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

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