISSION HOSPITAL/CLINIC . 22 PNARt4ACY . 23 PRIVATE DOCTOR . 24 MOBILE CLINIC . 25 FIELD WORKER . 26 OTHER PRIVATE MEDICAL 27 (SPECIFY) OTHER SOURCE SHOP . 31 FRIENDS/RELATIVES . 32 OTHER 36 (SPECIFY) 334 I Were you visited by a family planning program worker I in the test 12 months? I YES . 1 I NO . . . . . . . . . . . . . . . . oooo,,. . . . . . . . 2 WEN 13 227 NO. I QUESTIONS AND FILTERS 335 i Have you visited a health facility for any reason I in the last 12 months? I C~IHD CATEGORIES I GO TO YES . 1 I NO . 2 ¢337 I I . '1 to you about family planning methods? NO . 2 3371Do you think that breastfeeding can affect IYES . 1, a woman*s chance of becoming pregnant? NO . 2 ~401 DON'T KNOW . 8 I 338 Do you think a woman,s chance of becking pregnant is increased or decreased by breastfeeding? iNCREASED . I ~401 DECREASED . 2 | DEPENDS . 3 I DONIT KNC~ . 8 [~ NO BIRTHS 340 | Have you ever retfed on breastfeeding as a method I YES . 1 | I of avoiding pregnancy? | NO . 2 ~401 CHECK 227 AND 311: NOT PREGNANT OR UNSURE EITHER PREGNANT AND OR NOT STERILIZED [~ STERILIZED [~ l ate you currently relying on breastfeeding to avoid getting pregnant? 342 I YES . 1 NO . .,**.,,o,,o,oo,,o,o,.o.,Z g EN 14 I~4011 ~401 228 SECTION 4A. PREGNANCY AND BREASTFEEDING 402 403 404 405 l CHECK 225: ONE OR MORE r~ NO [--~ BIRTHS SINCE LT-] BIRTHS SINCE - ~(GO TO 465) I JAN. 1991 I _ JAN. 1991 ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OE EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE CONTINUATION SHEETS). NOW ! would like to ask you some more questions about the health of all your children born in the past five years. (We wilt talk about one child at a time.) / I LAST BIRTH LINE NUMBER FROH 0212 LINE NUMBER . FROH Q212 I NAME AND Q216 I ALIVE [~ DEAD [~ v B v At the time you became pregnant I THEN . 1- with (NAME), did you want [ (GO TO 407)~ to becocne pregnant then, did you LATER . 2 want to wait until later, or did you want no (more) children NO MORE . 3-- at all? (GO TO 407)4 NEXT-TO-LAST BIRTH LINE NUMBER . III NAME ALIVE [~ DEAD ? THEN . 1- (GO TO 407)4 LATER . 2 NO MORE . 3- (GO TO 407)4 406 I How much Longer would you like to have waited? I MONTHS . 1 YEARS . 2 BONIT KNOW . 998 r-~ MONTHS . 1 I 1 [ YEARS . 2 DOHIT KNOW . 998 407 When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. HEALTH PROFESSIONAL DOCTOR . A NURSE/MiDWIFE . B CLINICAL OFFICER . C OTHER PERSON TRADiTiONAL BIRTH ATTENDANT . O OTHER X (SPECIFY) NO ONE . Y-- (GO TO 410)~ HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . B CLiNiCAL OFFICER . C OTHER PERSON TRADITIONAL BIRTH ATTENDANT . D OTHER X (SPECIFY) NO ONE . Y-- (GO TO 410)~ 4081 o °nY= Pr= rey°u I when you first received MONTHS . MONTHS . antenatal care? DON=T KNOt# . 98 DON=T KNOW . 98 409 HOW many times did you receive I ~ ~-~ antenatal care during this NO. OF TIMES . NO, OF TIMES . pregnancy? DON'T KNOW . 98 DON~T KNOW . 98 409A| Were you given an antenatal card or I YES, SEEN . 1 YES, SEEN . 1 I do you have a card or a book for this I YES, NOT SEEN . Z YES, NOT SEEN . 2 pregnancy? NO CARD/BOOK . 3 NO CARD/BOOK . 3 May see the card (book) please? 410 When you were pregnant with (NAME) I YES . 1 [ YES . 1 were you given an injection in the arm I I to prevent the baby from getting tetanus, NO . 27 m I NO . 2- that is, convulsions after birth? (GO TO 412)4 |1 (GO TO 412)~ DON*T KNOW . 8-J I DONIT KNOW . ,,DurinBthisoregnencyhow nyti.[ DI D did you get this injection? TIMES . TIMES . DONIT KNOW . 8 DON*T KNOW . 8 229 w EN 15 FROM o.212 412 Where did you give birth to (NAME)? LAST BIRTH NAME HOME YOUR HOME . 11 OTHER HOME . 12 PUBLIC SECTOR GOVT. HOSPITAL . 21 GOVT. HEALTH CENTER.22 OTHER PUBLIC 26 (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC.]1 MiSSiON HOSP./CLiNIC.]2 OTHER PRIVATE MEDICAL ]6 (SPECIFY) OTHER 96 (SPECIFY) NEXT-TO-LAST BIRTH NAHE HONE YOUR HONE . 11 OTHER HONE . 12 PUBLIC SECTOR GOVT. HOSPITAL . 21 GOVT. HEALTH CENTER.22 OTHER PUBLIC 26 (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC.31 MiSSiON HOSP./CLINIC.32 OTHER PRIVATE MEDICAL 36 (SPECIFY) OTHER 96 (SPECIFY) I 413 Who assisted with the delivery of (NAHE)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . B CLINICAL OFFICER . C OTHER PERSON TRADITIONAL BIRTH ATTENDANT . D RELATIVE/FRIEND . E COMMUNITY HEALTH WORKER . F OTHER X (SPECIFY) NO ONE . Y HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . B CLiNiCAL OFFICER . C OTHER PERSON TRADITIONAL BIRTH ATTENDANT . D RELATIVE/FRIEND . E CO~4t4UNiTY HEALTH WORKER . F OTHER X (SPECIFY) NO ONE . Y 414 Around the time of the birth of (NAME), did you have any of the following problems: Long tabor, that is, did your regular contractions test more than 12 hours? Excessive bleeding that was so n~Jch that you feared it was life threatening? A high fever with bad smelling vaginal discharge? YES NO LABOR MORE THAN 12 HOURS.1 2 EXCESSIVE BLEEDING . 1 2 FEVER/BAD SMELLING VAG, DISCHARGE . 1 2 CONVULSIONS . 1 2 Convulsions not caused by fever? 415 i w== (NAME) ~eLivered by IYES . 11YES . 1 caesarian section? NO . 2 NO . 2 416 When (NAME) was born, was he/she: very tsrge~ VERY LARGE . 1 VERY LARGE . 1 Larger than average, LARGER THAN AVERAGE . 2 LARGER THAN AVERAGE . Z average, AVERAGE . ] AVERAGE . ] smaller than average, SMALLER THAN AVERAGE . 4 SMALLER THAN AVERAGE . 4 or very small? VERY SMALL . S VERY SMALL . S DONiT KNOW . 8 DONIT KNOW . 8 WEN 16 YES NO LABOR MORE THAN 12 HOURS.1 2 EXCESSIVE BLEEDING . 1 2 FEVER/BAD SMELLING VAG. DISCHARGE . 1 2 CONVULSIONS . 1 2 230 I I FROM Q. 212 LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME 417 | Was (NAME) weighed at birth? YES . 1 YES . 1 I NO . 29 NO . 2-- (GO TO 419)~ I (GO TO 420)~ 41B How much did (NAME) weigh? (ILOGRAMS FROM [] ~ KILOGRAMS FROM ~ ~--~ CARD . 1 . CARD . 1 . RECORD WEIGHT FROM HEALTH CARD, If AVAILABLE, (ILOGRAMS FROM D D KILOGRAMS FROM D [] RECALL . 2 . RECALL . 2 , DON~T KNOW . 998 DON'T KNOW . 998 419 I Has your period returned since the YES . 1--1 I birth of (NAME)? (GO TO 421)~ NO . 29 (GO TO 422)< ! 420 | Did your peried return between the birth YES . I I of (NAME) and your next pregnancy? NO . 2-- (GO TO 424)~ 421 For how many months after the birth of (NAME) did you not have a period? CHECK 227: RESPONDENT PREGNANT? MONTHS . DONIT KNOW . 98 MONTHS . DON'T KNOW . 98 423 I Have you resumed sexual retations since the birth of (NAME)? I YES . 1 NO . 2-- 1 (GO TO 425), ! 424 I F°r h°w many m°nths after the birth ~ of (NAME) did you not have MONTHS . MONTHS . sexual relations? DON'T KNOU . 98 DON'T KNOW . 98 425 I Did you ever breastfeed (NAHE)? I YES . . . . . . . . . . . . . . . . . . . . . . 11 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . 27 NO . 2- 7 (GO TO 431)a ! (GO TO 431)~ / 426 How tong after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, RECORD ~OO I HOURS. IF L~SS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. CHECK 404: CHILD ALIVE? IMMEDIATELY . OOO HOURS . 1 ~--~ DAYS . 2 ALIVE YES . 1-11 (GO TO 432)~ NO . 2 IMMEDIATELY . 000 HOURS . 1 DAYS . 2 428 I Are you still I breastfeeding (NAME)? 429 ] For how many months did you ~ ~I~ breastfeed (NAME)? MONTHS . MONTHS . DON'T KNO~/ . 98 DON'T KNOW . 98 WEN 17 DEAD (GO TO 429) YES . 1- (GO TO 43234 NO . ,.oooooo. . . . . . . . . . 2 231 FROfl o.212 430 Why did you stop breastfeeding (NAME)? 431 432 CHECK 404: CHILD ALIVE? How many times did you breastfeed test night between sunset and sunrise? LAST BIRTH NAME MOTHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . 03 NIPPLE/BREAST PROBLEM,,.04 NOT ENOUGH MILK . 05 HOTHER ~RKING . 06 CHILD REFUSED . 07 I~EANING AGE/AGE TO STOP.DB BECAME PREGNANT . 09 STARTED USING CONTRACEPTION . 10 OTHER 96 (SPECIFY) ALIVE DEn @ (GO TO 434) (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440) NUMBER OF NEXT'TO-LAST BIRTH NAME MOTHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . 03 NIPPLE/BREAST PROBLEM.04 NOT ENOUGH MILK . 05 MOTHER WORKING . 06 CHILD REFUSED . 07 WEANING AGE/AGE TO STOP.08 BECN4E PREGNANT . O9 STARTED US%NG CONTRACEPTION . 10 OTHER 96 (SPECIFY) ALIVE DEAD (GO TO 4]4) (GO BACK TO 40! IN NEXT COLUMI OR, IF NO MORE BIRTHS, GO TO 440) NUMBER OF . . . . . . . . . . . IF ANSWER IS NOT NL,q4ERIC, PROBE FOR APPROXIMATE NUMBER. 433 |How many times did you breastfeed [ ~'~ I yesterday during NUMSER OF NUMBER OF I the daylight hours? DAYLIGHT DAYLIGHT FEEDINGS . FEEDINGS . . . . . . . . . . . . IF ANSWER IS NOT NUMERIC, I PROBE FOR APPROXIMATE NUMBER. 434 IDid (NAME) drink anything frora . pottle I YES . 11 YES . 1 I with • nil~ole yesterday or last night? NO . 2 NO . 2 DONIT KNC~4 . 8 DONiT KN(~4 . 8 435 YES NO DK YES NO DK I At any time yesterday or last night, was (NAME) given any of the foLLowing: Plain water? Sugar water? Juice? Tea? Baby formula? Tinned or powdered milk? Fresh miLk? Any other liquids? Any solid or mushy food made from grain such as maize, rice, wheat and soybean? Any solid or mushy food made from tuber such as cassava, sweet potato and yam? Eggs, fish, or ~ltry? Meat? Any other solid or semi solid foods? PLAIN WATER . 1 2 8 SUGAR WATER . 1 2 8 JUICE . 1 2 8 TEA . 1 2 8 BABY FORMULA . 1 2 8 TINNED/PO~DR'D NLK.I 2 8 FRESH MILK . 1 2 8 OTHER LIQUIDS . 1 2 8 FO00 HADE FROM GRAIN . 1 2 8 FO00 MADE FRO~4 TUBER . 1 2 8 EGGS/FIBH/P(XILTRY.? 2 8 HEAT . 1 2 8 OTHER SOLID/ SEMI-SOLID FOOOS.,1 2 8 PLAIN WATER . 1 2 8 SUGAR WATER . 1 2 8 JUICE . 1 2 8 TEA . 1 2 B BABY FORMULA . 1 2 8 TIHHED/PO~OR'D NLK,.1 2 8 FRESH NILE . 1 2 8 OTHER LIQUIDS . 1 2 8 FOOD NkDE FROM GRAIN . 1 2 8 FO00 MADE FROM TUBER . 1 2 8 EGGS/FISR/P(XILTRY1 2 8 NEAT . 1 2 8 OTHER SOLID/ SEMI-SOLID FO00S.1 2 8 WEN 18 232 437 FROM Q. 212 CHECX 435: FO00 OR LIQUID GIVER YESTERDAY? J (Aside from bresstfeeding,) how many times did (NAME) eat yesterday, including beth meats and snacks? IF 7 OR MORE TIMES, RECORD '7'. LAST BIRTH NAME TO ONE TO ALL OR MORE (GO TO 438) NUMBER OE TIMES . D I DON'T KNOt4 . B NEXT-TO-LAST BIRTH NAME "YES" l "NO/DK" TO ONE TO ALL OR MORE (GO TO 438) v ~ NUMBER OF TIMES . [--1 I I DON'T KNOt/ . 8 43B On how many days during the last seven days was (NAME) given any of the following: Plain water? Any kind of milk (other than breast milk)? Liquids other than plain water or milk? Any solid or mushy food made from grain such as maize, rice, wheat and soybean? Any solid or mushy food made from tuber such as cassava, sweet potato and yam? Eggs, fish, or poultry? Meat? Any other solid or semi-soLid foods? IF DON'T KNOU, RECORD '8' RECORD THE NUMBER OF DAYS. m PLAIN WATER . NILK . OTHER LIQUIDS . FO00 MADE FROfl GRAIN . FOOD MADE FROM TUBER . EGGS~FISH~POULTRY . . . . . . MEAT . OTHER SOLID/SEMI- SOLID FO00S . GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440. RECORD THE NUMBER OF DAYS. m PLAIN WATER . MILK . OTHER LIQUIDS . FO00 MADE FROH GRAIN . FOOD MADE FROfl TUBER . EGGS/FISH/POULTRY . MEAT . OTHER SOLID/SEMI- SOLID FOODS . GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440. WEN 19 233 SECTION 4B. IMMUNIZATION AND HEALTH ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (iF THERE ARE MORE THAN 2 BIRTHS USE ADDITIONAL QUESTIONNAIRES). IN THE TABLE, 442 443 LINE NUMBER FROM G212 FROM Q212 AND o216 Do you have a card where (NAME,S) vaccinations ere written down? LAST BIRTH l NEXT-TO-LAST BIRTH LINE . . . . . . . . . . . . . . . . I LINE . . . . . . . . . . . . . . . . NAME ALIVE DEAD (GO TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.) NAME ALIVE DEAD (GO TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS GO TO 465.) I IF YES: May I see it please? I YES . 1 YES . 1-- 444 IDid Y°U ever have a vaccinati°n card ~ l I for (NAME)? 0 . 2 I NO . 2-- N (GO TO 447), (GO TO 447)4 445 YES, SEEN (GO . TO 445), 1711 YES, SEEN(Go . TO 445), I- YES, NOT SEEN . 271 YES, NOT SEEN . 2- (GO TO 447), 3Ill (GO TO 447)4 NO CARD . NO CARD . 3 (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD. (2) WRITE ~44' IN ~DAY j COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. BCG Potio I Potio 2 PoLio 3 DPT 1 DPT 2 DPT ] Measles DAY MO YR BCG . Pl . P2 . P3 . D1 . D2 . D3 . MEA . DAY MO YR 446 Has (NAME) received any vaccinations that are not recorded on this card? RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, OPT 1-3, AND/OR MEASLES VACCINE(S). YES . 1-11 YES . I ] (PROBE FOR VACCINATIONS ~1 (PROBE FOR VACCINATIONS < AND WRITE =~' IN THE_I__I AND WRITE J66' IN THE CORRESPONDING DAY CORRESPONDING DAY NoCOLUHN IN 445)---- COLUHN IN 445)------ , . , . , . . , . . . . . . . N O . . . . . . . . . . . . . . . . . . . . . . . 2-- DON'T XNOW . . . . . . . : : : : : : : .H I DON'T XNOW . . . . . . . . . . . . . . . 8-- (GO TO 449)~ / I (GO TO 449)4 W EN 20 234 I 447 I FRO~M O. 212 I Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases? LAST BIRTH I NAME I YES . 1 I NO . 2-1 I (GO TO 449)a l DON'T KNOW . e JI NAMENEXT-TO-LAST BIRTH I YES . . . . . . ° . . . . . . . . °o . . ° ° .1 NO . 2- I (GO TO 449)a • DON'T KNOW . 5 J 448 448A 448B 448C 446D 448E 448F 448G Please tell me if (NAME) received any of the following vaccinations: A BCG vaccination against tuberculosis, that is, an injection in the Left arm or shoulder that caused a scar? Polio vaccine, that iS, drops in the mouth? IF YES: How many times? When was the first polio vaccine given? DPT vaccination, that is, an injection usually given at the same time as polio drops? IF YES: How many times? An injection to prevent measles? YES . I NO . 2 DON'T KNOW . 8 YES . 1 NO . 2- (GO TO 448E), DON'T KNOW . 8-- NUMBER OF TIMES . D JUST AFTER BIRTH . 1 TUO MONTHS OR LATER . 2 YES . 1 NO . 2- (GO TO 448G), DON'T KNOW . 8- NUMBER OF TIMES . [~ m i YES°°°°°.,,°°°° . 1 NO . 2 DON'T KNOW . 8 YES . 1 NO°°°°°°°°°°°°°° . .2 DON'T KNOW . 8 YES . 1 NO'°°'°°°°°°°°°°'''°°°°°'~(GO TO 448E)4 DON'T KNOW . NUMBER OF TIMES . ~] I I JUST AFTER BIRTH . 1 TWO MONTHS OR LATER . 2 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO.°.°.°o°o.,,,,,,°o.2- (GO TO 4486), DON'T KNOW . 8- NUMBER OF TIMES . [---] L~ YES . 1 NO . 2 DON'T KNOW . 8 449 1 Has (NAME) been ill with a fever YES . 1 YES . 1 I etanytimeintheLest2weeks? OoNTNO . NNOW(DO . TO iii ]1N°ooNT . KNOW(O0 . TO ,,0), •2-1 ,°,A, oid you seek edvice or ,reetment I YEg . . . . . . . . . . . . . . . . . . . . . . , IYEg . . . . . . . . . . . . . . . . . . . . . . , I for the fever? (GO TO 450)4 ] (GO TO 4'0)4 ] NO . 2 NO . 2 449B Where did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED. PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH CENTER . B COMMUNITY HEALTH WORKER.C MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC.D MISSION HOSP./CLINICo.E PHARMACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . I OTHER X PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH CENTER . B COMMUNITY HEALTH WORKER.C MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC.D MISSION HOSP./CLINIC . E PHARMACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . I OTHER X (SPECIFY) (SPECIFY) 450 | Has (NAME) been itt with a cough YES . 1 I YES . 1 I at any time in the test 2 weeks? NO . 29l NO . 2-- (GO TO 454)4 _ II (GO TO 454)~ DON'T KNOW . 8~| DON=T KNOt# . 8- 451 I When (NAME) was ill with a cough, I YES . 1 I YES . 1 I did he/she breathe faster than usual I NO . 2 I NO . 2 with short, fast breaths? DON'T KNOW . 8 DON'T KNOW . 8 235 w EN 21 I 452 FROM Q. 212 Did you seek advice or treatment for the cough? I LAST BIRTH I NAME I YES . 1 I NO . 2-1 I (GO TO 454)~ "1 NANENEXT-TO-LAST BIRTH I YES . o.oooooo,,1 NO . 271 (GO TO 454)~ =| 453 453B kllere did you seek advice or treatment? Anywhere else? RECORD ALL MENTIONED, I Which provider did you go to first? PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH CENTER . B COMHUNITY HEALTH ~K)RKER.C MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC.D MISSION HOSP./CLINIC.E PHARMACY . F PRIVATE DOCTOR . . . . . . . . . . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . I OTHER X (SPECIFY) PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH CENTER . B COMMUNITY HEALTH WORKER.,C MEDICAL PRIVATE SECTOR PVT, HOSPITAL/CLINIC . . . . . D MISSION HOSP,/CLINIC . E PHARMACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . I OTHER X (SPECIFY) ONLY ONE PROVIDER MENTIONED ~ ~454 PUBLIC SECTOR GVT, HOSPITAL . A GVT. HEALTH CENTER . B COHHUNITY HEALTH WORKER,C MEDICAL PRIVATE SECTOR PVT, HOSPITAL/CLINIC.D MISSION HOSP,/CLINIC.E PHARHACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . ] OTHER X PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH CENTER . S COMMUNITY HEALTH t~ORKER,.C MEDICAL PRIVATE SECTOR PVT, HOSPITAL/CLINIC . D MISSION HOSP,/CLINIC . E PHARHACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . I OTHER X (SPECIFY) (SPECIFY) 454 | Has (NAHE) had diarrhoea in the last YES . 1 I YES . 1 I two weeks? NO . 2-11 NO . 2-1 (GO TO 464), ~1 (GO TO 464), • DON'T KNOW . ~1 DONiT KNOW . 8 -J NO . 2 NO . 2 DON IT KNOW . 8 DON'T KNOW . 8 456 On the worst day of the diarrhoea, NUMBER OF BOWEL r ~ I NUMBER OF BOWEL how many bowel movements did (NAME) have? MOVEMENTS . . . . . . . . . . . I I I I HOVENENTS . III OONIT KNOW . 98 DONIT KNOW . 98 457 gas he/she given the same amount to drink SANE . 1 I SANE . 1 as before the diarrhoea, MORE . 2 [ MORE . 2 or mare, or tess? LESS . ] LESS . 3 DON'T KNOW . 8 DON'T KNOW . 8 458 Was he/she given the same amount of food SANE . 1 SANE . 1 to eat as before the diarrhoea, MORE . 2 MORE . 2 or more, or tess? LESS . 3 LESS . 3 DON'T KNOW . 8 DON'T KNOW . 8 WEN 22 236 I 459 FRON Q. 212 Wee anything given to treat the diarrhoea? LAST BIRTH MANE YES . 1 NO . 21 (GO TO 461)4 / DK . . . . . . . . . . . . . . . . . . . . . . . 8-1 J NEXT'TO'LAST BIRTH NAME YES . 1 NO . 21 (GO TO 461)4 _I DK . . * o . . ° * * * . . , , . . . . . o o . . 460 What was given to treat the diarrhoea? Anything etse? RECORD ALL MENTIONED. FLUID FROM ORS PACKET.A HOMEMADE SUGAR/SALT SOLUTION . B ANTIBIOTIC PILL OR SYRUP.C OTHER PILL OR SYRUP . D INJECTION . E ( I .V . ) INTRAVENOUS . F HOME REMEDIES/ HERBAL MEDICINES . G OTHER X FLUID FROM ORS PACKET.A HOMEMADE SUGAR/SALT SOLUTION . B ANTIBIOTIC PILL OR SYRUP.C OTHER PILL OH SYRUP . D INJECTION . E ( I .V . ) INTRAVENOUS . F HONE REMEDIES/ HERBAL MEDICINES . G OTHER X (SPECIFY) (SPECIFY) 661 J Did you .eek .dvice or treatment for JYES . 1 IYES 7, . 1 the diarrhoea? NO . 2 NO . 2-- (GO TO 4~).a /J (GO TO 464)~ 462 Where did you seek advice or treatment? Anywhere etse? RECORD ALL MENTIONED. PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH CENTER . B COHMUNITY HEALTH WORKER,C MEDICAL PRIVATE SECTOR PVT, HOSPITAL/CLINIC.D MISSION HOSP,/CLIHIC.,E PHARHACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . I nTU~D V GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 665. PUBLIC SECTOR GVT, HOSPITAL . A GVT. HEALTH CENTER . B COHMUNITY HEALTH WORKER.C MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC.D MISSION HOSP./CLIHIC . E PHARHACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . H TRADITIONAL HEALER . ] OTHER X (SPECIFY) GO BACK TO 642 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465, EN 23 237 NO I QUESTIONS AND FILTERS 465 | When a child has diarrhoea, should he/she be given | Less to drink then usual, about the same amount, I or more than usue(? I COOING CATEGORIES I GO TO I . ] ABOUT SAME ANOUNT TO DRINK . 2 MORE TO DRINK . 3 DON'T KNOW . 8 466 IWhen a child has diarrhoea, should he/she be given I LESS TO EAT . 1 1 I tess to eat than usual, about the same amount, ABOUT SAME AMOONT TO EAT . 2 I or more than usual? MORE TO EAT . 3 DON'T KNOW . 8 467 When a child is sick with diarrhoea, what signs of illness would tell you that he or she should be taken to a health facility or health worker? RECORD ALL MENTIONED. REPEATED WATERY STOOLS . A ANY WATERY STOOLS . B REPEATED VOHITING . C ANY VONITING . D BLO00 IN STOOLS . E FEVER . F MARKED THIRST . G NOT EATING/NOT DRINKING WELL . H GETTING SICKER/VERY SICK . I NOT GETTING BETTER . J SUNKEN EYES . K OTHER X (SPECIFY) DONIT KNCY~ . Z 46a When e child is sick with e cough, whet signs of illness would tell you that he or she should be taken to a health facility or health worker? RECORD ALL MENTIONED. FAST BREATHING . A DIFFICULT BREATHING . B NOISY BREATHING . C FEVER . D UNABLE TO DRINK . E NOT EATING/NOT DRINKING WELL . F GETTING SICKER/VERY SICK . G NOT GETTING BETTER . H CHEST INDRAWING . I OTHER X (SPECIFY) DONIT KNOW . Z 46BA When a child is sick with a fever, what signs of illness would tell you that he or she should be taken to a health facility or health worker? RECORD ALL MENTIONEO. FEVER TWO OR MORE DAYS . A SEIZURES~SNAKING . . . . . . . . . . . . . . . . g CHEST INDRAWING . C NOT EATING/ROT DRINKING WELL.D GETTING SICKER/VERY SICK . E NOT GETTING GETTER . F OTHER X (SPECIFY) DON'T KNOW . Z WEN 24 238 NO. QUESTIONS AND FILTERS COOING CATEGORIES GOTO CHECK 460 (ALL COLUHNS) : I I NO CHILD ~ I RECEIVED ORS ANY CHILD RECEIVED ORS [~ ! ~Tx 470 J Have you ever heard of a special product catted Hedzi-a-~ Hoyo or ORS packet you can get for the treatment of J diarrhea? I YES . I r~72 m NO . 2 J 471 J Have you ever seen packets like this before? J YES . 1 J I I I SHOW PACKETS. NO . 2 ,476 472 m Have you ever prepared • solution uith one of these YES . 1 J I packets to treat diarrhoea in yourself or someone else? I NO . 2 ~47'5 SHOW PACKETS. J 47] J The test time you prepared Hedzi-a-Hoyo on ORS packet, WHOLE PACKET AT ONCE . 1 J I did you prepare the whole packet at once or only part I of the packet? PART OF PACKET . 2 ~475 I 474 How much water did you use to prepare Radzi-s-Hoyo or ORS packet the test time you made it? 112 LITRE (BANANA CUP) . 01 750 MLS . 02 1LITRE . 03 1 1/2 LITRES . O4 2 LITRES . 05 FOLLOWED PACKAGE INSTRUCTIONS.06 OTHER 07 (SPECIFY) DK . 98 475 476 477 Where can you get Nadzi-a-Moyo or ORS packet? PROBE: Anywhere else? RECORD ALL PLACES HENTIONED. CHECK 460 (ALL COLUHNS): HOHE-MADE FLUID HQ~E-MADE NOT GIVEH TO ANY CHILD FLUID GIVEN OR TO ANY CHILD A60 NOT ASKED Where did you learn to prepare the hccne flu{d made from sugar, salt and water that was given to (NAHE) when he/she had diarrhoea? PUBLIC SECTOR GOVERNHENT HOSPITAL . A GOVERHMENT HEALTH CENTER . B COMMUNITY HEALTH ~iORKER . C MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . D HISSION HOSPITAL/CLINIC . E PHARMACY . F PRIVATE DOCTOR . G OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . R TRADITIONAL HEALER . I OTHER X (SPECIFY) PUBLIC SECTOR GOVERNMENT HOSPITAL . 11 GOVERNMENT HEALTH CENTER . 12 COMHUNITY HEALTH ~iORKER . 13 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 21 MISSION HOSPITAL/CLINIC . 22 PHARMACY . 23 PRIVATE DOCTOR . 24 OTHER PRIVATE SECTOR SHOP . 31 TRADITIONAL HEALER . 32 OTHER 41 (SPECIFY) ~5011 239 WEN 25 SECTION 5. MARRIAGE NO. 502 QUESTIONS AND FILTERS PRESENCE OF OTHERS AT THIS POINT. I Are you currently married or Living with a man? L YES NO CHILDREN UNDER 10 . 1 2 HUSBAND/PARTNER . 1 2 OTHER HALES . 1 2 OTHER FEHALES . 1 2 I YES, CURRENTLY HARRIED . I YES, LIVING ~[TN A MAN . 2 -~50T NO, NOT IN UNION . 3 I 503 Do you currently have a regular sexual partner, REGULAR SEXUAL PARTNER . 1 | an occasional sexual partner, or no sexual partner OCCASIONAL SEXUAL PARTNER . 2 I st all? NO SEXUAL PARTNER . 3 504 I Have you ever baen married or lived with a man? I YES, FORMERLY MARRIED . 1 I YES, LIVED WITH A NAN . 2 ~511 NO . ] ~515F divorced, or separated? DIVORCED . 2 511 SEPARATED . ] 507 I Is your husband/partner living with you no~ I LIVES WITH HER . 1 1 or is he staying elsewhere? STAY%NG ELSEWHERE . 2 508 I ~T~|~;EN~M/~RO;R~#~RT~S~E~L;A~ULE. OBTAIN IF HE IS NOT LISTED IN THE HOUSEHOLD, WRITE =OO I I Does your husband/partner have any other wives besides yourself? YES . 1 I NO . 2 -1 DON~T KNO~ . B / ~511 NUMBER . DON'T KNON . 98 ~511 0me oDe eoo . e I . 511 I Have you been married or lived with a man only once, I ONCE . 1 I or more than once? HOME THAN C~CE . 2 I I 512 CHECK 511: MARRIED/LIVED WITH A MAN ONLY ONCE In what month and year did you start living with your husband/partner? MARRIED/LIVED WiTH A MAN MORE THAN ONCE r Now we wilt talk about your first husband~partner. In what month and year did you start living with him? MONTH . DONIT KNCY~ MONTH . 98 YEAR . DON~T KNOW YEAR . 98 ~514 "3 I"°" ° '° -e Y°°'h°n h'm' I AGEo . . . . . . . . ~ , , , , , , , , , , , . U EN 26 240 515 Now i need to ask you some questions about sexual activity in order to gain a batter understanding of some family planning issues. When was the Last time you had sexual intercourse Mith (your husband/the man you are Living with)? NEVER . 000 DAYS AGO . 1 WEEKS AGO . 2 HONTHS AGO . 3 YEARS AGO . 4 BEFORE LAST BIRTH . 996 r608 515A CHECK 301 AND 302: KNOWS CONDOM [~] The Last time you had sex with (your husband/ the man you are Living with), was a condom used? DOES NOT KNOt# CONDOM [~ S~l~N~ll,lle a condom, ~hich means that they put a rubber sheath on their penis during sexual intercourse. The Last time you had sex with (your husband/ the man you are Living uith), was a condom used? YES°°°°° . °°°°o°°.°.=.1 RO°°° . °°,°,,,, . °2 DOES NOT KN(~ . 8 ,,,BI "ave Y°u h'd"x " "h '=" °th'r 'h '°"°ur h ° " ~ ' , h . . o ,~ .r. , ,v,n. , ,h, ,° ,h. , . , , ,2 Do,h., I Y~s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' l NO . 2 r517 515C When was the Last time you had sexual intercourse with someone other than (your husband/ the man you are Living with)? DAYS AGO . 1 WEEKS AGO . 2 HONTHS AGQ . . . . . . . . . . . . . . . 3 BEFORE LAST BIRTH . 996 515DJ Was a condom used that time? YES . 1 I NO . ,ooo,,o,,o,,*. . °o.oooo2 DOES NOT KN~ . 8 515E I In the Last 12 months, how many different persons other than (your husband/the man you are Living with) have you had sex with? NUHSER OF PERSONS . ['~-] 517i DOES HOT KNO~ . 98 | 515F Now I need to ask you some questions about sexual activity in order to gain a batter understanding of some family planning issues. When was the Last time you had sexual intercourse (if ever)? NEVER . 000 DAYS AGO . 1 WEEKS AGO . 2 NONTHS AGO . 3 YEARS AGO . 4 BEFORE LAST BIRTH . 996 608 W EN 27 241 ND. CODING CATEGOR[ES GO TO 515G 515I I QUESTIONS AND FILTERS CHECK 301 AND 302: DOES NOT [~ KNOfHS CONDOM E~]~ KNOW CONDOM / I I The last time you had Some men use a condom, sex, was a condom used? which means that they put a rubber sheath on their penis during sexual intercourse. The test time you had sex. was • con¢~ used? In the last 12 months, how many different persons have you had sex with? YeS°°°°°.o°°°°°°°°ooooooo.o.°°l ND . °°o.,°,ooo.oo . 2 DOES RDT KNOW . 8 I 12 NDNTHS OR LONGER | SINCE LAST SEX [~ ~517 I NUHBER OF PERSONS . I l l DOES NOT NH~ . 98 517 I Do you know of a place where you can get condoms? IYES . 11 HD . 2 ~519 ! 518 Where is that? IF SOURCE IS HOSP%TALw HEALTH CERTERe OR CLINIC, WRITE THE NAME DF THE PLACE. PRDEE TD IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE° (NAME OF PLACE) PUBL]C SECTOR GDVERNMENT HOSP[TAL . 11 GOVERNMENT HEALTH CENTER . 12 COMMUNITY HEALTH WORKER . 13 OTHER PUBLIC 14 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 HISSIDN HOSPITAL/CLINIC . 22 PHARMACY . 23 PRIVATE DOCTOR . 24 MOBILE CLINIC . 25 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER SOURCE SHOP . 31 FRIENDS/RELATIVES . . . . . . . . . . . . . ]3 DTHER 36 (SPECIFY) I AOE . 519 Now old were you when you first had sexual intercourse? FIRST TIME WHEN MARRIED . 96 U EN 28 242 NO. SECTION 6. FERTILITY PREFERENCES QUESTIONS AND FILTERS CHECK 314: NEITHER HE OR SHE STERILIZED [~ STERILIZED COOING CATEGORIES I GO TO ~612 602 CHECK 227: NOT PREGANT OR UNSURE 9 I NOW I have socequestions about the future. Would you tike to have (a/another) child or would you prefer not to have any (more) children? PREGNANT 9 NOW [ have so~e questions about the future. After the child you are expecting now, would you like to have another child or gould you prefer not to have any more children? HAVE (A/ANOTHER) CHILD . I NO MORE/NONE . 2 SAYS SHE CAN'T GET PREGNANT . 3 UNDECIDED/DON'T KN(X/ . 8 r606 ~604 603 CHECK 227: NOT PREGANT OR UNSURE 9 I How long would you like to wait from now before the birth of (a/another) child? PREGNANT 9 I After the child you are expecting now, how long would you like to wait before the birth of another child? PREGNANT 605 If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much? 606 CHECK 315: USING A METHOD? NOT NOT 9 CURRENTLY 9 CURRENTLY ASKED USING USING J DO you think you will use a method to 607 I delay or avoid pregnancy within the next 12 months? I I--I MONTHS . 1 ~ J YEARS . 2 SOON/NOt/ . 993 "7 SAYS SHE CAN'T GET PREGNANT.~4 i r606 AFTER MARRIAGE . 995 J I OTHER 996 (SPECIFY) DONiT KNOW . 998 HAPPY . 1 UNHAPPY . 2 ~OULD NOT MATTER . 3 I I YES . 1 I ~609 NO . 2 DON'T KN~ . 8 608 J Do you think you will use a method IYES . 1 J at any time in the future? NO . 2 DON'T KNOW . 8 -] ~610 609 Which method would you prefer to use? PILL . 01 IUD . 02 INJECTIONS . 03 IMPLANTS . 04 FOAMING TABLETS/JELLY . 05 CONDOM . 06 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 NATURAL FAMILY PLANNING . 09 WITHDRAWAL . 10 OTHER 96 (SPECIFY) UNSURE . 98 --,,.612 243 ~ EN 29 NO. QUESTIONS AND FILTERS 610 ~nat is the main reason that you think you will never use a method? COOING CATEGORIES NOT MARRIED . 11 FERTILITY-RELATEO REASONS INFREQUENT SEX . 22 MENOPAUSAL/HYSTERECTOMY . 23 SUBFECUND/INFECUHD . 24 WARTS MORE CHILDREN . 26 OPPOSITION TO USE RESPONDENT OPPOSED . 31 HUSBAND OPPOSED . 32 OTHERS OPPOSED . 33 RELIGIOUS PROHIBITION . 34 LACK OF KNOWLEDGE KNOWS NO METHO0 . 61 KNONS NO SOURCE . 42 METHOD-RELATED REASONS HEALTH CONCERNS . 51 FEAR OF SIDE EFFECTS . 52 LACK OF ACCESS/TO0 FAR . 53 COST TOO MUCH . 54 INCONVENIENT TO USE . 55 INTERFERES WITH BQOYIS NORMAL PROCESSES . 56 OTHER 96 (SPECIFY) DON'T KNOW . 98 +"I +u'°+e+°''+++'++++++'+' I . +'I 612 GO TO --~612 CHECK 216: HAS LIVING CHILDREN [~ / I If you coutd go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? NO LIVING CHILDREN LT--J / I If you could choose exactly the number of children to have in your whore rife, how many would that be? PROBE FOR A NUMERIC RESPONSE. NUMBER . . . . . . . . . . . . . . . . . . . . . ~-~ OTHER (SPECIFY) 96 ---~614 I 613 How many of these children would you like to be boys, how many would you like to be girls and for how many would it not metter? BOYS NUMBER . OTHER 96 (SPECIFY) G[RLS NUHSER . OTHER 96 (SPECIFY) EITHER NUMBER . OTHER 96 (SPECIFY) 614 | Would you say that you approve or disapprove I APPROVE . | m I of couples using a method to avoid getting pregnant? I DISAPPROVE . 2 I NO OPINION . . . . . . . . . . . . . . . . . . . . . . Z 244 w EN zo NO. J QUESTIONS AND FILTERS 615 = i s it acceptable or not acceptable to you I rOn fnfor~tion on fomily planning to be provided: I On the radio? | On the television? J CODING CATEGORIES J GO TO I I ACCEPT- ACCEPT- ABLE ABLE DK RADIO . 1 2 8 TELEVISION . 1 2 8 616 In the last few months have you heard or read about family planning: On the radio? On the television? In a newspaper or magazine? From a poster? From leaflets or brochures? From live droma? From s doctor or • nurse? From a community health worker? YES NO RADIO . 1 2 TELEVISION . 1 2 NEWSPAPER OR MAGAZINE . I 2 POSTER . 1 2 LEAFLETS OR BROCHURES . 1 2 LIVE DRAMA . 1 2 DOCTOR OR NURSE . 1 2 COMHUNITY HEALTH WORKER . 1 2 618 I In the test few months have you dlsculaad I YES . 1 m I the practice of fwtIy planning with your husband, I NO . 2 ,620 I partner, friends, neighbors, or relatives? l 619 620 621 With whom? Anyone else? RECORD ALL MENTIONED. CHECK 502: YES, [~ YES, ~ NO, CURRENTLY LIVING WITH NOT IN MARRIED A NAN UNION Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/bartner's views on famity planning. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy? HUSBAND/PARTNER . A HOTXEN . B FATHER . C SISTER(S) . D BROTHER(S) . E DAUGHTER . F HOTHER-IN-LAW . G FRIENDS/NEIGHBORS . H CQHHUNITY HEALTH WORKER . [ LOCAL COMMUNITY LEADER . J RELIGIOUS LEADER . K OTHER X (SPECIFY) APPROVES . 1 DISAPPROVES . 2 DON'T KNOW . O L701B I' VE' . I family planning in the past year? ONCE OR TWICE . 2 HORE OFTEN . 3 ,23 1 Do you thinR your ho.band/partn.r .hE. the . . n~r ,E NU,B . . . . . . . . . . . . . . . . . . . . . '1 of children that you want, or does he want mere NORE CHILDREN . 2 or fewer than you want? FEWER CHILDREN . 3 DON'T KH(~ . 8 624 Who do you think should decide on the number of children a couple should have? WIFE . 1 HUSBAND . 2 SOTH . 3 NO ONE . 4 OTHER .6 (SPECIFY) DON'T KNOW . 8 WEN 31 245 NO. 702 SECT%ON 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK OUESTiONS AND FILTERS COOING CATEGORIES CHECK 502 AND Si4: CURRENTLY FORNERLY IJ MARRIED/ MARRIED/ NEVER MARR|EO LIVING WITH LIVED WITH AND NEVER k NAN A MAN IN UNION II m I How old was your husbsnd/partner on his last birthday? I '°E . . . . . . . . . . . . . . . . . . . . . . . . GO TO ~709 703 m Did your (last)husbsnd/partner ever attend school? I YES . 1 | I I NO . 2 ~706 704 What was the highest Level of school he attended: PRIMARY . 1 I primary, secondary, or higher? SECONDARY . 2 I HIGHER . 3 DON'T KNOW . 8 ~706 705 How many years did he complete at that level? ~ I YEARS . I]1 I DON'T KNOW . 98 706 What is (was) your (Last) husband/partner's occupation? That is, what kind of work does (did) he mainly do? 708 DOES (OLD) NOT WORK IN AGRICULTURE (Does/did) your husband/partner work mainly on his oNn land or on family Land, or (does/did) he rent Land, or (does/did) he work on someone else's Land? HIS LAND . 1 FAMILY LAND . 2 RENTED LAND . ] SOHEONE ELSE'S LAND . 4 .709 I I 709 I Aside from your own housework, I YES . 1 =712 I are you currently working? I NO . 2 | 710 As you know, some women take up jobs for which they | are paid in cash or kind. Others sell things, I have a small business or work on the family farm or in the family business. Are you currently doing any of these things YES . 1 ~712 or any other work? NO . 2 ] 711 I Have you done any work in the last 12 months? I YES . 1 | I I NO . 2 ~801 712 What is your occupation, that is, what kind of work do you mainly do? 714 [~ DOES NOT WORK IN AGRICULTURE [-~ Do you work mainly on your own Land or on family land, or do you rent land, or work on someone else~s land? OWN LAND . 1 FAMILY LAND . 2 RENTED LAND . 3 SOHEONE ELSE'S LAND . 4 .715 I I ~4() W EN 32 NO. I QUESTIONS AND FILTERS 715 l Do you do this work for a membar of your family, I for someone else, or are you self-employed? I COOING CATEGORIES I GO TO I FOR FAMILY MEMBER . 1 I FOR SOMEONE ELSE . 2 SELF-EMPLOYED . 3 716 I 0o you usually work throughout the year, or I THROUGHOUT THE YEAR . 1 .718 I do you work seasonally, or only once in e while? I SEASONALLY/PART OF THE YEAR . 2 | ONCE IN A WHILE . 3 ~719 717 .llDuring the last 1 2 r n ° n t h S ' h o w mony months did you work? I NUMBER OF MONTHS . ~ 1 O,.,w,,k I 0 ' " . D' 718 I did usually work? How many NUMBER OF .720 I ,,9 ,ork, ° ° 'h" '=- - " h°" °°Y I - - . O, . 720 I 0o you earn cash for your work? I YES . 1 m I PROBE: Do you make money for working? I NO . 2 r723 721 How moch do you usually earn for this work? KWACHA PROBE: Is this by the day, by the week, or by the month? PER KWACHA PER HOUR.1 PER DAY.2 PER WEEK,.3. PER MONTH.4 PER YEAR.5 OTHER (SPECIFY) 99999996 722 CHECK 502: YES, CURRENTLY MARRIED YES, LIVING WITH A MAN Who mainly decides how the money you earn wilt be used: you, your husband/partner, NO, NOT IN UNION Li--J I Who mainly decides how the money you earn Will be used: you, soceone else, or you and someone else you and your husband/partner jointly? jointly, or someone else? RESPONDENT DECIDES . 1 HUSBAND/PARTNER DECIDES . 2 JOINTLY WITH HUSBAND/PARTNER.3 SOMEONE ELSE DECIDES . 4 JOINTLY WITH SOMEONE ELSE . 5 723 I Do you usually work at home or away from home? HONE=, . ,,.,,,,.,,.,.,,.,.1 AWAY . 2 m CHECK 217 AND 218: IS A CHILD LIVING AT HONE WHO 1S AGE 5 OR LESS? YES E~ NO ~801A I .801/ 725 Who usually takes care of (NAME OF YOUNGEST CHILD AT HONE) white you are working? RESPONDENT . 01 HUSBAND/PARTNER . 02 OLDER FEMALE CHILD . 03 OLDER MALE CHILD . 04 OTHER RELATIVES . 05 NEIGHBORS . 06 FRIENDS . 07 SERVANTS/HIRED HELP . 08 CHILD IS IN SCHOOL . 09 INSTITUTIONAL CHILDCARE . 10 HAS NOT WORKED SINCE LAST BIRTH . 95 OTHER 96 (SPECIFY) 247 w EN 33 SECTION 8. AIDS AND OTHER SEXUALLY TRANSNITTED DISEASES NO. I QUESTIONS AND FILTERS I COOING CATEGORIES I GO TO 8O,AI Hsve oohesrde tOiseasesthatcan etransmitt' IYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , through sexual intercourse? NO . 2 ~801x 801B Which diseases do you know? RECORD ALL RESPONSES SYPHILIS . . . . . . . . . . . . . . . . . . . . . . . A GONORRHEA . . . . . . . . . . . . . . . . . . . . . . B AIDS . C GENITAL ~ARTS/CONDYLONATA . . . . . . . D OTHER W (SPECIFY) OTHER X (SPECIFY) DOES NOT KNOW . Z HAS HAD SEXUAL HAS NEVER HAD INTERCOURSE SEXUAL INTERCOURSE [--7 ~801 I 801DI Outing the last twetvemo.ths, did you have any of these I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I diseases? I NO . 2---] DOES NOT KNOW . 8 ~801K 801E Which of the diseases did you have? SYPHILIS . A GONORRHEA . B AIDS . C GENITAL WARTS/CONDYLOHATA . D OTHER W (SPECIFY) RECORD ALL RESPONSES OTHER X (SPECIFY) DONJT KNOW . Z 801F| The Last time you had (OISEASE(S) FRON 801E) did you YES . 1 | I seek advice or treatment? I NO . 2 ~801H I BO1G Where did you seek advice or treatment? Any other place or parson? RECORD ALL NENTIONED PUBLIC SECTOR GOVT. HOSPITAL . A HEALTH CENTER . B OTHER PUBLIC SECTOR . C NEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . D NiSSION HOSPITAL/CLINIC . E PHARHACY . F PRIVATE DOCTOR . G HOBILE CLINIC . H OTHER NED. PRIVATE SECTOR . I OTHER SHOP . J RELATIVES/FRIENDS . K TRADITIONAL HEALER . L OTHER X (SPECZFY) OOES NOT KNOW . Z I . . 2'1 8011J When you had (DISEASE(S) FRON801E) did you do I something not to infect your partner(s)? J YES . 1 I NO . 2"--] PARTNER ALREADY INFECTED . ] rBO1K 248 WEN 34 NO. J 801J I 801L I OUESTIONS AND FILTERS What did you do? RECORD ALL MENTIONED J COOING CATEGORIES I NO SEXUAL INTERCOURSE . A USED CONDONS . B TOOK MEDiCiNES . C OTHER X (SPECIFY) MENTIONED 'AIDS' [~ Have you ever heard of an iLLness caLLed AIDS? J YES . 1 I H O o o o , , . . , , o . . . . ° . . . . . . , . . . . . . o.2 - I GO TO ~802 I I ~811C 802 Frown which sources of information have you Learned most about AIDS? Any other sources? RECORD ALL MENTIONED RADIO . A TV . B NEWSPAPERS/MAGAZINES . C PAMPLETS/POSTERS . D HEALTH WORKERS . E MOSQUES/CHURCHES . F SCHOOLS/TEACHERS . G COMMUNITY MEETINGS . H FRIENDS/RELATIVES . I ~RK PLACE . J LIVE DRAMA . K OTHER . X (SPECIFY) 802B How can a person get AIDS? Any other ways? RECORD ALL MENTIONED SEXUAL INTERCOURSE . A SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS . B SEX WITH PROSTITUTES . C NOT USING CONDON . D HONOSEXUAL CONTACT . E BLOOD TRANSFUSION . F INJECTIONS . G KISSING . H HOSQUITO BITES . I CONTAHINATED RAZOR BLADE . J OTHER W (SPECIFY) OTHER X (SPECIFY) DOES NOT KNOW . Z 803 J Is there anything a person can do to avoid getting IYES . 1 , AIDS or the virus that causes AIDS? NO . 2 DOES NOT KNOW . 8/ =807 804 What can a person do? Any other ways? RECORD ALL NENTIONED SAFE SEX . A ABSTAIN FRON SEX . B USE CONDONS . C AVOID HULTIPLE SEX PARTNERS . D AVOID SEX WITH PROSTITUTES . E AVOID SEX WiTH HC~OSEXUALS . F AVOID BLO00 TRANSFUSIONS . G AVOID INJECTIONS . H AVOID KISSING . I AVOID NOSQUITO BITES . J SEEK PROTECTION FRON FROM TRADITIONAL HEALER . K OTHER W (SPECIFY) OTHER X (SPECIFY) DOES NOT KNOt# . Z WEN 35 249 NO. 806 ~ ~ T ~ _ ~ T E G O R I E S Q U E S T I O N S AND FILTERS COOING CATEGORIES ;TOGO TO ISAFE SEX ~ ~ ~SAFE SEX j t t r807 What does "safe sex" mean to you? RECORD ALL MENTIONED ABSTAIN FROM SEX . B USE CONDOMS . C AVOID MULTIPLE SEX PARTNERS . D AVOID SEX WITH PROSTITUTES . E AVOID SEX WITH HOMOSEXUALS . F OTHER X (SPECIFY) DOES NOT KNOW . Z 807 J Is it possible for s healthy-looking person to have J YES . 1 ' I the AIDS virus? I NO . 2 I DOES NOT KNOW . 8 I I . 'l from the disease, sometimes die or almost always die SOMETIMES . 2 from the disease? ALMOST ALWAYS . 3 DOES NOT KNOW . 8 I . ' I NO. . . . . . . . ° ° . .o . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . 8 '°"1 I'"oo.'O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =l 0o you POrs°°a(~Y ~no" s--°°e "h° hss AIDS °r IYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ , has died of AIDS? NO . 2-- 1 DOES NOT KNOW . 8 ! u809 have AIDS? NUMBER OF PERSONS . died of AIDS? NUMBER OF PERSONS . 809 CHECK 801E: IF RESPONDENT HAS AIDS~ CIRCLE 5. Do you think your chances of getting AIDS are smaLL, moderate, great, or no risk at art? I SMALL . 1 I MODERATE . 2 7 GREAT . 3 1809B NO RISK AT ALL . 4 l HAS AIDS . 5 tB11A 809A Why do you think that you have (no rtsk/a smaLL chance) of Retting AIDS? Any other reasons? RECORD ALL MENTIONED ABSTAIN FROM SEX . B USE CONDOMS . C HAVE ONLY ONE SEX PARTNER . D LIMITED NUMBER OF SEX PARTNERS,,E SPOUSE HAS NO OTHER PARTNER . F NO HOMOSEXUAL CONTACT . G NO BLO(~) TRANSFUSIONS . H NO INJECTIONS . Z OTHER X (SPECIFY) -~-811A 809B Why do you think that you have a (moderate/great) chance of getting AIDS? Any other reasons? RECORD ALL MENTIONED DO NOT USE CONDOMS . C MORE THAN ONE SEX PARTNER . D MANY SEX PARTNERS . E SPOUSE HAS OTHER PARTNER(S) . F HOMOSEXUAL CONTACT . G HAD BLOOD TRANSFUSION . H HAD INJECTIONS . I OTHER X (SPECIFY) WEN 36 250 Bo I 811A OUESTIONS AND FILTERS Since you heard of AIDS, have you changed your behavior to prevent getting AIDS? IF YES, what did you do? Anything else? RECORD ALL HENTIONED I CODES I GO TO DIDN'T START SEX . A -q STOPPED ALL SEX . B / ,811C STARTED USING CONDOMS . C ,811F RESTRICTED SEX TO ONE PARTNER.D NEDUCED NUMBER OF PARTNERS . E ~-~811C ASK SPOUSE TO BE FAITHFUL . F _J NO MORE HOMOSEXUAL CONTACTS . G STOPPED INJECTIONS . I OTHER W (SPECIFY) OTHER X (SPECIFY) NO BEHAVIOR CHANGE . Y 811B Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior? IF YES, In whet way? RECORD ALL MENTIONED DIDN=T START SEX . A STOPPED ALL SEX . g STARTED USING CONDOMS . C RESTRICTED SEX TO ONE PARTNER.D REDUCED NUMBER OF PARTNERS . E NO MORE HOMOSEXUAL CONTACTS . G OTHER X (SPECIFY) NO CHANGE IN SEXUAL BEHAVIOR.Y DOES NOT KNOW . Z 811C I 8E I some people use a condom during sexual intercourse to avoid setting AIDS or other sexually transmitted diseases. Have you ever heard of this? We may already have talked about this. Have you ever used a condom during sex to avoid setting or transmitting diseases, such as AIDS? YES . 1 I NO . 2 ~811F HAS NEVER HAD ! I SEXUAL INTERCOURSE [~ =813 YES . 1 "-'] NO . 2 _j-*811G HAS NEVER HAD SEXUAL INTERCOURSE [~ 811GI Have you given or received money, gifts or favours I YES . 1 I in return for sex at any time in the Last 12 months? I 812 I Would you say that you approve or disapprove of couples I APPROVE . 1 I I using cor~doms to avoid contracting or spreading AIDS I DISAPPROVE . 2 I and other sexually transmitted diseases? NO OPINION . 3 s13 1 is it acceptable or not acceptable to you NOT I for information on AIDS to be provided: ACCEPT- ACCEPT- ABLE ABLE DE On the radio? RADIO . 1 2 8 On the teLevisic~? TELEVISION . 1 2 8 814 In the last few months have you heard or read about AIDS: YES NO !=813 I I On the radio? On the television? In a newspaper or magazine? From a pester? From leaflets or brochures? From Live drama? From a doctor or a nurse? From a cormnunity health worker? RADIO . 1 2 TELEVISION . 1 2 NEWSPAPER OR NAGAZINE . 1 Z POSTER . 1 2 LEAFLETS OR BROCHURES . 1 2 LIVE DRA~ . 1 2 DOCTOR OR NURSE . 1 2 COMMUNITY HEALTH WORKER . 1 2 251 u EN 37 SECTION 9 . 14ATERNA[ MqRTA[IT Y NO. 901 QUESTIONS AND FILTERS Now I would tike to ask you some questions about your brothers and sisters, that is, aU of the children born to your natural mother, including those who are tiring with you, those living elsewhere and those who have dfed. How many children did your mother give birth to, including you? COOING CATEGORIES NUMBER OF BIRTHS TO NATURAL NOTHER . I I I I I I GO TO 903 CHECK 901: T~/O OR NORE BIRTHS OtlLY ONE BIRTH (RESPONDENT ONLY) [--1 How many of these births did your mother have before you were born? NUMBER OF PRECEDING BIRTHS . I I I i l l ~916 L_ I EN 38 252 904 What was the name given to your motheras (first born, second born,.)? [1] [2) [3] [4] [5] [6] 905 Is (NAME) MALE . 1 HALE . 1 HALE . 1 HALE . 1 HALE . 1 HALE . 1 male or female? FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 • = = = 906 Is (NAME) YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 s t i l l oUve? NO . . . . . . . . . Z l .o . . . . . . . . . z~ NO . . . . . . . . . z l Mo- - . - - . - - -21 HO . . . . . . . . . 21 HO . . . . . . . . . 21 GO TO 908< J GO TO 908~ J GO TO 908< J GO TO 9084 J GO TO 9084 J GO TO 90843 DK . DK . DK . DK . OK . oo TO 00 ,0 00 To 00 TO 00 ,0 907 How old is GO TO [21 GO TO [3] GO TO [41 GO TO iS] GO TO [61 GO TO [71 DK . 98 DK . 98 DK . 98 OK . 98 DK . 98 DK . 98 , o , Ho, many I-T--1 years ago did (NAME) die? 910 How old was (NAME) when ~ ~- - ] ~-~ ~ ] ~ ] ~ ] she/he died? IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [5] IF HALE OR DIED BEFORE 12 YEARS OF AGE GO TO [2] IF MALE OR DiED BEFORE 12 YEARS OF AGE GO TO [4] YES . 11 GO TO 914~ ~ YES . .11 90 TO 914~ -J IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [5] YES . .11 GO TO 914~ -~ 911 Was (NN4E) pregnant when she died? IF HALE OR DIED BEFORE 12 YEARS OF AGE GO TO [6] YES . 11 GO TO 9144 ~ YES . .11 GO TO 914~ IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [7] YES . 11 GO TO 914~ -J NO . . . . . . . . . 2 NO . . . . . . . . . 2 NO . . . . . . . . . 2 NO . . . . . . . . . 2 NO . . . . . . . . . 2 NO . . . . . . . . . 2 - - - . . - , i ! 912 Did (NAHE) YES . .1] YES . .11 YES 1 Yes . .1] YES . 11 YES . h die during GO TO glS,~ -J GO TO 915,~ J GO'TO'915,--J GO TO 915~ GO TO 915, ~' GO TO 915~ ~ childbirth? NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 913 Did (HARE) die within two YES . I YES . I YES . I YES . I YES . 1 YES . I months after the end of a NO . .21 NO . .21 NO . .21 NO . .21 NO . ~q2 NO . "=12 pregnancy or GO TO 915~ -J GO TO 915~ -j GO TO 915~ -I GO TO 915~P J GO TO 915. ~ GO TO 915~r ~ childbirth? 914 Was her death due to YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 complications of pregnancy NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 or childbirth? GO TO [2] 915 HON many children did (NAME) give birth to during her Lifetime? GO TO [6] GO TO [3] GO TO [5] GO TO [4] IF NO MORE BROTHERS OR SISTERS, GO TO 916 253 GO TO [7] I WEB 39 904 What was the [7] [8] [9] [10] (11) [12] i n~ given to ) your mother's (first born, second born,.)? . , . 905 Is (NAME) MALE . 1 HALE . 1 MALE . 1 HALE . 1 HALE . 1 ~LE . 1 mate or f~te? FEHALE . 2 FEMALE . 2 FEMALE . 2 FEMALE . 2 FEHALE . 2 FEMALE . 2 | i i I I 906 Is (NAME) YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 DK . OKGO';O'i8;~ GO TO [9]~ DE . ~ DK . DK . DK . 0o TO [1o] oo ,o [11].- Go TO <12]-- 0O TO [ ,3 ) - - GO TO [8] GO TO [9] GO TO [10] GO TO [11] GO TO [12] i GO TO [13] year did (NAME) 19 19 19 19 19 19 die? i BE . . . . . . . . 98 DE . . . . . . . . 98 BK . . . . . . . . 98 i DK . . . . . . . . 98 DK . . . . . . . . 98 DK . . . . . . . . 98 P 909 How many years aRO 0,0 FVll -I F-1 (NAJ4E) die? i 910 How old - -< , . ,when I - - I - - I I - -T - - I she/he died? 911 Was (NAHE) pregnant when she died? IF MALE OR ) IED BEFORE 12 YEARS OF AGE GO TO [8] YES . .11 GO TO 914- -I IF HALE OR DIED BEFORE 12 YEARS OF AGE GO TO [9] YES . .11 GO TO 914.e ~ IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [10] YES . 1 GO TO 914~ ] IF HALE OR DIED BEFORE 12 YEARS OF AGE GO TO [11] YES . .11 GO TO 914~ IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO [12] YES . 1 GO TO 914~ ~-] IF HALE OR DIED BEFORE 12 YEARS OF AGE GO TO [13] YES . .11 GO TO 914~ NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 i i ! 912 Old (NAME) YES . .lq YES . .11~ YES . 11 YES . .11 YES . .11 YES . .11 die during GO TO 915~ -J GO TO 915.~ -I GO TO 915~ --J GO TO 915~ -j GO TO 915,I--J GO TO 915~ -I childbirth? NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 913 Did (RAHE) die within two YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 months after the end of a NO . 21 NO . 21 NO . 21 NO . 21 NO . ,21 NO . .21 pregnancy or 00 TO 9154 ~ GO TO 915, ~ GO TO 915, ~ GO TO 915w ~ GO TO 915~ GO TO 915~ -J childbirth? 914 Was her death due to YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 YES . 1 co~o[icationa of pregnancy NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 NO . 2 or childbirth? GO TO [11] GO TO [8) n-1 GO TO [10] GO TO [12] GO TO [9] 915 How many children did (NAHE) give birth to during her lifetime? GO TO [13] I F NO MORE BROTHERS OR SISTERS, GO TO 916 254 u EN 40 SECTION 10. HEIGHT AND WEIGHT CHECK 215: ONE OR MORE NO BIRTHS SINCE BIRTHS SINCE JAN. 1991 [~ JAN. 1991 I~] END 1002 IN 1002 (COLLN4NS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE MANE AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (MOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1991, USE CONTINUATION SHEETS), Ill RESPONDENT I LINE NO. FROR 0.212 I YOUNGEST NEXT'TO- L~ LIVING CHILD L~ YOUNGEST I m LIVING CHILD r-n oo31- i- i- I-- FRGI4 0.212 FOR CHILDREN 1004 DATE OF BIRTH FROH Q.215, AND DAY . DAY . I I I ASK FOR DAY OF BIRTH HONTH . MONTH . YEAR . YEAR . 1005 BCG SCAR ON TOP . 7 . I OF LEFT SHOULDER I SCAR SEEN . 1 SCAR SEEN . 1 NO SCAR . 2 NO SCAR . 2 1006 I NEIG~In cent 'meters) I rrn.D I rr-n.DI rT~.D 1007 WAS LENGTH/HEIGHT OF CHILD I MEASURED LYING DOWN I LYING . 1 LYING . 1 OR STANDING UP? STANDING . 2 STANDING . 2 I°°G I"E'% ~'I°o~'' I rrT1.D I ~-~.DI ~n.D '°°91°'TE I I ~E I GHED DAY . DAY . DAY . AND MEASURED NORTH . MONTH . MONTH . YEAR . YEAR . YEAR . 1010 RESULT MEASURED . 1 NOT PRESENT . 3 REFUSED . 4 OTHER . 6 (SPECIFY) CHILD MEASURED . 1 CHILD SICK . 2 CHILD NOT PRESENT . 3 CHILD REFUSED . 6 HOTHER REFUSED.5 OTHER . 6 (SPECIFY) CHILD MEASURED . 1 CHILD SICK . 2 CHILD NOT PRESENT . ] CHILD REFUSED . 4 MOTHER REFUSED . 5 OTHER . 6 (SPECIFY) loll I ,A.E OF MEASURER: [ - -~ HANE OF ASSISTANT: [ - -~ WEN 41 255 INTERVIEWER'S OBSERVATIONS TO be filled in after completing interview Comments about Respondent: Comments on Specific Questions: Any Other Coemnts: SUPERVISOR'S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS Name of Editor: Date: W EN 42 256 1996 ZAHBIA DEMOGRAPHIC AND HEALTH SURVEY MENIS QUESTIONNAIRE FOR MEN AGED 15-59 IDENTIFICATION CLUSTER NUMBER . PROVINCE DISTRICT HOUSEHOLD NUMBER . NAME OF HOUSEHOLD HEAD URBAN/RURAL (urban=lw ruraL=2) . LUSAKA/OTBER CITY/TOWN/VILLAGE . (Lusaka=l, Other city=Z, Town=3, Viltage=4) NAME AND LINE NUMBER OF MAN NAME AND LINE NUMBER OF FIRST WIFE NAME AND LINE NUMBER OF SECOND WIFE NAME AND LINE NUMBER OF THIRD WIFE INTERVIEWER VISITS 1 2 ] FINAL VISIT DATE INTERVIEWERIB NAME RESULT* NEXT VISIT: DATE TIME DAY MONTH YEAR NAME RESULT TOTAL NO. OF VISITS I *RESULT CODES: 1 CQHPLETEO 4 REFUSED Z ROT AT HOME 5 PARTLY COMPLETED ] POSTPONED 6 INCAPACITATED 7 OTHER (SPECIFY) LANGUAGE OF OUESTIONNAIRE** ENGLISH LANGUAGE USED IN INTERVIEW** . RESPONDENT'S LOCAL LANGUAGE** . TRANSLATOR USED (1=NOT AT ALL; 2=SONETIME; ]=ALL THE TIME),. O I **LANGUAGE CODES: 01 ENGLISH 02 BEMBA SUPERVISOR NAME DATE O] IO~ONDE 05 LUNDA 07 NYANJA 04 LOZI 06 LUVALE 08 TONGA FIELD EDITOR NAME DATE OFFICE EDITOR 257 09 OTHER KEYED BY MEN 1 SECTION I, RESPONOENTZS BACKGROUND NO, I QUESTIONS AND FILTERS I COOING CATEGORIES I GO TO 102 RECORD THE TIRE. :::::::::::::::::::::::::: I Firat I would Like to ask some questions about you and your household. For most of the ti~e until you were 12 years old, did you Live in a city, in a town, or in a village? I LUSAK.~ . I I OTHER CITY . 2 TOWN . 3 VILLAGE . 4 103 m How long have you been Living continuously I in (RARE OF CURRENT PLACE OF RESIDENCE)? I YEARS . ~ I :::::::::::::::::::::::::::::::::::::: 104 Just before you moved here, did you Live in a city, I LUSAKA . 1 I in o town, or in a village? I OTHER CITY . 2 I TOWN . 3 VILLAGE . 4 105 In what month and year were you born? MONTH . I l l DONIT KNON MONTH . 98 YEAR . [ -~ DON'T KNOW YEAR . 98 '°' I"°" °'°"r'*°"*°u* I AGE IN COMPLETED YEARS . COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. 1071 Have you ever attended school? I YES . 1 | NO . 2 ~111 108 I What is the highest Level of schoot you attended: primary, secondary, or higher? I PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . 1 I SECONDARY . 2 HIGHER . . . . . . . . . . . . . . . . . . . . . . . . . . 3 TO9 111 I How many years did you co~otete at that level? COlelENT I Con you read and understand a Letter or newspaper easily, with difficulty, or not at all? I YEARS . EASILY . 1 ~]TH DIFFICULTY . 2 NOT AT ALL . 3 [ I I .113 112 Row often do you usually read a newspaper or magazine? Would you say every day, every other day, at least once e week, at Least once a month, a few times a year, or never? CIRCLE ONLY ONE ANSWER. I EVERYDAY . 1 EVERY OTHER DAY . 2 AT LEAST ONCE A WEEK . 3 AT LEAST ONCE A MONTH . 4 FEW TIMES A YEAR . 5 NEVER . 6 113 I How often do you usually listen to a radio? Would you say every day, every other day, at Least once a week, at Least once a month, a few times a year, or never? CIRCLE ONLY ONE ANSWER, I EVERYDAY . 1 I EVERY OTHER DAY . 2 AT LEAST ONCE A WEEK . 3 AT LEAST ONCE A MONTH . 4 FEW TIMES A YEAR . 5 NEVER . 6 114 HOW often do you usual|y watch television? I EVERYDAY . 1 I Would you say every day, every other day, at least once I EVERY OTHER DAY . 2 [ • week, It least once m month, • few tir~es a year, or AT LEAST ONCE A WEEK . 3 never? AT LEAST ONCE A MONTH . 4 FEW TIMES A YEAR . 5 CIRCLE ONLY ONE ANSWER. NEVER . 6 258 M EH Z NO J 115 I Are QUESTIONS AND FILTERS you currently working? J COOING CATEGORIES J GO TO I ; YES . 1 m117 ,,., NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ;' 124 I 117 What is your occupation, that is, what kind of work do you mainly do? 119 DOES NOT I~ORK i--'I I I IN AGRICULTURE J Do you work mainly on your own land or on family lands or J I do you rent land, or work on someone etsems land? I OUN LAND . 1 FAMILY LAND . 2 RENTED LAND . 3 SOMEONE ELSE'S LAND . 6 j~120 J ] ,20 ' Oo you do ,h,. work ,or . - - o, your , . , ,y, ,or . '1 I someone else, or are you self-employed? FOR SOMEONE ELSE . 2 SELF-EMPLOYED . 3 I= I i 121 you usuatty work at this job throughout the year, or THROUGHOUT THE YEAR . 1 ~123 you work seasonatly, or only once in a while? SEASONALLY/PART OF THE YEAR . 2 ONCE IN A WHILE . 3 122 J at this job? 12 many months did you work NUMBER OF 123 How much do you earn for this work? ~/ACHA PROBE: Is this by the hour, by the day, by the week, by the rl~onth or by the year? PER KWACHA PER HOUR.1 PER DAY. .2 PER WEEK.3. PER MONTH.4 PER YEAR.5 OTHER (SPEC[FY) 99999996 I I CATHOLIC . 1 I 124 What religion are you? PROTESTANT . 2 NtJSLIM . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OTHER A (SPECIFY) t°' P 259 MeN 3 SECTION 2. REPRODUCTION NO. I GUESTIONS AND FILTERS 201 I Now i woutd Like to ask about your children. I em m | interested only in your own children. Do not include | children you may have adopted or care for as a father but | whose rest father is soc~eone else. Have you ever had | children? I CODING CATEGORIES YES . 1 NO,,,,,,,,.,.,,,,,.,., . 2 - I GO TO I ~-206 I 20Z I Oo you have any sons or daughters who are now tfving IYES . 1l I with you? NO . 2 ,204 203 I HOW many sons Live with you? SONS AT HOIIE . ~-~ 1 I I I not live with you? NO . 2 ~206 I -E - . . . . . . . . . . . . . And how many daughters are alive but do not live with you? DAUGHTERS ELSEUHERE . iF NONE, RECORD .00'. 206 I Have you ever had a son or a daughter who was I I born alive but later died? I YES . I I IF NO, PROBE: Any baby who cried or showed signs of Life NO . 2 ~208 I 10ut survived only a few hours or days? I 207 209 I Now boys have died? many And how many girls have died? IF NONE, RECORD aOO~. I SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'. I CHECK 208: Just to make sure that I have this right: you have had in total children during your Life. Is that correct? i -~ PROBE AND CORRECT YES ~ NO ~ 201-208 AS NECESSARY. HAS NEVER HAD CHILDREN (NONE) [~ 2,01 ;)11 In what manth and year was your last child born? I Wi~en you were expecting your last born child, did you want to have the child then, did you want to wait until later, or did you not want to have any (mare) children at aLL? BOYS DEAD . ~ I GIRLS DEAD . TOTAL . . . . . . . . . . . . . . . . . . . . . . ::::::::::::::::::::::::::::::: BEF(~E JANUARY 1~K)1[---] THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 LATER . 2 NOT AT ALL . 3 ~301 I L301 260 . EN 4 SECTION 3. CONTRACEPTION Now ] would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid e pregnancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD NENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUNN 302, READING THE NAHE AND DESCRIPTION OF EACH NETNOD NOT NENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF NETNOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH NETHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303. 301 Which ways or methods have you heard about? 302 Have you ever heard I 303 Nave you ever of (NETHOD)? I used (NETHOD)? 0_~ PILL Women can take a pitt every day. 2( IUCD Women can have a Loop or coil placed inside them by a doctor or a nurse . 31 INJECTIONS Woraen can have an injection by a doctor or nurse which stops them from becoming pregr~nt for several ¢~onths. 41 IHPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years. 51 FOAHING TABLETS/JELLY Wo~en can place a sponge, suppository, diaphragm, jetty, or cream inside themselves before intercourse. 61 CONDOM Hen can put a rubber sheath on their penis during sexual intercourse. 07~ FEHALE STERILIZATION women can have an operation to avoid having any more children. 81 HALE STERILIZATION Hen can have an operation to avoid having any more children. 9J NATURAL FANiLY PLANNING Couples can avoid having sexual intercourse on the days of the month when the woman is more Likely to become pregnant. 01 WITHDRAWAL Hen can be careful end putt out before climax. 1[ Have you heard of any other ways or methods that wo~en or men can use to avoid pregnancy? 304 ICHECK 303: [~ NOT A SINGLE "YES" (NEVER USED) SPONTANEOUS PROBED YES I YES 1 2 NO 3 7 1 z 3 - I 1 2 3- 1 2 1 2 3 - 1 2 3-- I 2 I 2 3-- I 3 - (SPECIFY) (SPECIFY) AT LEAST ONE "YES"~ (EVER USED) I I 261 YES . 1 NO, DOES NOT KNOW . 2 YES. . . . 1 NO, DOES NOT KNOW . 2 YES . 1 NO, DOES NOT KNOW . 2 YES . 1 NO t DOES NOT KNOW . Z YES . 1 NO, DOES NOT KNOW . 2 YES . I NO. . ., . Nave you ever had a partner who had an operation to avoid having children? YES . I NO, DOES NOT KNOW . Z Have you ever had an operation to avoid having any more children? YES . I NO,. . . . 2 YES. . .1 NO, DOES NOT KNOW . 2 YES . 1 NO. . . . 2 YES . .,. . .1 NO . 2 YES . 1 NO. . . . .Z rSKIP TO 307 NEN5 .o I QUESTIONS AND FILTERS 1 1 305 I Have you or any of your partners ever used anything or I tried in any way to delay or avoid pregnancy? I COOING CATEGORIES I Go TO IqEs . '1 NO . 2 r309 ! 3° I hvy°uu °r- I I CORRECT ]O] AND 304 (AND 302 IF NECESSARY). 307 J Are you or your partner currently doing something or I YES . 1 I I using a method to delay or avoid a pregnancy? J NO . 2 ~309 I 308 Which method ere you using? PILL . 01 IUD . 02 INJECTIONS . 03 IHPLANTS . 04 FOAMING TABLETS/JELLY . 05 CONDOM . 06 FEMALE STERILIZATION . 07 HALE STERILIZATION . 08 NATURAL FANILY PLANNING . 09 WITHDRAWAL . 10 OTHER METHO0 96 (SPECIFY) --~401 309 What is the main reason you are not using a method of contraception to avoid pregnancy? NOT NARRIED . 11 FERTILITY-RELATED REASONS NOT HAVING SEX . 21 INFREQUENT SEX . 22 WIFE HENOPAUSAL/HYSTERECTOI4Y.Z] WIFE SUSFECUND/INFECUND . . . . . . Z4 POSTPARTUH/BREASTFEEDIHG . 25 gANTS (HORE) CHILDREN . Z6 WIFE PREGNANT . 27 OPPOSITION TO USE RESPONDENT OPPOSED . ]1 WIFE/PARTNER OPPOSED . 32 OTHERS OPPOSED . 33 RELIGIOUS PROHIBITION . 34 LACK OF KNOWLEDGE KNO~S NO NETHOO . 41 KHOgS NO SOURCE . 42 HETNOO-RELATED REASONS HEALTH CONCERNS . 51 FEAR OF SIDE EFFECTS . 52 LACK OF ACCESS/TO0 FAR . 53 COST TOO NUCN . 54 INCONVENIENT TO USE . 55 INTERFERES WITH BOOY'S HORHAL PROCESSES . 56 UP TO THE 1~OI4AN TO USE . 61 OTHER 96 (SPECIFY) DOES NOT KNOW . 98 MEN6 262 SECTION 4. MARRIAGE NO. I 401 I GUESTIONS AND FILTERS Are you currently married or living with a woman? I COOING CATEGORIES ~ GO TO I YES. CURRENTLY ~RRIED . 1 I YES, LIVING WITH A WOMAN . 2 .402A NO, NOT IN UNION . 3 ~04 ,02] 402A 404 How many wives do you have? How many women are you Living with as if you are married? WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE/WIVES, IF A WIFE D~S HOT LIVE IN THE HOUSEHOLD, WRITE IO0 I. THE NUMBER OF BOXES FILLED MUST EOUAL THE NUMBER OF WIVES. HUMBER O, WIVES . . . . . . . . . . Do you currently have a regular sexual partner, an occasional sexual partner or no sexual partner at all? REGULAR SEXUAL PARTNER . 1 I OCCASIONAL SEXUAL PARTNER . 2 NO SEXUAL PARTNER . 3 405 Have you ever been married or lived with a woman? I YES, FORMERLY MARRIED . 1 I I YES, LIVED WITH A WOMAN . 2 ~407 NO . 3 r41OF 406 What is your marital status now: are you widowed, I WIDOWED . 1 I divorced, or separated? J DIVORCED . 2 I SEPARATED . 3 ' ° ' I "ave Y°u ~en ' r r ied °r lived with ' w~n °n'Y °n°a' [ oNCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' l or more than once? MORE THAN ONCE . 2 408 CHECK 407: MARRIED/LIVED WITH 9 A W(~4AN ONLY ONCE I In what month and year did you start Living with your wife/woman? MARRIED/LIVED WITH A r~ ~)MAN MORE THAN ONCE i Now we wil l ta lk about your first wife/woman you Lived with. In what month and year did you start Living with her? MONTH . ~-~ DOES ROT KNOt# MONTH . 98 YEAR . DOES NOT KNOW YEAR . 98 ~409A '0' I"o o'd w"h h°r' I . MEN7 263 NO. QUESTIONS AND FILTERS CHECK 401: CURRENTLY NARRIED OR LIVING WITH AIRMAN NOT IN UNION [~ 410 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse with (your wife/the woman you are living with)? DAYS AGO . I WEEKS AGO . 2 MONTHS AGO . 3 YEARS AGO . 4 &IOA CHECK 301 AND 302: KNOWS CONDOM [~ I The last time you had sex with (your uife/ the woman you are living with), did you use a condom? DOES NOT [~ KNOW CONDOM I Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The Last time you had sex with (your wife/the woman you are Living with) did you use a condom? YES.°., . °°°°°°.°°°.,.1 NO . 2 DOES NOT KNOtJ/NOT SURE . 8 4,0~1 H've Y°° h'° s '~" 'h 'n - - °'~er 'h'n'Y°°r ~ " e ' , h e - -o y~ .re ,,vin, ~,,h, ,o ,he ,. . , ,2 =h. , I Y~s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' l NO . Z ~410J 410C I When was the last time you had sexual intercourse I with someone other than (your wife/the woman you DAYS AGO . 1 are living with)? WEEKS ADO . 2 MONTHS AGO . 3 I . 1 NO . 2 DOES NOT KNOW/NOT SURE . 8 41DEll in the Last 12 months, how many different persons [-]-]m other than (your wife/the woman you are living with) NUMBER OF PERSONS . have you had sex with? 410J DOES NOT KNC~/ . 98 I 410F Now I need to ask you some questions about sexual LS09 activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)? NEVER . 000 DAYS AGO . 1 WEEKS AGO . 2 MONTHS AGO . 3 YEARS AGO . 4 MEN8 264 NO. 4lOG 4101 QUESTIONS AND FILTERS CHECK 301 AND ]02: DOES NOT KNOWS CONDON E? KNOW CONDON 9 I I The last time you had Some men use a condom, sex, did you use a which means that they condom? put • rubber sheath on their penis during sexual intercourse. The last time you had sex, did you use a condom? In the last 12 months, how many different parsons have you had sex with? COOING CATEGORIES YES . .o.°.1 NO.,.2 DOES NOT KNOW . 8 12 MONTHS OR LONGER SINCE LAST SEX II NUMBER OF PERSONS . I I I DOES NOT KNOU . 98 GO TO ,,,o I 410J CHECK 401: CURRENTLY MARRIED OR LIVING WITH A I The last time you had sex, was it with your (wife/the woman you rive with), a regular partner, an acquaintance, someone you paid for sex, or someone else? NOT CURRENTLY MARRIED AND HOT LIVING WITH A W~qAN LiJ / I The last time you had sex, was it with a regular partner, an acquaintance~ someone you paid for sex, or someone else? WIFE/~4AN LIVES WITH . 1 REGULAR PARTNER . 2 ACQUAINTANCE . 3 SOHEONE HE PAID FOR SEX . 4 SOMEONE ELSE . 5 413 I Do you know of a place where You can get condoms? IYES . 1 I NO . 2 ~416 414 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE COOE. (NAHE OF PLACE) PUBLIC SECTOR GOVERNMENT HOSPITAL . 11 GOVERNMENT HEALTH CENTER . 12 FIELDWORKER . 13 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 HISS%ON HOSPITAL/CLINIC . 22 PHARMACY . 23 PRIVATE DOCTOR . 24 MOBILE CLiNiC . 25 FIELD WORKER . 26 OTHER PRIVATE MEDICAL 27 (SPECIFY) OTHER SOURCE SHOP . 31 FRIENDS/RELATIVES . 33 OTHER 36 (SPECIFY) I AGE . M 416 How old were you when you first had sexual intercourse? FIRST TIME WHEN MARRIED . 96 HEN 9 265 SECTION S. FERTILITY PREFERENCES NO. QUESTIONS AND FILTERS COOING CATEGORIES GO TO 501 I CHECK 401: v ~ ,02 I CHECK 404: / ~i~ I REGULAR OCCASIONAL ~ NO SEXUAL ~ SEXUAL SEXUAL I-~ rSO5A PARTNER PARTNER PARTNER m I I I 503 | IS your wife (or one of your wives)/partner pregnant now? I YES . 1 | I I NO.,. . .,.2 UNSURE . 8 / ~505A 504 When she became pregnant, did you want her to become THEN . 1 pregnant then, did you want her to wait until tater, or LATER . 2 505B did you not want this pregnancy at all? NOT AT ALL . ] 505 A) WIFE/PARTNER NOT PREG- NANT OR UNSURE OR NO WIFE/PARTNER I Now I have some questions about the future. Would you Like to have (a/another) child or would you prefer not to have any (more) children? B) WIFE/PARTNER PREGNANT [~ I Now I have so~ questions about the future. After the child your wife/ partner is expecting, would you Like to have another child or would you prefer not to have any more children? HAVE (A/ANOTHER) CHILD . . . . . . . . . . 1 NO MORE/NONE . . . . . . . . . . . . . . . . . . . . 2 SAYS WIFE CAN'T GET PREGNANT.] SAYS HE CANJT HAVE ONE ANY MORE.4 UNDECIDED/DOES NOT KNOW . . . . . . . . . 8 I ~ 507 I 506 CHECK 503: WIFE/PARTNER NOT PREG- NANT OR UNSURE OR r-7 Y NO WIFE/PARTNER I How long would you like to wait frcxn now before the birth of (a/another) child? WIFE/PARTNER PREGNANT [~] I After the child your wife/ partner is expecting, how long would you like to wait before the birth of another child? SING ? I Dp°eY°Untchyin~t~ Ou A METHOO? G?RRENTLY CURRENTLY USING [--7 MONTHS . 1 I l l YEARS . 2 SOON/NOW . 993 SAYS WIFE CAN'T GET PREGNANT,,994 AFTER MARRIAGE . . . . . . . . . . . . . . . . ~5 OTHER ~6 (SPECIFY) DOES NOT KNOW . ~8 i~5121 508 will use a method to delay or avoid YES . 1 the next 12 n~nths? NO . 2 I DOES NOT KNOW . 8 I 5091 oo you think you will use a method delay or avoid YES . 1 I I pregnancy at any time in future? NO . 2 DOES NOT KNOW . 8 ! ~511 MEN 10 I ~510 266 NO. DUESTIONS AND FILTERS 510 Which method would you prefer to use? COOING CATEGORIES PILL . 01 IUO . 02 INJECTIONS . 03 IMPLANTS . 04 FON41NG TABLETS/JELLY . 05 CONDOM . 06 FEMALE STERILIZATION . 07 HALE STERILIZATION . OS NATURAL FAMILY PLANNING . 09 WITHDRAWAL . 10 OTHER 96 (SPECIFY) UNSURE . 98 J GO TO ,512 511 What is the main reason that you think you wiLL never use a method? ROT NARRIED . 11 FERTILITY-RELATED REASONS INFREOUENT SEX . 22 WIFE HENOPAUSAL/HYSTERECTO~IY.23 WIFE SUBFECUND/INFECUND . 24 WANTS MORE CHILDREN . 26 OPPOSITION TO USE RESPONDENT OPPOSED . 31 WIFE OPPOSED . 32 OTHERS OPPOSED . 33 RELIGIOUS PROHIBITION . 34 LACK OF KNOWLEDGE KNOWS NO HETHOO . 41 KNOWS NO SOURCE . 42 NETHOO-RELATED REASONS HEALTH CONCERNS . $1 FEAR OF 51DE EFFECTS . 52 LACK OF ACCESS/TO0 FAR . 53 COST TOO MUCH . 54 INCONVENIENT TO USE . 55 INTERFERES WITH BOOY=S NORMAL PROCESSES . 56 UP TO THE ~4AN TO USE . 61 OTHER 96 (SPECIFY) DOES NOT KNOW . 98 512 CHECK 202 AND 204: HAS LIVING CHILDREN [~ NO LIVING CHILDREN [~ I I If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life. ho~ many would that be? If you could choose exactly the number of children to have in your whole Life, ho~ many would that be? PROBE FOR A NUMERIC RESPONSE. NUMBER . OTHER 96 (SPECIFY) =514 I 513 How many of these children would you Like to be boys, how many would you Like to be girls and for how many would it not matter? BOYS NUMBER . ~-~ ~ER 96 (SPECIFY) GIRLS NUMBER . ~-~ OTHER 96 (SPECIFY) EITHER NUMBER . [~ OTHER 96 (SPECIFY) 267 MEN 11 . o I QUESTIONS AND FILTERS ,161 Would you say that you approve or disapprove l of couples using a method to avoid pregnancy? I COOING CATEGORIES APPROVES . 1 DISAPPROVES . 2 NO OPINION . 3 GO TO 515 I Is it acceptable or not acceptable to you for information on family planning to be provided: On the radio? J On the television? NOT DOES ACCEPT- ACCEPT- NOT ABLE ABLE KNOW RADIO . 1 2 8 TELEVISION . 1 2 8 516 In the last few months have you heard about family planning: On the radio? On the television? In a newspaper or magazine? From a poster? From leaflets or brochures? From live drama? From a doctor or a nurse? From community health worker? YES NO RADIO . 1 2 TELEVISION . 1 2 NEWSPAPER OR MAGAZINE . 1 2 POSTER . 1 2 LEAFLETS OR BROCHURES . 1 2 LIVE DRAMA . 1 2 DOCTOR OR NURSE . 1 2 COMMUNITY HEALTH ~3RKER . 1 2 I I 518 J In the Last few months have you discussed the practice YES . 1 J J of family planning with your (wife, partner), NO . 2 ~520 J friends, neighbors, or relatives? | 519 521 With whom? Anyone else? RECORD ALL MENTIONED. LIVING WITH NOT IN A WOMAN ~ UNION [~ I Spouses do not always agree on everything. Now I want to ask you about your wife's /the woman you Live withes views on family planning. Do you think that your wife /the woman you Live with al~oroves or disapproves of couples using a method to avoid pregnancy? WIFE/PARTNER . A MOTHER . B FATHER . C SISTER(S) . D BROTHER(S) . E DAUGHTER . F MOTHER-IN-LAW . G FRIENDS/NEIGHBORS . H COMMUNITY HEALTH WORKER . I LOCAL COMMUNITY LEADER . J RELIGIOUS LEADER . K OTHER X (SPECIFY) J APPROVES 1 DLSAPPROVES . 2 DOES NOT KNOW . 8 0t 522 How often have you talked to your wife/the woman you Live with about family planning in the past year? I NEVER . 1 I ONCE OR TWICE . 2 I MORE OFTEN . 3 N EN 12 268 SECTION 6. AIDS AND OTHER SEXI, JALLY TRANSMITTED DISEASES NO I QUESTIONS AND FILTERS I COOING CATEGORIES I GO TO 601A I Have you heard about diseases that can be transmitted IYES . 1 J through sexuat intercourse? NO . 2 ~601F 601B Which diseases do you know? RECORD ALL RESPONSES SYPHILIS . A GONORRHEA . B AIDS . C GENITAL WARTS/CONDYLOHATA . D OTHER W (SPECIFY) OTHER X (SPECIFY) DONIT KNOW . Z NEVER HAD I JAL INTERCOURSE [~ r6OIF 6OlD l Dur|ng the last twetvem°nths' did y°u have any °f these J YES . III diseases? NO . 2--~ DOES NOT KNOW . 8 r601F 601E Which of the diseases did you have? RECORD ALL RESPONSES SYPHILIS . A GONORRHEA . B AIDS . C GENITAL WARTS/CORDYLONATA . D OTHER W (SPECIFY) OTHER X (SPECIFY) DON'T KNOW . Z . ' 1 from your penis? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . 8 6OlGI Dur|ng the last twelve months, did Y°u have ' '°re or J YEs . 1 I ulcer on your penis? NO . 2 DOES NOT KNOW . 8 6Dill CHECK 601E, 601F AND 601G HAD ONE OR MORE F DISEASES L The Last time you had (DISEASE FROM 6DIE/DISCHARGE/SORE) did you seek advice or treatment? NONE OF THE DISEASES [~ I YES . 1 NO,.o.ooooooooooooooooo., 2 I ~6011 I r6OIJA 601J Where did you seek advice or treatment? Any other place or person? RECORD ALL MENTIONED PUBLIC SECTOR GOVERNMENT HOSPITAL . 11 GOVERNMENT HEALTH CENTER . 12 FIELDk'ORKER . 13 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 MISSION HOSPITAL/CLINIC . 22 PHARMACY . 23 PRIVATE DOCTOR . 24 MOBILE CLINIC . 25 FIELD I~ORKER . 26 OTHER PRIVATE MEDICAL 27 OTHER SOURCE (SPECIFY) SHOP . 31 FRIENDS/RELATIVES . 3] OTHER 36 (SPECIFY) 269 . EN 13 60"l ''ny° h'O'O'--F'°O'E'O'SC--'SORE'O'dY°°lqES n,or, your,r,ner,,,, ,0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 '1 6OlLI When you had (DISEASE FROI4601E/DISCNARGE/SORE) did you J YES . 1 I I do something not to infect your partner(s)? J NO . 2 "-7 PARTNER ALREADY iNFECTED . 3 / ~601N 601N I Whet did you do? I RECORD ALL NENTIONED 601NI CHECK 6018 60101 NO SEXUAL INTERCOURSE . A USED CONDOMS . B TOOK HEDICINES . C OTHER X (SPECIFY) DID NOT NENTION 'AIDS' vE ~ HENTIONED 'AIDS' [-~ Have you ever heard of an iitness catted AIDS? J YES . 1 I NO . 2 1 ~602 I I ~611C 602 From which sources of information have you learned most about AIDS? Any other sources? RECORD ALL HENTIONED RADIO . A TV,o.,,,oo.,oooo,ooooo,,o.,o,oo.D NEWSPAPERS/HAGAZiNES . C PANPLETS/POSTERS . D HEALTH WORKERS . E HOSOUES/CHURCHES . f SCHOOLS/TEACHERS . G COHMUNITY HEETINGS . H FRIENDS/RELATIVES . I WORK PLACE . J OTHER X (SPECIFY) 602B How can a parson get AIDS? Any other ways? RECORD ALL NENTIONED SEXUAL INTERCOURSE . A SEXUAL INTERCOURSE WITH HULTiPLE PARTNERS . B SEX WITH PROSTITUTES . C NOT USING CONDOI . D HOHOSEXUAL CONTACT . E BLO00 TRANSFUSION . F INJECTIONS . G KISSING . H MOSQUITO BITES . I CONTAMINATED RAZOR BLADES . J OTHER W (SPECIFY) OTHER X (SPECIFY) DOES NOT KNOW . Z 603 I Is there anything • parson can do to avoid Betting I YeS . 1 I I AIDS or the virus that causes AIDS? J NO . 2 DOES NOT KNC~ . 8 1 ~607 N EN 14 270 I GO TO NO. I QUESTIONS AND FILTERS 604 What can a person do? 606 An, other ways? RECORD ALL MENTIONED r607 What does "safe sex" r~an to you? COOING CATEGORIES SAFE SEX . A ABSTAIN FROM SEX . B USE CONDOMS . C AVOID MULTIPLE SEX PARTNERS . D AVOID SEX WITH PROSTITUTES . E AVOID SEX WITH H(~4OSEXUALS . F AVOID GLOOO TRANSFUSIONS . G AVOID INJECTIONS . H AVOID KISSING . ! AVOID MOSQUITO BITES . J SEEK PROTECTION FROM FROM TRADITIONAL HEALER . K OTHER W OTHER (SPECIFY) X (SPECIFY) DOES NOT KNOt# . Z NOT MENTION LFE SEX" [-~ ABSTAIN FRON SEX . B USE CONDOMS . C AVOID MULTIPLE SEX PARTNERS . D AVOID SEX WITH PROSTITUTES . E AVOID SEX WITH HOHOSEXUALS . F OTHER X (SPECIFY) DOES NOT KNOW . Z RECORO ALL MENTIONED I . 'I the AIDS virus? NO . 2 DOES NOT KNOW . 8 608 | Do you think that persons with AIDS almost never die ALMOST NEVER . 1 m I from the disease, sometimes die, or almost always die SOHETIHES . 2 I from the disease? ALMOST ALWAYS . 3 DOES NOT KNOW . 8 NO . 2 DOES NOT KNOW . 8 °1 n °" °° °c ° I . . o o . I °G~CI D° Ya° pers°nallY ~n°w a~'°n° wh° h" AIDS °r IYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , - - . has d ied of AIDS? NO . 2 DOES NOT KNOW . 8 1 L609 have AIDS? NUMBER OF PERSONS . 6°aEI R°" ~nY Pe°P'° that '°u per°°°sllY k°°" "°ve I ~1 d ied of AIDS? NUMBER OF PERSONS . . . . . . . . . 609 | CHECK 601E: IF RESPONDENT HAS AIDS, CIRCLE 5. SMALL . 1 | I NOOERATE . . . . . . . . . . . . . . . . . . . . . . . . 2 9 Do you think your chances of getting AIDS are small, GREAT . 3~ ~609B moderate, great, or no risk at aLl? NO RISK AT ALL . 4 I HAS AIDS . 5 ~611A 609A Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS? Any other reasons? RECORD ALL MENTIONED ABSTAIN FROM SEX . B - USE CONDOHS . C HAVE ONLY ONE SEX PARTNER . D LIMITED NUMBER OF SEX PARTNERS.E AVOID SEX WITH PROSTITUTES . F SPOUSE HAS NO OTHER PARTNER . G NO HOMOSEXUAL CONTACT . N NO BLOOD TRANSFUSIONS . I NO INJECTIONS . J OTHER (SPECIFY) .-~611A 271 MEN 15 NO.I QUESTIONS AND FILTERS 1 609B Why do you think that you hove a (NOOERATE/GREAT) chance of getting AIDS? Any other reasons? RECOND ALL MENTIONED COOES DO NOT USE CONDOMS . C MORE THAN ONE SEX PARTNER . D MANY SEX PARTNERS . E SEX WITH PROSTITUTES . F SPOUSE HAS OTHER PARTNER(S) . G HOMOSEXUAL CONTACT . H HAD BLO00 TRANSFUSION . I HAD INJECTIONS . J OTHER X (SPECIFY) I GO TO 611A Since you heard of AIDS, have you changed your behavior to prevent setting AIDS? IF YES, what did you do? Anything else? RECORD ALL MENTIONED DIDN'T START SEX . A -11 STOPPED ALL SEX . B / ~611C STARTED USING CONDOMS . C ~611F RESTRICTED SEX TO ONE PARTNER.D REDUCED NUMBER OF PARTNERS . E | AVOID SEX WITH PROSTITUTES . F __~611C ASK SPOUSE TO BE FAITHFUL . G NO MORE HOMOSEXUAL CONTACTS . H STOPPED INJECTIONS . J OTHER W (SPECIFY) OTHER X (SPECIFY) NO BEHAVIOR CHANGE . Y 611B Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior? IF YES, In what way? RECORD ALL MENTIONED DIDN'T START SEX . A STOPPED ALL SEX . B STARTED USING CONDOMS . C RESTRICTED SEX TO ONE PARTNER,,.D REDUCED NUMBER OF PARTNERS . E AVOID SEX WITH PROSTITUTES . F NO MORE HOHOSEXUAL CONTACTS . G OTHER X (SPECIFY) NO CHANGE IN SEXUAL BEHAVIOR.Y DOES NOT KNOW . Z 611C I diseases. Have you ever heard of this? 611E I We may already have talked about this, used a condom ~tming sex to avoid get t i~ or 611G Some people use a condom during sexual intercourse to avoid getting AIDS or other sexually transmitted transmitting diseases, such as AIDS? Have you ever Hove you given or received money, gifts or favors in return for sex at any time in the Last 12 months? RECORD THE TIME. YES . 1 I I NO . 2 ~611F I HAS NEVER I I SEXUAL INTERCOURSE ~ ~613 YES., . .,.,. . 1 NO.,.,.,,,,.,.,.,,.,,,.2 ~611G RSE n I I I YES . 1 I NO,. . 2 M EN 16 272 Comments about Respondent: INTERVIEWER=S OBSERVATIONS To be fiLLed in after completing interview Comments on Specific Questions: Any Other Cocments: SUPERVISOR~S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS Name of Editor: Date: N ER 17 273 Front Matter World Summit for Children Indicators: Zambia 1996 Title Page Citation Page Table of Contents List of Tables List of Figures Preface Acknowledgments Summary of Findings Map of Zambia Chapter 1 - Introduction Chapter 2 - Characteristics of Households and Respondents Chapter 3 - Fertility Chapter 4 - Fertility Regulation Chapter 5 - Other Proximate Determinants of Fertility Chapter 6 - Fertility Preferences Chapter 7 - Infant and Child Mortality Chapter 8 - Maternal and Child Health Chapter 9 - Infant Feeding, Childhood, and Maternal Nutrition Chapter 10 - Maternal Mortality Chapter 11 - AIDS and Other Sexually Transmitted Diseases References Appendix A - Survey Design Appendix B - Estimates of Sampling Errors Appendix C - Data Quality Tables Appendix D - Persons involved in the Zambia Demographic and Health Survey Appendix E - Questionnaire Household Questionnaire Woman's Questionnaire Men's Questionnaire

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